Wisdom teeth are the third and final set of molars that most people get in their late teens or early twenties. Sometimes these teeth can be a valuable asset to the mouth when healthy and properly aligned, but more often, they are misaligned and require removal. Wisdom teeth present potential problems when they are misaligned – they can position themselves horizontally, be angled toward or away from the second molars or be angled inward or outward. Poor alignment of wisdom teeth can crowd or damage adjacent teeth, the jawbone, or nerves. Wisdom teeth that lean toward the second molars make those teeth more vulnerable to decay by entrapping plaque and debris. In addition, wisdom teeth can be entrapped completely within the soft tissue and/or the jawbone or only partially break through or erupt through the gum. Teeth that remain partially or completely entrapped within the soft tissue and /or the jawbone are termed "impacted." Wisdom teeth that only partially erupt allows for an opening for bacteria to enter around the tooth and cause an infection, which results in pain, swelling, jaw stiffness, and general illness. Partially erupted teeth are also more prone to tooth decay and gum disease because their hard-to-reach location and awkward positioning makes brushing and flossing difficult.

How Do I Know if I Have Wisdom Teeth?

Ask your dentist about the positioning of your wisdom teeth. He or she may take an X-ray periodically to evaluate for the presence and alignment of your wisdom teeth. Your dentist may also decide to send you to an oral surgeon for further evaluation.

Your dentist or oral surgeon may recommend that your wisdom teeth be extracted even before problems develop. This is done to avoid a more painful or more complicated extraction that might have to be done a few years later. Removal is easier in young people, when the wisdom teeth roots are not yet fully developed and the bone is less dense. In older people, recovery and healing time tend to be longer.

How Is a Wisdom Tooth Removed?

The relative ease at which your dentist or oral surgeon can extract your wisdom teeth depends on the position of the impacted teeth. Your oral health care provider will be able to give you an idea of what to expect during your pre-extraction examination. A wisdom tooth that is fully erupted through the gum can be extracted as easily as any other tooth. However, a wisdom tooth that is underneath the gums and embedded in the jawbone will, require an incision into the gums and then removal of the portion of bone that lies over the tooth. Oftentimes for a tooth in this situation, the tooth will be extracted in small sections rather than removed in one piece to minimize the amount of bone that needs to be removed to get the tooth out.

What happens During the Procedure?

Before your wisdom tooth is extracted, the tooth and the surrounding tissue will be numbed with a local anesthetic – the same injection with the same medication you would receive to numb a tooth prior to having a cavity filled. In addition to the local anesthetic to numb the pain, you and your dentist or oral surgeon may decide that a sedative is desired to control your anxiety. Sedating medications that could be selected include: nitrous oxide (otherwise known as "laughing gas"), an oral sedative (for example, Valium, Halcion), or an intravenous sedative (administered via an injection into your veins). If nitrous oxide is given, you will be able to drive yourself home. If any of the other medications is selected, you will need someone to drive you both to and from the appointment in which your tooth will be extracted.

What Does Recovery Involve?

How quickly you heal depends on the degree of difficulty of the extraction (a simple extraction of a fully erupted tooth versus a tooth impacted into the jawbone). In general, here's what to expect.

During the first 24 hours

• Bleeding may occur for several hours after tooth extraction. To control it, position a piece of clean moist gauze over the empty tooth socket and bite down firmly. Apply constant pressure for about 45 minutes. A moistened tea bag is an effective alternative. The tannic acid in tea helps healing blood clots to form (blood clots function similarly to a scab on an open wound). Repeat this process if a small degree of bleeding continues; if heavy bleeding continues to occur, contact your dentist or oral surgeon. Avoid rinsing or spitting for 24 hours after tooth extraction, avoid "sucking" actions (for example, don't drink beverages through straws or smoke) and avoid hot liquids (such as coffee or soup). These activities can dislodge the clot, causing dry socket (see below) to develop.
• Facial swelling in the area where the tooth was extracted typically occurs. To minimize swelling, place a piece of ice, wrapped in a cloth, on that area of your face on a schedule of 10-minutes on, followed by 20-minutes off. Repeat as necessary during this first 24-hour period.
• Pain medications, such as acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) can be taken for minor pain. Your dentist or oral surgeon may prescribe more potent pain relievers, such as narcotics, if necessary.
• Antibiotics that may have been prescribed prior to tooth extraction (to treat any active infection around the wisdom tooth to be extracted) should continue to be taken until the full prescription is gone.
• Foods should be chewed on the side of the mouth opposite the extraction. Avoid hot liquids and alcoholic beverages for at least 24 hours. In the case of difficult extractions, consume a soft or liquid diet for the first 24 hours.
• Continue to brush your teeth, but avoid the teeth directly neighboring the extracted tooth during the first 24 hours. On day two, resume the gentle brushing of your teeth. Do not use commercial mouth rinses - these can irritate the extraction site.

