Wisdom Teeth

Every tooth in our mouth has its own name and function. The teeth in the front of the mouth (incisors, canine, and bicuspid teeth) are intended for holding and biting food into smaller pieces, while the back teeth (molar teeth) are used to grind food into a consistency that’s easy to swallow.

The average adult has 32 teeth: 16 on top and 16 on the bottom, but the average mouth is made to hold only 28 teeth. When 32 teeth are trying to fit in a mouth that holds only 28, the result can be painful. The four teeth causing the overage are your third molars, also known as “wisdom teeth.”

Why Should I Have My Wisdom Teeth Removed?

Wisdom teeth are the last teeth to show up in the mouth. If they are properly aligned and the gum tissue remains healthy, they do not have to be removed. However, this is not typically the way it goes. As teeth try to find a pathway out of the gum, they can end up partially erupted, impacted, and in problematic positions, and must be extracted. If the opening around the wisdom teeth allows bacteria to grow and cause an infection, the result will be swelling, stiffness, pain, and illness. The pressure caused by the erupting wisdom teeth may move other teeth and disrupt the orthodontic work or natural alignment of the teeth. When tumors or cysts form around impacted wisdom teeth, the jawbone and healthy teeth are destroyed. To avoid problems caused by wisdom teeth and to decrease the surgical risk involved in their removal, we recommend acting early.

Oral Examination

Using x-rays and an oral examination, Dr. Rezvan will evaluate the position of the wisdom teeth to see if there are current problems, and predict if there might be problems in the future. Studies show that early wisdom tooth evaluation and treatment lead to positive outcomes for the patient. Patients are generally first evaluated in the mid-teenage years by their dentist, orthodontist, or oral and maxillofacial surgeon so they can take early action if necessary.

All extraction surgery is performed under appropriate anesthesia to ensure patient comfort. Dr. Rezvan is prepared with the necessary training, license, and experience to provide various types of anesthesia, including the anesthesia necessary for the comfortable completion of this surgery.

Removal

In most cases, the removal of wisdom teeth is performed under local anesthesia, nitrous oxide/oxygen analgesia, or general anesthesia. You will discuss these options and the surgical risks (including sensory nerve damage and sinus complications) with your doctor or Dr. Rezvan before the procedure is performed. Once the teeth are removed, the gum is sutured, and you should rest under supervision in the office until you’re ready to be taken home. To help control bleeding, bite down on the gauze you’ll be provided. Upon discharge, your postoperative kit will include instructions for the week following the surgery, a prescription for pain medication, antibiotics, and a follow-up appointment for suture removal. If questions arise, please do not hesitate to call us at Gilroy & Monterey, 408-842-9045. Our services are provided in a safe environment that utilizes modern monitoring equipment and staff who are experienced in anesthesia techniques.

Orthodontics Exposure

When a tooth is “impacted,” it simply means that it is stuck and cannot fully and successfully erupt into function. We often see patients with impacted wisdom teeth, which get “stuck” in the back of the jaw as they’re trying to find room in the mouth, often times causing painful infections and an array of other problems. Due to their lack of functional need, if wisdom teeth don’t grow in perfectly they are usually extracted. The second most common tooth to become impacted is the maxillary cuspid (known as the upper “eyetooth”). The cuspid tooth is critical in the dental arch and plays a pivotal role in your bite. The cuspids are strong biting teeth and have the longest roots of any human teeth. They are designed to be the first teeth that touch when your jaw closes, so they act as a guide for the rest of the teeth, making sure each one fits right in its intended space.

The maxillary cuspid teeth usually grow in around age 13, and are normally the last of the front teeth to erupt into place. If a cuspid tooth gets impacted, every effort will be made to get it to erupt into its proper position in the dental arch. The techniques involved to aid eruption can be applied to any impacted tooth, but most commonly they are applied to the maxillary cuspid (upper eye) teeth. More than half of these impacted eyeteeth are located on the palatal (roof of the mouth) side of the dental arch, while the remaining impacted eye teeth are stuck in an elevated position in the middle of the supporting bone, above the roots of the adjacent teeth or out to the side of the dental arch.

Early Identification of Impacted Teeth Is Essential to Successful Treatment

The older the patient, the more likely an impacted eyetooth will not erupt naturally, even if space is available in the dental arch. The American Association of Orthodontists recommends that an x-ray and dental examination be performed on all dental patients around the age of seven to count their teeth and determine if there are signs of potential future problems. Even at a young age, it is important to determine if any adult teeth are missing, if there are extra teeth or unusual growths blocking the eruption of the eyetooth, and if there is extreme crowding or too little space that would cause eruption.

Your dentist or hygienist can administer this assessment, and will refer you to an orthodontist if they detect a problem. Solutions may include braces (to create space allowing for proper eruption of the adult teeth) and may also require a referral to an oral surgeon to have crowded baby teeth and/or adult teeth blocking the eruption of the all-important eyeteeth extracted. There is a good chance that an impacted eyetooth will erupt naturally If the path is cleared and space is opened up by age 11-12. By the age of 13-14, the eyetooth will have had too much time to develop and it will not erupt on its own, even if the space cleared. Once a patient turns 40, it’s likely that the tooth will be fused in its current position and will never erupt, even with efforts of the orthodontist and oral surgeon. At this point, the only option is to extract the impacted tooth and consider a crown on a dental implant or a fixed bridge to replace it.

What If The Eyetooth Will Not Erupt, Even When Adequate Space Is Available?

Orthodontists and oral surgeons can combine efforts to get unerupted eyeteeth to erupt when they will not do so naturally. Each case is evaluated individually, but the most common plan of action calls for the orthodontist to put braces on the teeth (at least the upper arch), which will create space for the impacted tooth to be moved to its proper position. If it has not fallen out yet, the baby eyetooth will typically remain untouched until the adult eyetooth has room. The oral surgeon will step in once the space is opened to expose the impacted eyetooth by lifting the gum on top of the hidden tooth. If the baby tooth hasn’t fallen out yet, it will be removed during this process. Once the impacted tooth is uncovered, the oral surgeon will bond an orthodontic bracket to the tooth. This bracket has a small gold chain that will be temporarily attached to the orthodontic arch wire. The surgeon may leave the exposed tooth completely uncovered by suturing the gum high above the tooth, or they may create a window in the gum (or sometimes the roof of the mouth) to cover the tooth. In most cases, the gum will be sutured (apart from the small hole for the chain) and returned to its original location. The patient will return to the orthodontist 1-14 days after the surgery to have a rubber band attached to the chain. This will create a light eruptive pulling force on the impacted tooth and begin the process of moving the tooth into its place in the dental arch. The goal of this procedure is to erupt the impacted tooth as naturally as possible, so this carefully-controlled process may take up to a year to complete. Once the tooth makes its way to its final position in the arch, your mouth will be evaluated to ensure the gum around the tooth is strong and healthy enough to withstand a lifetime of chewing and brushing. If it isn’t, minor “gum surgery” may be required to strengthen the gum tissue over the relocated tooth, especially if it was moved a long distance. If this applies to you, your dentist or orthodontist can walk you through this process and the next steps.

Why Should I Have My Wisdom Teeth Removed?

Oral Examination

Removal

Orthodontics Exposure

Early Identification of Impacted Teeth Is Essential to Successful Treatment

What If The Eyetooth Will Not Erupt, Even When Adequate Space Is Available?

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