Our third molars are referred to as our wisdom teeth. We have 1st molars, also called 6-year molars, because they erupt around that age. Then 2nd molars, also called 12-year molars are behind them. Our third molars are called our wisdom teeth, and in the majority of people, they do not erupt because there is not enough room for them. They develop in your middle teenage years and early 20’s. They are called wisdom teeth because this is a time traditionally associated with the onset of maturity and the attainment of wisdom.
Oral Examination for Extraction of Wisdom Teeth
Patients in their teens should have an evaluation of their wisdom teeth, either by their dentist, orthodontist, or an oral surgeon.
We typically perform an oral examination and take a panorex radiograph which helps to clearly outline the situation of your wisdom teeth. After the x-rays are taken, we can see existing problems, or future potential problems. Issues we often identify are inflammation or infection around the tooth, developing cavities on the adjacent teeth, cysts, or crowding due to the wisdom teeth. Studies have shown that early evaluation and treatment result in a superior outcome for the patient.
All outpatient surgery is performed under appropriate anesthesia to maximize patient comfort. One of the advantages of coming to Dr. Loetscher, he has additional training in anesthesia, and offers full general anesthesia as done in a hospital setting, rather than just offering deep sedation. This provides a safe airway, and complete patient comfort.
Anesthesia is an important factor with removing third molars. They are in the back of your mouth so it is ideal for you to be fully asleep and most importantly so the surgeon can be gentle while removing your wisdom teeth.
Types of Anesthesia
We will discuss the best type of anesthesia for you. Basically there are 4 types of anesthesia for procedures:
- Local anesthesia – where lidocaine, etc is injected.
- Local anesthesia with Nitrous oxide added via a nasal mask
- IV sedation – this can be deep or light sedation. You are sedated with drugs in the IV, and also given local anesthesia. You may have some awareness with this type of sedation.
- General Anesthesia – this is where you are completely asleep, and not aware of the procedure. Local anesthesia is also given so when you wake up you are comfortable and the surgical site is numb and will not cause uncomfortable pain.
For the majority of our third molar patients – we recommend general anesthesia.
Our surgical suites are set up and equipped identical to a hospital setting. We provide the utmost level of safety and anesthesia that can be achieved.
Dr. Loetscher explains the process of getting your wisdom teeth removed at our office:
Why do we have wisdom teeth?
Why do wisdom teeth cause pain?
Why should I have my wisdom teeth removed?
If you do not have enough room in your mouth for your third molars to fully erupt, a number of problems can happen. Impacted wisdom teeth should be removed before their root structure is fully developed. In some patients it is as early as 12 or 13, and in others it may not be until the early twenties. Problems tend to occur with increasing frequency after the age of 30. Some of the possible problems related to not removing your wisdom teeth include:
The most frequent clinical problem we see is pericoronitis, (a localized gum infection). Without enough room for total eruption, the gum tissue around the wisdom tooth can become irritated and infected, resulting in recurrent pain, swelling, and problems with chewing and/or swallowing.
Non-infectious diseases may also arise in association with an impacted wisdom tooth. Cysts are fluid-filled “balloons” inside the jaw bone that develop as a result of impacted teeth and slowly expand destroying adjacent jaw bone and occasionally teeth. They can be very difficult to treat if your wisdom teeth are not removed in your teenage years. Although rare, tumors can be associated with the delayed removal of wisdom teeth.
Impacted wisdom teeth may contribute to crowding of your teeth. This is most noticeable with the front teeth, primarily the lower front teeth and is most commonly seen after a patient has had braces. There are a number of factors that cause teeth to crowd after braces or in early adulthood. Retained, impacted wisdom teeth may be a contributing factor. Unless you have an active problem when you see the oral surgeon, the reason for removal is primarily to prevent long-term damage to your teeth, gums and jaw bone.
Damage to Adjacent Teeth:
If there is inadequate room to clean around the wisdom tooth, the tooth directly in front, the second molar, can be adversely affected resulting in gum disease, bone loss around the tooth, and/or decay.
What if I don’t have my wisdom teeth removed as a teenager or young adult?
As wisdom teeth develop, the roots become longer and the jawbone denser. When it is necessary to remove impacted wisdom teeth in your thirties, forties or beyond, the post-operative course can be prolonged and there may be a higher complication rate. Treating these complications may be more difficult and less predictable than with a younger patient. Healing may be slower, and the chance of infection can be increased. In general, you will heal faster, more predictably and have fewer complications if treated in your teens or early twenties. As an oral surgeon, we have a high skill level of removing wisdom teeth, and have many adjunctive techniques to improve your recovery. We also can provide a gentler surgical environment since you are asleep and sitting still during the procedure.
What happens on the day wisdom teeth are removed?
