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Wisdom Teeth Removal   The gentle removal of fully or partially impacted wisdom teeth, soft tissue impactions, root tips, abscessed teeth, and the treatment of dry socket.  For appointments, or for further information, please call our Encino dental office at (818) 990-6659.   When to Remove Wisdom Teeth Wisdom teeth cause more problems than any other tooth in the mouth. They will either partially break the gum tissue and grow in crooked or remain underneath the gum. In nine out of ten people, at least one tooth remains underneath the gum - referred to as an impacted tooth, causing symptoms of future problems of varying degrees.  "Even if you have no symptoms now, headaches, earaches, pain in the face, neck, throat and upper and lower teeth can occur if impacted wisdom teeth are not removed."

Wisdom teeth generally cause problems when they erupt partially through the gum. The most common reasons for removing them are:

Decay
Saliva, bacteria and food particles can collect around an impacted wisdom tooth, causing it, or the next tooth to decay. It is very difficult to remove such decay. Pain and infection will usually follow.

Gum Infection
When a wisdom tooth is partially erupted, food and bacteria collect under the gum causing a local infection. This may result in bad breath, pain, swelling and trismus (inability to open the mouth fully). The infection can spread to involve the cheek and neck. Once the initial episode occurs, each subsequent attack becomes more frequent and more severe.

Pressure Pain
Pain may also come from the pressure of the erupting wisdom tooth against other teeth. In some cases this pressure may cause the erosion of these teeth.

Orthodontic Reasons
Many younger patients have had prolonged orthodontic treatment to straighten teeth. Wisdom teeth may cause movement of teeth (particularly the front teeth) when they try to erupt and this will compromise the orthodontic result.

Prosthetic Reasons
Patients who are to have dentures constructed should have any wisdom tooth removed. If a wisdom tooth erupts beneath a denture it will cause severe irritation and if removed, the patient will need to have a new denture constructed as the shape of the gum will have changed.

Cyst Formation
A cyst (fluid filled sac) can develop from the soft tissue around an impacted wisdom tooth. Cysts cause bone destruction, jaw expansion and displacement or damage to nearby teeth. The removal of the tooth and cyst is necessary to prevent further bone loss. Rarely, tumors may develop within these cysts or the jaw may fracture spontaneously if the cyst grows very large.

Why Should an Impacted Wisdom Tooth be Removed if it Hasn't Caused any Trouble?
Impacted wisdom teeth are almost certain to cause problems if left in place. This is particularly true of the lower wisdom teeth. Such problems may occur suddenly, and often at the most inconvenient times.

When is the Best Time to Have my Wisdom Teeth Removed?

It is now recommended by specialists that impacted wisdom teeth be removed between the ages of 14 and 22 years whether they are causing problems or not. Surgery is technically easier and patients recover much more quickly when they are younger. What is a relatively minor operation at 20 can become quite difficult in patients over 40. Also the risk of complications increases with age, and the healing process is slower.

Travel to Inaccessible Places
If you are going to an area where specialist dental services are not available and your wisdom teeth are impacted, it may be advisable to have them removed beforehand.

Should a Wisdom Tooth be Removed When an Acute Infection (Pericoronitis) is Present?
Generally, no. Surgery in the presence of infection can cause infection to spread and become more serious. Firstly, the infection must be controlled by local oral hygiene, antibiotics and sometimes the extraction of the opposing wisdom tooth.

"We should remove them because..." 

	Wisdom teeth may be hard to access with your toothbrush or floss. Over time, the accumulation of bacteria, sugars and acids may cause a cavity to form in the tooth. If it is not restored with a filling, the cavity may spread and destroy more tooth structure causing severe consequences to the tooth and surrounding supportive structures.
	Due to the difficulty of keeping these teeth clean with your daily home care (brushing and flossing), bacteria and food debris remaining on the wisdom teeth may present a foul smell-causing bad breath.
	A wisdom tooth that is still under the gums in a horizontal position (rather than a vertical position) may exert pressure to the surrounding teeth, causing crowding and crooked teeth. This also may occur if there is not enough space in the mouth for the wisdom tooth. This may warrant braces to repair the damage.
	A wisdom tooth that is still under the gums may become irritated. The gum tissue that lays over the tooth may harbor food debris and bacteria that gets trapped under the gum, resulting in an infection in the gums.

"Let them stay because..."

	Depending on the size shape and position of the tooth, removal can vary from a simple extraction to a more complex extraction. With a simple extraction, there is usually little swelling, bruising and/or bleeding. More complex extraction will require special treatment which may result in more bruising, swelling and bleeding. However, your dental professional will provide you with post treatment instructions to minimize these side effects.
	Following an extraction, a condition called dry socket may occur (see below).  If the blood clot that formed in the extraction area becomes dislodged, it exposes the underlying bone. This condition is very painful, but resolves after a few days. It is preventable by following the post treatment instructions provided by your dental professional.
	The longer you wait and the older you get, there is the potential for more problems to occur. This is because as you get older, the bone surrounding the tooth becomes more dense, making the tooth more difficult to remove. The healing process may also be slower.

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