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Impacted Teeth

Wisdom teeth, otherwise known as third molars, are the last set of teeth to develop. Sometimes these teeth emerge from the gum line and the jaw is large enough to allow room for them, but most of the time, this is not the case. More often, one or more of these third molars fails to emerge in proper alignment or fails to fully emerge through the gum line and becomes entrapped or "impacted" between the jawbone and the gum tissue. Impacted wisdom teeth can result in swelling, pain, and infection of the gum tissue surrounding the wisdom teeth. In addition, impacted wisdom teeth can cause permanent damage to nearby teeth, gums, and bone and can sometimes lead to the formation of cysts or tumors that can destroy sections of the jaw. Therefore, dentists recommend people with impacted wisdom teeth have them surgically removed.

It's not just wisdom teeth that sometimes become impacted and need to be removed. Other teeth, such as the cuspids and the bicuspids can become impacted and can cause the same types of problems described with impacted wisdom teeth.

Tooth Loss

Dental implants are an option for tooth loss due to an accident or infection or as an alternative to bridges and dentures. The implants are tooth root substitutes that are surgically anchored in place in the jawbone and act to stabilize the artificial teeth to which they are attached. Suitable candidates for dental implants need to have an adequate bone level and density, must not be prone to infection, and must be willing to maintain good oral hygiene practices.

 

Why Take Them Out?

Wisdom teeth are a third set of molars in the back of your mouth. They usually come in between the ages of 17 and 25, and they're spotted on X-rays. Most people have them removed for one of these reasons:

  • They’re impacted. Because they're so far back in your mouth, wisdom teeth may not come in normally. They can be trapped in your jawbone or gums, which can be painful.
  • They come in at the wrong angle. They may press against your other teeth.
  • Your mouth isn’t big enough. Your jaw has no room for an extra set of molars.
  • You have cavities or gum disease. You may not be able to reach your wisdom teeth with your toothbrush or dental floss.

Before Surgery

You’ll meet with the oral surgeon to talk about the process. At this appointment, make sure you:

  • Talk about any health problems you have.
  • List any drugs you take on a regular basis.
  • Ask any questions you have about the surgery.
  • Discuss what type of anesthesia you’ll have. You can either be numb or asleep during your surgery.
  • Plan time off from work or school to have your surgery and rest afterward at home. Set up child care, pet care, or a ride home if needed.

During Surgery

Your surgery should take 45 minutes or less.

You’ll get one of these types of anesthesia so you don’t feel pain during the removal:

  • Local: Your doctor will numb your mouth with a shot of Novocaine in your gums.You may also breathe nitrous oxide, or laughing gas, to relax or even doze during surgery. You should feel alert again shortly afterward.
  • IV sedation: The surgeon will numb your mouth and also give you drugs through a vein in your arm to make you drowsy. You might sleep during the whole procedure.
  • General: You’ll either get drugs through a vein or breathe gas in through a mask. You’ll be asleep the whole time and might not wake up for an hour or so after the surgery.

Your doctor may have to cut your gums or bone to get the teeth out. If so, he'll stitch the wounds shut so they heal quickly. These stitchesusually dissolve after a few days. He may also stuff gauze pads in your mouth to soak up some of the blood.

Reasons for Pulling Teeth

Although permanent teeth were meant to last a lifetime, there are a number of reasons why tooth extraction may be needed. A very common reason involves a tooth that is too badly damaged, from trauma or decay, to be repaired. Other reasons include:

 

A crowded mouth. Sometimes dentists pull teeth to prepare the mouth for orthodontia. The goal of orthodontia is to properly align the teeth, which may not be possible if your teeth are too big for your mouth. Likewise, if a tooth cannot break through the gum (erupt) because there is not room in the mouth for it, your dentist may recommend pulling it.

Infection.  If tooth decay or damage extends to the pulp -- the center of the tooth containing nerves and blood vessels -- bacteria in the mouth can enter the pulp, leading to infection. Often this can be corrected with root canal therapy (RCT), but if the infection is so severe that antibiotics or RCT do not cure it, extraction may be needed to prevent the spread of infection.

Risk of infection. If your immune system is compromised (for example, if you are receiving chemotherapy or are having an organ transplant), even the risk of infection in a particular tooth may be reason enough to pull the tooth.

Periodontal (Gum) Disease. If periodontal disease -- an infection of the tissues and bones that surround and support the teeth -- have caused loosening of the teeth, it may be necessary to the pull the tooth or teeth.

What to Expect With Tooth Extraction

Dentists and oral surgeons (dentists with special training to perform surgery) perform tooth extractions. Before pulling the tooth, your dentist will give you an injection of a local anesthetic to numb the area where the tooth will be removed. If you are having more than one tooth pulled or if a tooth is impacted, your dentist may use a strong general anesthetic. This will prevent pain throughout your body and make you sleep through the procedure.

If the tooth is impacted, the dentist will cut away gum and bone tissue that cover the tooth and then, using forceps, grasp the tooth and gently rock it back and forth to loosen it from the jaw bone and ligaments that hold it in place. Sometimes, a hard-to-pull tooth must be removed in pieces.