Wisdom teeth are the last of the adult or permanent dentition to develop. They are the third molar or grinding teeth and are situated at the back of the dental arches. It is because they are the last teeth to develop that they can be left without space to erupt and become impacted. In this situation, they become partially erupted with some of their surface covered by gum. This can lead to infection under the gum flap (pericoronitis) or decay in the crown of the wisdom tooth itself, or in the crown of the tooth in front of the wisdom tooth. Their existence can be a factor causing crowding (malocclusion) in a developing dentition. Very occasionally, they can be associated with other pathology in the jaw, such as cysts.

Even though impacted wisdom teeth are not visible in the mouth, they can cause a number of problems. Commonly, patients will go to their dentist because of pain in the back of the jaws. An impacted wisdom tooth itself may be the source of the pain. Bacteria that are always present in the mouth can work their way down under the gum tissue and cause a painful infection around the crown of the wisdom tooth, even though the tooth is not visible. People often mistake repeated soreness of the gum tissue overlying the wisdom teeth as an effort by the teeth to erupt. Unfortunately this is often a warning sign that trouble is brewing. If this situation goes untreated for an extended period of time, the infection may become chronic and lead to destruction of bone around the impacted tooth (a condition known as periodontal disease).

This bone destruction can extend around the other teeth in the back of the mouth and lead to future tooth loss. The same types of bacteria that are responsible for infections can also cause tooth decay or cavities on the roots of the other molar teeth. The constant pressure from the impacted wisdom tooth alone can lead to destruction of the teeth adjacent to it. Although the overall occurrence of cysts and tumors associated with the jaws is low, when they do occur it is most frequently around an impacted wisdom tooth. We may request that wisdom teeth be removed prior to braces, as they may interfere with straightening the other teeth. In addition, an impacted wisdom tooth in the lower jaw occupies space that is usually filled by bone. This creates an inherent area of weakness in the lower jaw, which may render it more susceptible to fractures.

As soon as it is determined that the wisdom teeth will become impacted, they should be removed. This can usually be determined by age sixteen as the jaws have attained the majority of their adult size. Removal of impacted wisdom teeth in this age group has several distinct advantages. At this level of development, the roots are seldom fully formed, even though the tooth has become impacted. If left in place, the tooth will not erupt into the mouth but the roots will continue to grow. Removing an impacted wisdom tooth before the roots are fully formed is easier and less traumatic for the patient. Also, at this stage of the patient's development, the bone surrounding the impacted tooth is more pliable. Typically, patients having impacted wisdom teeth removed in their mid-teens heal more rapidly and have a less complicated post-operative recovery.

Historically, patients having impacted wisdom teeth removed were admitted to their local hospital, taken to the operating room, and given general anesthesia. Now the vast majority of patients have their wisdom teeth removed right in the office. Improvements in surgical technique and sedative medications allow patients to have their impacted wisdom teeth removed comfortably and efficiently in a pleasant environment that is far less costly and intimidating than the hospital setting. There are several anesthetic options available to provide patients with the optimum in comfort during their surgery and minimize the postoperative side effects. You will have the opportunity to discuss these options, as well as your individual needs and concerns, with your doctor and his associates at your consultation appointment.

Postoperative pain is usually well controlled with simple analgesics. If postoperative pain persists after taking these simple analgesics, it is usually caused by an infected wound. Further antibiotics or dressings may then be required. Patients who smoke regularly are far more susceptible to infections after the operation. Some slight oozing of the wound afterwards is quite common. Profound bleeding is not common.

There should be no major bleeding prior to discharge from the surgery or hospital. Minor oozing can be controlled by biting on clean gauze for about 20 minutes. Some patients may experience swelling of the face, particularly associated with removal of the lower wisdom teeth. Bruising can also occur, which will frequently appear 24 - 48 hours after surgery and may gravitate down the side of the neck. A few patients may also experience postoperative numbness or tingling in the lower lip or tongue particularly following removal of difficult impacted teeth. This is due to bruising of the nerve that supplies sensation to these areas, the motor supply that makes these parts move is however not affected.