After 24 hours

• Facial swelling in the area of the tooth extraction should be treated with heat after the first 24 hours of ice. Apply a moist warm towel to the area on a 20-minute on, 20-minute off schedule. Repeat as necessary.
• Rinse your mouth with warm salt water (1/2 teaspoon of salt in a cup of warm water) after meals and before bed. Do not use commercial mouth rinses.
• Stitches, if used and if not of the self-dissolving type, need to be removed by your oral health care provider in about 1 week. If you do require stitches, ask what type you have been given.
• Watch for signs of dry socket (described below). This condition requires treatment by your oral health care provider.
• Complete healing doesn't occur for a few weeks to a few months following the extraction. However, usually within the first week or two, enough healing has taken place for use of your mouth to be reasonably comfortable in the area of the extraction.

Your dentist will explain what to expect in your specific case.

What Are Potential Complications?

Two of the more important complications include:

• Dry socket. Dry socket is a common complication that occurs when either a blood clot has failed to form in the extracted tooth socket or else the blood clot that did form has been dislodged. Without clot formation, healing will be delayed. When it happens, dry socket typically occurs 3 or 4 days following the extraction and is accompanied by pain (ranging from "dull" to moderate to severe) and a foul mouth odor. Your dentist or oral surgeon will treat the dry socket by placing a medicated dressing in the socket. Dressing will need to be removed and replaced every 24 hours until symptoms subside.

  　

• Paresthesia. Paresthesia is a less frequently occurring complication. Wisdom teeth entrapped in the jawbone are often close to nerves. Sometimes these nerves can be bruised or damaged during the tooth removal process. The result is a numbness (called a paresthesia) of the tongue, lip or chin that can last a few days, weeks, months or may even be permanent.

How Much Does Wisdom Teeth Extraction Cost?

Simple extraction of a wisdom tooth can cost as little as $150 per tooth in some areas. The cost of wisdom teeth that are impacted can cost between $250 and $340 and even more. Because costs vary in different areas of the country, contact your dentist or oral surgeon for their charges. Also check with both your dental insurance carrier and medical insurance provider. One or the other type of insurance may cover a portion of the cost of wisdom teeth removal.

Common Medications Used in Dentistry?

