Third molars, or "wisdom teeth", are the teeth furthest back in the mouth. There is one in each quadrant of your mouth (Upper right, upper left, lower right, lower left). When normal, these teeth usually begin to erupt through the gums during the late teens to early twenties. If you look into your mouth simply count back from the frontmost, or first molar, past the second molar, to the third and last molar. In many cases, you will not see it, or only see a portion of it. If it has not been removed already, it may have never formed or may be delayed in coming in. However, in many cases, the third molars may be impacted. Impaction simply means that something is covering the tooth, or the that tooth is it from eruputing through the gums properly.

Why are they removed so often?
Most third molar removal is done as an elective procedure. Unless a patient presents with pain eminating from the third molar, the decision of removal versus non-removal comes down to a matter of judgment between the patient and the doctor. And this judgment is based on the probability that the wisdom teeth will cause a problem in the future balanced against the potential risks of removal.>

There are many factors influencing the likelihood of a wisdom tooth causing infection and pain in the future. Most of the time, the decision is very clear-cut. Many individuals, especially those of European descent, simply do not have sufficient room in the back of their mouths for another tooth. Or, the tooth may be rotated horizontally, or wedged behind the second molar. These conditions almost guarantee future problems if not addressed at an early stage.

Most dentists now agree that in these cases early removal during the teen to early twenties, before problems arise, is highly beneficial. There are several reasons for this rationale:

• Young people heal much faster and better than older individuals. This is especially true for bone filling in the empty socket left after removal. In young people, there is usually complete bone-fill. In older adults, a permanent defect may persist
• Risk of nerve damage minimal - The nerve that supplies sensation to the lower lip and teeth runs its course just below the roots of the third molars. Although still low statistically, the risk of nerve damage increases exponentially after age 25. If the wisdom teeth are removed before the roots are fully formed, however, the risk is negligible. It is important to note that in our practice, we have removed several thousands of third molars in patients in all age groups, but have yet to encounter a case of permanent nerve damage, however we always consider this risk very seriously when evaluating third molars.
• Ease of removal: Post-operative discomfort is usually directly proportional to the degree of difficulty encountered in extraction of the teeth. Since the wisdom teeth are usually easier to remove in young people, they usually encounter less post-operative discomfort.
• Minimizes the possibility of an ill-timed toothache- By removing the wisdom teeth before they cause a serious infection, one minimizes the possibility of a problem later on. Case in point: We have seen several patients who have experienced tooth problems while out of the country. This can be especially disconcerting if the country's current standard of care in Dentistry is much different than in the U.S. In most of these instances, these patients endured the pain until their return rather than take any chances.

PROCEDURE

For all patients, local anesthetic is used so that the mouth is completely numb (most people still call it novocaine, but it is no longer used, replaced usually with lidocaine). Additionally, many patients also choose nitrous oxide (laughing gas), or IV sedation (twilight sleep.)

Contrary to popular myth, wisdom teeth are not "pulled". Instead, they are usually simply loosened with judicious application of pressure to the sides of the teeth until they simply fall out.

Stitches are usually placed to accelerate the healing of the gum tissue (which are removed a week later.)

Afterward, specific instructions are given for post-operative care, along with prescriptions for medications such as antibiotics and analgesics.