Those Pesky Wisdom Teeth

Those Pesky Wisdom Teeth

In North America, it is a rite of passage to be considered for removal of wisdom teeth, particularly in the orthodontic population. The first appearance of wisdom teeth occurs in the early teens and is complete in the late teens. Sometimes the jaw doesn’t have enough room to accommodate wisdom teeth, resulting in an “impacted” wisdom tooth. Patients who have received orthodontics (straightening of teeth) are often prescribed for removal of wisdom teeth prior to, during, or shortly after the completion of orthodontic work. This helps to ensure that the new teeth positions remain stable in the jaw.

Some of the other problems that wisdom teeth (also called “third molars”) can produce vary from minor infections or inflammation as they begin to erupt (local swelling), to more severe infections when they become trapped. Cystic changes or even tumour development in the walls of cysts may occur around wisdom teeth that are retained for a long period of time. Some wisdom teeth start to disintegrate (resorb) or develop cavities even before they erupt.

Recent research also confirms that retained wisdom teeth contribute to increased incidents of gum disease.

Diagnosis and Treatment

Using patient history and clinical and x-ray examinations, the family dentist and/or the orthodontist will determine and advise on retention or removal of wisdom teeth. Most commonly, patients with impacted third molars are referred to dental specialists known as Oral & Maxillofacial Surgeons (OMFS) for their assessment. OMFS is the oldest specialty in the dental profession. An OMFS surgeon has specific training in surgical treatment of diseases of the jaws and soft tissues of the oral cavity and the maxillofacial region. Training includes a full dental education and then five to six years more in specialty training. This graduate work/residency includes medical, surgical, and anaesthesia training and dealing with the surgical care and management of post-operative complications.

Most OMFS surgeons now have digital radiology (x-rays) including ConeBeam scans in their offices, which allows for close examination and determination of disease (pathology) and nerve position, as well as more intelligent treatment planning, based on the position of teeth, particularly in complicated cases. Panoramic x-rays, which are widely available at dental offices, are the standard image of choice. Most patients being assessed or requiring removal should have, at the very minimum, a panoramic x-ray.

Not all impacted teeth are necessarily removed. The risks and benefits have to be weighed. The patient’s general health must be considered and, as it is an elective procedure, the patient must be fully aware of the risks and benefits and agree to consent to the removal with that knowledge.

Anaesthesia

Many patients prefer to be unaware of the surgical procedure and OMFS offices provide all kinds of pain control. This includes local “freezing” to intravenous conscious sedation or general anaesthesia. In severe cases or where pathology and cysts exist, general anaesthetics are more often used.

OMFS surgeons also are able to admit and treat their patients in hospital when necessary. Argyle Associates also have two-day-stay surgery centres (SurgiCentres) in East and West Ottawa staffed by Ottawa Hospital Anaesthetists for more complex surgeries under general anaesthesia.

Post-Operative Care

Recovery from the removal of wisdom teeth varies depending on factors such as age, degree of impaction, and pre-existing medical conditions. Generally, two to three days off from normal activities is recommended, as some swelling generally occurs. Potential risks and complications, however minor, are reviewed with your OMFS before surgery.

Argyle Associates have served the dental and medical communities and the patients of Ottawa and the Eastern Ontario region with OMFS services since 1976. We are a diverse group of fully certified OMFS surgeons offering a full range of OMFS services.