There are a number of different medications your dentist may prescribe for you, depending on your condition. Some medications are prescribed to fight certain oral diseases, to prevent or treat infections, or to control pain and relieve anxiety. The list that follows describes some of the most commonly used medications in dental care. The dose of the drugs and instructions on how to take them will differ from patient to patient, depending on what the drug is being used for, patient age, weight and other considerations. Even though your dentist will provide information to you about any medication he or she may give to you, make sure you fully understand the reasons for taking a medication and inform your dentist of any health conditions you may have. Commonly used medications in dentistry include: Local Anesthesia, General Anesthesia, Nitrous Oxide or Intravenous Sedation. Commonly used in dental procedures, these medicines help control pain and anxiety and are used in procedures ranging from cavity removal to oral surgery. Chlorhexidine. Chlorhexidine is an antibiotic used to control gingivitis in the mouth or in periodontal pockets (the space between your gum and tooth). The medication is available as a mouth rinse and as a gelatin-filled chip that is placed in the deep gum pockets next to your teeth after root planing. The medication in the gelatin-filled chip is released slowly over about 7 days. Dental products containing this antibacterial are marketed under various prescription-only brand names, such as Peridex, PerioChip, and PerioGard, as well as other over-the-counter trade names. Of note: Chlorhexidine may cause an increase in tartar on your teeth. It may also cause staining of the tooth, tooth filling, and dentures or other mouth appliances. Brushing with a tartar-control toothpaste and flossing your teeth daily may help reduce this tartar build-up and staining. In addition, you should visit your dentist at least every 6 months to have your teeth cleaned and your gums examined. Be sure to tell your dentist if you have ever had any unusual or allergic reaction to this medicine or to skin disinfectants containing chlorhexidine. Corticosteroids. Corticosteroids are anti-inflammatory medications that are used to relieve the discomfort and redness of mouth and gum problems. Corticosteroids are available by prescription only and are available as pastes under such brand names as Kenalog in Orabase, Orabase-HCA, Oracort, and Oralone. Anesthetics. Dental anesthetics are used in the mouth to relieve pain or irritation caused by many conditions including toothache, teething, and sores in or around the mouth (such as cold sores, canker sores, and fever blisters). Also, some of these medicines are used to relieve pain or irritation caused by dentures or other dental appliances, including braces. Some of these medicines are available only by prescription; others are available without a prescription. These medicines are available in many dosage forms including aerosol spray, dental paste, gel, lozenges, ointments, and solutions. Dental anesthetics are contained in such brand name products as Anbesol, Chloraseptic, Orajel, and Xylocaine. Of note: Most benzocaine-containing medications used for teething may be used in babies 4 months of age and older. Most of the other nonprescription medicines that contain a dental anesthetic should be used only in children 2 years of age and older. Because the elderly are particularly sensitive to the effects of many local anesthetics, they should be careful not to use more than directed by the package label or the dentist. Anesthetics used for toothache pain should not be used for a prolonged period of time; they are prescribed for temporary pain relief until the toothache can be treated. Denture wearers using anesthetics to relieve pain from a new denture should see their dentist to determine if an adjustment to the appliance is needed to prevent more soreness. Doxycycline Periodontal System. This medication (marketed as Atridox) contains the antibiotic doxycycline and is used to help treat periodontal disease. Doxycycline works by preventing the growth of the bacteria. Doxycycline periodontal system is placed by your dentist into deep gum pockets next to your teeth and dissolves naturally over 7 days. Of note: Tell your dentist if you have ever had any unusual or allergic reaction to doxycycline or to other tetracyclines. Use of doxycycline periodontal system is not recommended during the last half of pregnancy or in infants and children up to 8 years of age because the product may cause permanent discoloration of teeth and slow down bone growth. Use of doxycycline periodontal system is not recommended, if breastfeeding, since doxycycline passes into breast milk. This class of drugs also may decrease the effectiveness of estrogen-containing birth control pills, increasing the chance of unwanted pregnancy. Fluoride. Fluoride is used to prevent tooth decay. It is available on a nonprescription basis in many toothpastes. It is absorbed by teeth and helps strengthed teeth to resist acid and block the cavity-forming action of bacteria. As a varnish or a mouth rinse, fluoride helps reduce tooth sensitivity. Prescription-strength fluoride is available as a liquid, tablet, and chewable tablet to take by mouth. It usually is taken once daily. It is prescribed for children and adults whose homes have water that is not fluoridated (has not had fluoride added to water). Of note: Before taking fluoride, be sure to tell your dentist if you are allergic to fluoride, tartrazine (a yellow dye in some processed foods and drugs), or any other drugs. Do not take calcium, magnesium, or iron supplements while taking fluoride without checking with your dentist. Tell your dentist if you are on a low-sodium or sodium-free diet. Do not eat or drink dairy products 1 hour before or 1 hour after taking fluoride. Fluoride can causing staining of the teeth. Other Antibiotics. Besides chlorhexidine and doxycycline periodontal system, other antibiotics, including the tetracyclines (the class of drugs including demeclocycline, doxycycline, minocycline, oxytetracycline and tetracycline) and the drug triclosan (marketed as Irgasan DP300) can be used. These medications are used either in combination with surgery and other therapies, or alone, to reduce or temporarily eliminate the bacteria associated with periodontal disease, to suppress the destruction of the tooth's attachment to the bone or to reduce the pain and irritation of canker sores. Dental antibiotics come in a variety of forms including gels, thread-like fibers, microspheres (tiny round particles) and mouth rinses. Pain Reliever. Your dentist may recommend a nonprescription pain-relieving drug and/or an anti-inflammatory drug – such as Motrin or Tylenol to relieve mild pain and/or swelling caused by dental appliances, toothaches and fevers. Unless directed by your dentist, never give infants and children aspirin. Antiseptics. Your dentist may recommend the use of an over-the-counter antiseptic mouth rinse product to reduce plaque and gingivitis and kill the germs that cause bad breath. Pilocarpine. This medication, marketed as Salagan, may be prescribed by your dentist if you have been diagnosed with dry mouth. The drug stimulates saliva production. Muscle Relaxants. Muscle relaxants may be prescribed to reduce your stress to help you stop grinding your teeth and to treat temporomandibular joint disorders. Antifungals. Antifungal medications are prescribed to treat oral thrush. The goal of treatment is to stop the spread of the Candida fungus. Antifungal medicines are available in tablets, lozenges, or liquids that are usually "swished" around in your mouth before being swallowed.