Wisdom Teeth Extraction

Wisdom teeth appear behind the back molars; removal of wisdom teeth is important when the teeth have no room in the mouth to grow.

• Wisdom teeth usually make their first appearance in young adults between the ages of 15 to 25.
• Because most people's mouths are too small for these four additional molars, an extraction (removal) procedure is often necessary.
• The following symptoms may indicate that the wisdom teeth have erupted and surfaced, and should be removed before they become impacted:
  • pain
  • infection in the mouth
  • facial swelling
  • swelling of the gumline in the back of the mouth

Most oral health specialists will recommend an immediate removal of the wisdom teeth, as early removal will help to prevent problems, such as an impacted tooth that destroys the second molar.

For several reasons:

• Partially impacted wisdom teeth can cause infection, pain, crowding, and decay or damage to surrounding molars.
• Completely impacted teeth can form an infection around the root resulting in permanent damage of the nerves, jawbone, and surrounding teeth if not treated.
• In rare cases a tumor may develop from the enlargement of the walls of the tooth and a more extensive surgical procedure would be required to remove it.

• bacteria and plaque build-up
• cyst (a fluid-filled sac) development
• tumor development
• infection
• jaw and gum disease

Early removal of wisdom teeth is safest. Once roots are completely formed, removal becomes more difficult and can be associated with complications to surrounding structures. Fully erupted wisdom teeth can be extracted with a minimally invasive procedure.

Impacted teeth are removed by making an incision in the gum to expose the tooth. If bone covers the tooth, the surgeon will remove a small portion of the bone. Sutures will hold the gum together once the tooth has been removed, and will either dissolve on their own or be removed.

Most wisdom teeth extractions are performed in the dentist's office under local anesthesia. Consult your child's dentist or oral surgeon about supplements to local anesthesia or alternative forms of anesthesia, if your child is particularly anxious.

Surgical risks and complications

• Pain and bleeding usually occur for up to 24 hours after the procedure.
• Sore joints and muscles are also common following surgery.
• If a portion of the bone was removed, weakening of the jaw can occur.
• Sinus and nerve problems can also occur but are extremely uncommon.

Infection is rare but can occur; symptoms include fever, swelling, pain, and a prolonged foul taste in the mouth. If this should occur, contact your child's surgeon immediately.

Dry sockets

A dry socket develops if the blood clot that formed after the tooth was extracted prematurely loosens, leaving the socket open and dry. The exact cause of a dry socket is mostly unknown but certain risk factors, such as smoking, increase the likelihood of it happening.

Recovery

During the first 72 hours following surgery, an ice pack may reduce swelling and decrease bleeding. Skin discoloration, which should disappear within a few days, can occur. For the first two days following the operation, your child should eat soft food and stay well hydrated.

During the first three to five days, make sure you or your adolescent avoids the following:

• sucking fluids through straws
• tobacco
• vigorous rinsing of the mouth
• hard or sticky foods
• exercise

Any of these could disrupt the blood clot and delay healing.

The surgeons in the Department of Oral and Maxillofacial Surgery at Boston Children's Hospital have performed countless numbers of wisdom teeth extractions. They'll assess your child's unique situation and then develop a customized treatment plan.