Wisdom Teeth/Third Molars

The average adult has thirty-two teeth by age eighteen and each has a specific name and function. However, the average mouth is only large enough to hold 28 teeth. These four other teeth are your Third teeth are located in the back of the mouth and may have two or three roots. They are the teeth farthest back in the mouth which means they may also be the most difficult to clean, even if they erupt into the proper position! The crown develops first and as the root develops, the teeth begin to move slowly through the bone towards the mouth.

Unfortunately for the majority of today's young adults, their jaws are not large enough to allow the eruption of the third molar tooth in a normal, healthy and functional position. A third molar tooth that is prevented from erupting is termed impacted. The impacted third molar because of insufficient space can develop at an improper angle. These teeth may sometimes appear partially through the gum, or they may remain completely encased by gum tissue and bone.
Although blocked from erupting, these teeth can exert significant amounts of pressure to the adjacent teeth and jaw structures resulting in a variety of symptoms. An individual can experience swelling of the affected area, sore throat, headaches, and ultimately infection. Adjacent teeth may shift or develop caries (decay). Impacted teeth are also known to develop cysts that can enlarge, hollowing out the jaw, causing permanent damage to the adjacent bone, teeth and nerves. Tumors can arise from the walls of these cysts further complicating treatment.

Many of the problems created by impacted third molars can develop without symptoms. When they do occur, significant and occasionally permanent damage may have already occurred. When the presence of third molars has been determined, it is best to have them evaluated. If their removal is indicated, it is frequently recommended that third molars be treated before symptoms occur. As an individual ages, the bone becomes more dense making the removal of third molars more difficult and more complications are encountered.

Treatment of Third Molars

To determine if wisdom teeth are present and if removal is indicated a thorough examination of your mouth is performed. A specialized panoramic x-ray is frequently necessary for a proper evaluation, revealing characteristics of the third molars, jawbone and adjacent nerves that are not observed by visual inspection of your mouth. The results of these procedures are discussed with you and recommendations are made.

Under certain circumstances it may be recommended not to remove third molars. Many individuals have sufficient room in their mouths to accommodate third molars. Occasionally the removal of third molars can be delayed when further development of the third molars will make their removal less complicated.

Wisdom Tooth Impaction
The removal of third molars is frequently recommended. This requires selective surgical procedures that are individualized according to patient need. The uses of modern anesthetic techniques make the surgery virtually pain-free.

The majority of procedures are performed in the office. Most surgery is completed and the patient discharged from the office within an hour. Analgesics are prescribed to minimize post-operative discomfort. Hospitalization for the surgery on an outpatient or inpatient basis is available when medically necessary.

Recovery is usually rapid with most patients resuming normal activities within a few days following the procedure. Serious complications following the removal of third molars are infrequent; however, a discussion of potential complications is made so that an informed consent for surgery is obtained.

Why get my wisdom teeth out?

Wisdom teeth, especially those that are stuck down in the bone or gums (impacted), can cause some major complications. The typical symptoms are usually just soreness in the area as the tooth comes in. But a majority of wisdom teeth don't come into the mouth nice and straight. Most people have at least one wisdom tooth that is heading towards problems such as:


Wisdom Tooth Infection
A tooth that is stuck or impacted in the bone can leave a space under the gums and into the bone where bacteria, food, and other irritants can get lodged. When this happens, an infection grows in the area. It can be very painful and in some cases can lead to infections of the face and throat. In extreme cases this can result in major surgery or death.

Crowding and damage to other teeth

Wisdom Tooth Crowding
Wisdom teeth that are coming into the mouth at the wrong angle will tend to lean against the tooth in front of it. This added pressure will push the other teeth forward in the mouth and usually shows up as crowding of the bottom front teeth.
If the wisdom teeth get stuck up under the tooth in front, it will slowly damage the roots of that tooth to the extent where we sometimes need to take both teeth out due to the extent of the damage.

Cyst Formation

Wisdom Teeth Cyst
A cyst is similar to a tumor that forms in the bone around an impacted wisdom tooth. The cyst destroys the bone around the tooth and can sometimes continue to grow and destroy a large portion of the jaw. If left too long, these cysts may require major surgery and removal of a portion of the lower jaw.

My wisdom teeth came in straight, why should I remove them?

A recent study finds that third molars which have broken through the tissue and erupted into the mouth in a normal, upright position may be as prone to disease as those third molars that remain impacted.
I had the wisdom teeth on my left side extracted because they were impacted. The teeth on my right side came in straight so we allowed them to stay. Sure enough, later in life I started having problems back there because I was having a tough time brushing way back there. Eventually my tooth broke in half and after a couple days of pain, I had it removed. Sometimes its best not to wait for something horrible to happen.

