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Michael A. Starkey, DDS MS and The Team
There are those who think removing wisdom teeth is a racket. You can click on the tooth above to find out their rationale.
There are reasons for NOT removing wisdom teeth but they are based on individual situations.
First of all wisdom teeth removal have risks that are generally higher than average tooth.
Critical structures like the mandibular nerve and lingual nerve which gives feeling to lip and tongue can be cut or injured from extraction of w/t.
As you can see in picture to the right wisdom tooth roots can be convoluted and long and the result is broken root tips that can result in complications from trying to remove them. Sometimes the root tips cannot be removed.
Today 3 D scans are advised to evaluate if the lower wisdom teeth are wrapped around the mandibular nerve and blood vessels.
As patient's get older the bone around wisdom teeth get's harder and the roots get longer the result is higher risk of complications.
The most common being a dry socket. As a rule of thumb it is better to get wisdom teeth out when you are in late teens or early twenties. The incidence of complications is ten times greater when you are 30 years old having w/t removed than when you are 20 years old.
There are other surgical risks and you will need to read the list so there are no surprises. There are things you can do before during and after procedure that will reduce incidence of complications that is discussed elsewhere.
My non scientific observation is that about 5% of the population has room for there wisdom teeth and are able to keep them.
But even then there are problems because it is hard to brush and clean that far back in the mouth so most of the time the wisdom teeth will get tooth decay.
Pain from wisdom teeth most often is in the form of a "pericoronitis." That means inflamed gum tissue around the wisdom tooth that is not completely erupted into place. The dentist can clean around the flap of gum tissue to eliminate that inflamation along with your brushing it well and possibly antibiotics.
IV sedation is advisable for wisdom teeth removal because wisdom teeth removal is rather invasive procedure.
And in the IV we can introduce anti swelling medication that if not used you will swell up like a pumpkin, also we can drip antibiotics as needed, pain medication in the IV, and anti nausea drug.
W/T removal post operatively results in nausea much of the time but by injecting Zofran a great anti nausea medication at the start of IV and maybe at the end nausea is not the problem it use to be.
Usually the pain of wisdom tooth is due to inflammation of a flap of gum tissue over the wisdom tooth that is trying to erupt into place. the gum tissue gets inflamed from food getting under the flap and creating bacteria and toxins. This activates your immune response.
If you are in pain from wisdom tooth but you want to not have it extracted that may be possible.
Some times an operculectomy can be done. That is when the surgeon removes the flap of tissue covering the wisdom tooth and the patient is able to avoid a painful wisdom tooth extraction and keep a functioning tooth. See photo below.
It has been my experience that If you are having pain and you come in to see us the risk of complications and pain increase if we take the wisdom tooth out while your gums are inflamed and you are in pain.
We prefer to give you LA and to clean out the pocket around the tooth; place you on antibiotics and pain meds, and special mouth wash, and then take out the wisdom tooth at a later date when it is NOT hurting.
In a modern western socio-economic system the right of passage to adulthood for citizens is wisdom tooth extractions. While in primitive societies wisdom teeth erupt nicely in to place so young adults have to do terrifying things like bungee jumping with bamboo rope, or file their front teeth off, or get tatoos on the faces.
Master, College of Conscious Sedation American Dental Society of Anesthesiology