About Wisdom Teeth

Kingston Wisdom Teeth Extractions - General & Impacted Tooth Removal

Wisdom teeth, or third molars, are the last teeth to develop and appear in your mouth. They come in between the ages of 17 and 25, a time of life that has been called the “Age of Wisdom.” Our practice specializes in the removal of wisdom teeth in Kingston, NY.

Dr. Matthew Hilmi has removed thousands complex wisdom teeth during his years of practice in Kingston, NY.

What is an impacted third molar?

When a tooth is unable to fully enter the mouth, it is said to be “impacted.” In general, impacted teeth are unable to break through the gums because there is not enough room. Nine out of ten people have at least one impacted wisdom tooth.

How serious is an impacted wisdom tooth?

If left in the mouth, impacted wisdom teeth may damage neighboring teeth, or become infected. Because the third molar area of the mouth is difficult to clean, it is a site that invites the bacteria that leads to gum disease. Furthermore, oral bacteria may travel from your mouth through the bloodstream, where it may lead to possible systemic infections and illnesses that affect the heart, kidneys, and other organs.

Research has shown that once periodontal disease is established in the third molar areas, the problem is persistent and progressive, but may improve the following extraction of the teeth.

In some cases, a fluid-filled cyst or tumor may form around the base of the untreated wisdom tooth. As the cyst grows, it may lead to more serious problems as it hollows out the jaw and damages surrounding nerves, teeth, and other structures.

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

Many people believe that as long as they are not in pain, they do not have to worry about their wisdom teeth. However, pain free does not mean disease or problem free. In fact, wisdom teeth that come in normally may still be prone to disease, according to a study by the American Association of Oral and Maxillofacial Surgeons and the Oral and Maxillofacial Surgery Foundation. AAOMS strongly recommends that third molars be evaluated by an oral and maxillofacial surgeon by the time a patient is a young adult in order to assess the presence of third molars, disease status, and to suggest management options ranging from removal to a monitored retention plan to ensure optimal patient-specific outcomes.

In general, dental and medical professionals agree that wisdom teeth should be removed in the following instances:

  • Infections and/or periodontal disease
  • Cavities that cannot be restored
  • Pathologies such as cysts and tumors coexisting
  • Damage to neighboring teeth

Wisdom teeth that are completely erupted and functional, painless, cavity-free, in a hygienic environment with healthy gum tissue, and are disease-free may not require extraction. They do, however, require regular, professional cleaning, annual checkups, and periodic radiographs to monitor for any changes.

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.

What happens during surgery?

If your dentist or healthcare professional recommends that your wisdom teeth be removed, you will most likely be referred to an oral and maxillofacial surgeon for the procedure. Before surgery, your oral surgeon will discuss the procedure with you and tell you what to expect. This is a good time to ask questions. Also, talk to your surgeon about any concerns you have. Be sure to let your doctor know about any illness you have and medications you are taking.

There are several conditions that affect how easy it will be to remove a wisdom tooth. These conditions include how the tooth is positioned and the stage of root development. If the wisdom teeth are impacted, the surgery might be more complicated.

Most of the time, third molars can be removed with little or no pain. Usually, they can be extracted at the oral and maxillofacial surgery office. Patients are given either local anesthesia, intravenous sedation, or general anesthesia. Your surgeon will recommend the anesthetic option that is right for you. I.V. sedation options are available in Dr. Hilmi's office.

What happens after surgery?

Following surgery, you may experience some swelling and mild discomfort, which are part of the normal healing process. Cold compresses may help decrease the swelling, and medication prescribed by your oral and maxillofacial surgeon can help manage the discomfort. You may be instructed to modify your diet following surgery and later progress to more normal foods.

What if I decide to keep my wisdom teeth?

If after discussing your situation with your family dentist or oral and maxillofacial surgeon, you decide to keep your wisdom teeth, be sure to take particular care in cleaning and flossing your teeth, especially the molars. Your third molars must be professionally examined regularly and X-rays of your wisdom teeth should be taken every year to make sure that the health of your teeth and gum tissue does not change.

Types of Wisdom Tooth Impactions

When a wisdom tooth erupts into the oral cavity, it’s said to have erupted. Impaction is where the third molars (wisdom teeth) erupt in an unusual position. Four types of impaction situations exist in varying degrees. Some of them require surgical intervention by a trained oral surgeon.

Many dentists and physicians assume that impacted wisdom teeth automatically need surgical extraction; this is not always necessary. Our practice specializes in the removal of wisdom teeth in Kingston, NY. Every patient must be evaluated individually. Thus, the importance of a thorough consultation, including clinical examination with panoramic X-ray review, is emphasized in our office.

There have been many systems used to classify wisdom tooth impactions based on bone depth and angulation. For the sake of simplicity, a brief description follows:

Mesial Impaction

The mesial impaction is the most common type of impaction. It’s where the wisdom tooth is angled towards the front of the mouth. It impinges upon the space of the molar in front of it. The angulation of the mesial impaction determines whether it becomes a problem.

It commonly leads to a partial eruption where only part of the tooth is visible beyond the gingiva (gums). In some clinical cases, observation is sufficient. Eventual eruption is possible. General dentists may keep a watchful eye on these teeth or refer to have a surgeon remove them.

We are the experts in wisdom tooth surgery and will evaluate your case and make recommendations based on our clinical findings.

Vertical Impaction

These molars occasionally require surgical intervention. These teeth have a relatively normal orientation. There is a strong likelihood that, over time, they will erupt and assume a normal position in the oral cavity.

If a vertically impacted wisdom tooth does need removing, it’s because it’s pushing against the underside of the molar in front of the bones at the back of the mouth. These are difficult to remove and often result in damage to the surrounding teeth and bone areas. It’s unusual for a vertical impaction to be clinically significant.

Vertically impacted wisdom teeth can normally be extracted by your oral surgeon using a local anesthetic. IV sedation would only be required in the case of an extremely nervous patient.

Distal Impaction

A distally (backward facing) impaction is the least commonly found type of impaction. It’s the complete opposite, as far as orientation is concerned, of the mesial impaction.The tooth is angled towards the back of the mouth. It doesn’t have a higher chance of needing a wisdom tooth removal. It depends on how dramatic the angle is.

If it’s almost pointing towards zero degrees, it will erupt as normal but will always have a slight incline. It will fit in the mouth and dentists will normally give it a year or two before they make a decision on whether they need to remove it.

It’s usually up to the oral and maxillofacial surgeon as to whether the tooth needs extraction.

Horizontal Impaction

The horizontal impaction is the most challenging kind of impaction to have. It’s pointing entirely away from the gingival (gum) surface and towards the molar in front of it. It’s completely horizontal and is running parallel to the jawbone. It often needs removal or it can start to damage the adjacent teeth.

The challenges presented by this type of impaction are best handled by a highly trained oral and maxillofacial surgeon. It takes a lot of skill to complete this type of wisdom tooth extraction without complications (i.e. trauma to the surrounding area).

This type of impaction may require having some bone removal, so general anesthetic or IV sedation is generally recommended. The patient should also be prescribed painkillers and a thorough aftercare plan, as always, to decrease discomfort and possible post-surgery complications.

Make sure you always use an experienced oral and maxillofacial surgeon like Dr. Matthew Hilmi for this kind of surgery to minimize the damage caused to the surrounding area.

If wisdom tooth surgery has been recommended by your general dentist, you must be thoroughly informed of what will happen during the procedure. A complete explanation of post-surgical care should also be part of your overall treatment plan. Please ask questions. Second opinions are not uncommon.

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