Must the tooth come out if it hasn't caused any problems yet?

Not all problems related to third molars are painful or visible. Damage can occur without your being aware of it. As wisdom teeth grow, their roots become longer, the teeth become more difficult to remove and complications become more likely. In addition, impacted wisdom teeth are more likely to cause problems as patients age.
No one can predict when third molar complications will occur, but when they do, the circumstances can be much more painful and the teeth more difficult to treat. It is estimated that about 85% of third molars will eventually need to be removed.

When Should I Have My Wisdom Teeth Removed?

Wisdom Teeth Growth by Age
Age 14 years
14 years
Age 17 years
17 years
Age 25 years
25 years
Wisdom teeth are easier to remove when the patient is younger, since their roots are not completely formed, the surrounding bone is softer, and there is less chance of damaging nearby nerves or other structures. Removal of wisdom teeth at a later age becomes more complicated as the roots have fully developed (may involve the nerve), and the jawbone is denser.

It isn't wise to wait until your wisdom teeth start to bother you. In general, earlier removal of wisdom teeth results in a less complicated healing process. We strongly recommend that wisdom teeth be removed by the time the patient is a young adult in order to prevent future problems and to ensure optimal healing. The research has found that older patients may be at greater risk for disease, including periodontitis, in the tissues surrounding the third molars and adjacent teeth.


An easy method to help ensure quicker healing

What is PRF or A-PRF?

PRF is platelet rich fibrin (also known as A-PRF and PRF-M). It is a natural, biological mediator that contains a concentrated collection of a patient's own growth factors which enhances the healing capability of bone and soft tissue.

PRF is created by collecting a small sample of your own blood and spinning it in a special centrifuge. This creates a fibrin "super clot" that is rich in platelets and your own natural growth factors. The clot can be shaped and compressed to use as a "cover" over extraction sites and bone grafts.

This "super clot" protects the surgical site and the growth factors from the platelets stimulate and direct stem cell migration to speed up your wound healing. The A-PRF method was developed by Dr. Joseph Choukroun in France and the benefits of PRF have been scientifically documented in numerous journal articles. A recent study was done using PRF in lower jaw wisdom tooth sites and compared 100 consecutive patients whose treatment included PRF compared to a control group of 100 patients whose treatment did not include PRF1.

In the cases with PRF, no "dry sockets occurred", healing time and post operative pain was significantly reduced. The patients who did not receive PRF had over 8% incidence of "dry sockets" and required more medications to manage discomfort.
1 D. Hoaglin and G. Lines, "Prevention of Localized Osteitis in Mandibular Third-Molar Sites Using Platelet-Rich Fibrin," International Journal of Dentistry, article id 87530, vol. 2013.

No More Dry Sockets…

When patients hear that they need to have their wisdom teeth removed, the immediate thought that comes to mind in most patients is "I don't want a dry socket". Often the patient has had a friend or family member share a bad experience with a "dry socket" after having their wisdom teeth removed. Dry socket (Acute Alveolar Osteitis or Localized Alveolar Osteitis) has been studied many times throughout the past and have been noted to be associated with trauma during extraction, following post operative instructions, oral contraceptive use, hormone replacement use, gender, tooth location, smoking and several other factors.

When the initial blood clot formation does not mature or is dislodged, the normal healing of the fresh tooth socket does not occur resulting in exposed bone with sensitive nerve endings exposed; painful dry sockets are the result of this loss of the blood clot. PRF (Platelet Rich Fibrin) is the best solution to eliminating "dry sockets" and improves healing in most every type of oral surgery and other medical procedure including but not limited to tooth extractions, dental implants and bone grafting sites. The success rate in eliminating "dry sockets" with PRF was nearly 100% in the mentioned article!

Dr. Brian J. Dorfman and his staff are on the cutting edge of medical and surgical technology using scientifically proven surgical and medical techniques to provide optimum patient care with predictable, long lasting results.

Following the Removal of Impacted Teeth

The removal of impacted wisdom teeth is quite different from the extraction of erupted teeth. The following conditions may occur, all of which are considered normal:
  1. There may be swelling around the surgical site.
  2. Trismus (tightness) of the muscles may cause difficulty in opening mouth.
  3. You may have a slight earache and a sore throat.
  4. Your other teeth may ache temporarily.
  5. If the corners of the mouth are stretched, they may dry out and crack. Your lips should be kept moist with a cream or ointment.
  6. There may be a visible socket where the tooth was removed. This area should be rinsed with warm salt water after meals. This cavity will gradually fill in with new tissue.
  7. There may be a slight elevation of temperature.
  8. Slight bleeding (oozing) may occur from area of surgery for 24 hours.