Most of our patients have their wisdom teeth removed under a true general anesthesia. The beauty of this is you will not be aware of the procedure, are sitting still, and we can provide a gentler surgery of high technical skill. With a general anesthesia you are unaware of the experience when they have their wisdom teeth removed. Our office staff has the training, licensing, and experience to provide the various types of anesthesia. These services are provided in an environment of optimum safety, utilizing modern monitoring equipment and a well trained experienced staff. The Surgical Care Team, the office facilities, and the doctors are inspected on behalf of the Board of Dental Examiners on a regular basis.
On the day of your procedure, you will take medications to help minimize postoperative pain and swelling. We ask that a parent or responsible adult accompanies you to the office and plans to stay with you the rest of the day. The procedure will take about 30 to 40 minutes and you will probably be in the office for 90 minutes. Recent advances in medicine and technology allow patients to undergo wisdom tooth removal in a manner, which promotes rapid healing and minimal postoperative discomfort. State-of-the-art sterilization and infection control techniques are used at all times.
On the morning or afternoon of your surgery, it is essential that you have nothing to eat or drink (excluding prescription medications with a sip of water) for at least 8 hours prior to your procedure. You can actually have what we call clear liquids – water, or fluids with sugar in them up to 4 hours prior to your surgery. Clear liquids are water, Gatorade, orange juice without the pulp and coffee without cream. Milk products and soup are not clear liquids and should not be during this 8 hour or 4-hour pre-op period where you are allowed clear liquids.
Having anything in your stomach can increase the risk for serious anesthetic complications, including nausea and vomiting. Your procedure will be rescheduled if you have not heeded these guidelines. We may provide you with a prescription for pain medication at your consultation appointment, which for your convenience, can be filled in advance. When you are seated in the surgical room, we will make every effort to make you as comfortable as possible. Prior to your anesthesia, we will place an IV. This is a quick and nearly painless procedure that ensures optimal delivery of your medication. For people with a phobia of needles, talk to Dr. Loetscher during your consultation. Often if your health allows, we can let you breath anesthesia gasses prior to starting your IV, so seeing a needle is not an issue. Local anesthesia is given once you are asleep to ensure comfort and allow adequate time to travel home and rest. You will be sleepy for a significant portion of the day.
The Day of Treatment
Be sure to have an adult with you at the time of removal. Make plans to have a parent or responsible adult stay with you for the rest of the day, following wisdom tooth removal.
What happens if my surgery requires stitches? Will I need to have them removed?
If your surgery requires stitches, these are usually the type that dissolve in 4-to-7 days and do not require removal. You may also notice a sensation of your gums feeling swollen and pulling away from your teeth. This is all part of the normal recovery, and will subside in several days.
Once the local anesthesia wears off, you may require prescription pain medication. Please try non-narcotic anti-inflammatory medications such as ibuprofen (Advil®) first, to see if that adequately treats your pain. If not, begin your other prescription pain medication. The local anesthesia may last until the following day, and should not be confused with an injury to your nerve. We recommend starting your post-operative diet with clear liquids such as jello and broths, gradually increasing in substance as your body permits.
After surgery we recommend soft foods, such as pasta, milkshakes without a straw. All desserts are good – cakes, puddings, pies, etc. You should avoid popcorn for about 10 days, and similar food. Once the numbness has worn off, you can use most of your other teeth, so sandwiches, and pizzas, etc are ok.
If you are given antibiotics and you take birth control pills, please be aware that the birth control pills might become ineffective and take appropriate precautions.
Straws should be avoided for the first 24 -36 hours or so, because the suction may loosen blood clots.
Have a phobia of needles? No worries!
Dr. Loetscher and his team have a solution for children or adults that are afraid of needles. With this method the patient will not see a needle during their procedure. The patient will receive some laughing gas for one minute to allow them to relax. Next, the patient will receive a inhalational anesthetic that is FDA approved for the induction and maintenance of general anesthesia in adults and pediatric patients for inpatient and outpatient surgery. After 2-3 minutes the patient will be sound asleep and Dr. Loetscher’s team of registered nurses can begin the IV and prepare for surgery.
How long does it take to recover from wisdom teeth surgery?
What does wisdom tooth removal cost and is it covered by insurance?
The fee for your treatment is determined by a number of factors. These may include the difficulty involved in removing your teeth and which type of anesthesia is best for you. During your consultation appointment, the surgeon will need to review your x-rays, complete an examination and determine the best option for anesthesia, before an accurate estimate can be provided. Every insurance company has a different policy regarding the extent of coverage for a given surgical procedure. Our oral surgeon’s office staff will help you obtain maximum insurance coverage for your treatment.
What if I have questions before surgery?
At the time of your consultation, your specific situation will be discussed in greater detail. We encourage you to ask any questions you may have. If new questions arise after your consultation, please call our office at Alpharetta Office Phone Number 770-664-5550 to speak to one of our patient care coordinators.
The Day of Wisdom Teeth Treatment
Please do not eat or drink anything prior to your surgery. Having anything in your stomach can increase the risk for serious anesthetic complications.