What are wisdom teeth?

Wisdom teeth, also called third molars, are the very last tooth in each quadrant of your mouth. Almost everybody has four wisdom teeth in their mouth, however it is not out of the ordinary for some patients to be missing one, two, three or even (lucky for them) all four wisdom teeth.

Do I need to have my wisdom teeth extracted?

Not everybody has to have their wisdom teeth removed. Sometimes, the wisdom teeth erupt in a normal orientation that is upright and in line with the rest of the teeth that allows for proper oral health. However, most people do not have a jaw large enough to accommodate wisdom teeth and as such, most people should consider having their wisdom teeth removed. Many times, the wisdom teeth erupt in a poor position that can cause irreversible destruction of the adjacent teeth, gums and bone. A poorly positioned wisdom teeth may lead to bacterial growth and subsequent infection. Failing to address impacted wisdom teeth may also lead to cavities, swelling, bleeding and pain. Rarely, impacted wisdom teeth can potentially cause cysts or tumors to form that may cause damage to structures such as nerves, bone and teeth.

When is the best time to remove wisdom teeth?

For the majority of patients, the best time to remove wisdom teeth is mid-teens to early twenties. There are many reasons for this, but some of the main ones are listed below:

There is less risk of nerve injury. Numerous studies have shown that extracting wisdom teeth during these years have less risk of nerve injury. The two main nerves that are located near the vicinity of lower wisdom teeth are the lingual nerve and inferior alveolar nerve. During the teenage years, the wisdom teeth roots have not fully formed yet. Over the years, the roots of the wisdom teeth tend to grow closer and closer to the inferior alveolar nerve, thus making it more likely for the nerve to get injured.

Recovery is easier and shorter when you are younger. There tends to be less pain, swelling and bleeding when wisdom teeth are extracted in younger patients compared to older patients.

Extracting wisdom teeth helps facilitate orthodontics and improves the alignment of the teeth in some patients. Sometimes, an orthodontist or general dentist will instruct you to have your wisdom teeth extracted earlier to facilitate orthodontics.

Is it still safe to have my wisdom teeth extracted after the “ideal” age of wisdom teeth surgery?

Yes. Wisdom teeth surgery is routinely performed in older patients and there is no age limit. Each individual case varies from patient to patient and your risk is determined by many factors such as position of the teeth, location of the nerve, medical history, etc. Age is just one of the many factors Drs. Hall, Sy and Hui use to expertly determine your risk. At your consultation, they will give you their opinion regarding your condition and a customized treatment plan given your situation.

What should I expect on the day of surgery and what is the recovery process?

On the day of surgery, your preferred method of anesthesia (local anesthesia/nitrous oxide gas or intravenous sedation) will be safely administered by one of our highly trained doctors. Detailed pre-op instructions will be provided to you during the initial consultation. We will make sure you are comfortable throughout the procedure, which will take 30 minutes or longer, depending on how many implants are being placed and how complex the case is.

After the surgery, we will be prescribing the appropriate medications to maximize your comfort. You should expect some facial swelling, possible bruising, for the first 3 to 5 days after the surgery. Most patients can resume normal activities within 2 weeks of surgery. It is very important that you maintain proper hygiene during this time and follow our post-operative instructions. All of this will be reviewed with you in detail verbally and in written form on the day of surgery.

What is a coronectomy?

A coronectomy is a surgical procedure designed to minimize the risk of injuring the nerve in high risk cases. It is done by cutting the crown of the tooth off and intentionally leaving the root or roots in the socket. When done properly, this procedure offers a decreased risk of injury to the inferior alveolar nerve (IA) and has no greater risk of infection than a conventional extraction. The main drawback of this procedure is that in a minority of cases, the residual root fragment will migrate on its own to the top of the socket and it may require a second surgery to remove the root fragment. However, when the roots migrate, it has the added advantage in that it migrates away from the nerve; thus, the second surgery will have a slim to no risk of injuring the nerve at that time.

What is PRF?

Platelet rich fibrin (PRF) is the second-generation line of platelet derived growth factors. Numerous studies contemporary medical and dental literature have shown that these natural, autogenous growth factors accelerates healing by stimulating tissue regeneration and proliferation, reduces pain and swelling and shortens recovery time. It also greatly minimizes the chances of “dry socket” which is an intense, painful inflammation of exposed jaw bone that sometimes happens after extractions. Before the teeth are extracted, blood is drawn and then processed. This results in the formation of a translucent yellow, jello-like substance full of regenerative growth factors that are carefully extracted from the tube, then packed gently into the extraction sites before getting sutured over to hold it in place. All of this is done on site during your visit.