Wisdom teeth, or third molars, are the last teeth to develop and appear in the mouth. They are called "wisdom teeth" because they usually appear during a person's late teens or early twenties, which has been called the "age of wisdom". The normal position of wisdom teeth is behind the upper and lower second, or 12-year, molars. Many times the jaws of modern humans are not normally large enough to accommodate the four wisdom teeth. This is why wisdom teeth cause more problems than any other teeth in the mouth. In fact, for nine out of ten people at least one wisdom tooth remains underneath the gum due to lack of space in the mouth. Impacted Wisdom Teeth When a wisdom tooth is blocked from erupting or coming into the mouth normally, it is termed impacted. A tooth may be only partially impacted, meaning it grows in crooked and breaks through the gum only partially, or it may fail to break through at all and thus remains totally impacted. Serious problems can develop from partially impacted teeth, such as pain, infection, and crowding of, or damage to, adjacent teeth. For totally impacted teeth, more serious problems can occur if the sac that surrounds the impacted tooth fills with fluid and enlarges to form a cyst. This enlargement can hollow out the jaw and result in permanent damage to the adjacent teeth, jawbone and nerves. If the cyst is not treated, a tumor may develop from the walls of the cyst and a more involved surgical procedure may be required for removal. Many problems with wisdom teeth can occur with few or no symptoms, so there can be damage without your knowing it. It is important to know that as wisdom teeth develop, their roots become longer and the jawbone denser. Thus, as a person grows older, it becomes more difficult to remove wisdom teeth and complications can become more severe. In addition, as people age there is an increased chance of the symptoms mentioned above. For these reasons, the surgeon may recommend the removal of wisdom teeth even if they are not yet causing obvious problems, particularly for young adults. How Wisdom Teeth Are Treated Treatment of impacted wisdom teeth involves their removal using special surgical techniques appropriate for each individual case. A dentist who has specialized training in the removal of wisdom teeth is called an oral and maxillofacial surgeon, or OMFS. If the wisdom teeth have fully erupted in normal position, they may be observed by your dentist during your regular visits to ensure that you are properly cleaning them and no problems are developing, such as decay. Minor abnormalities in the position of an erupted wisdom tooth may be taken care of by your dentist, or removal might still be best. The removal of wisdom teeth can be performed on an outpatient basis, either in the dental office, or in certain cases, in a hospital setting. Usually the surgical procedure will take up to one hour although this varies according to each case. In most cases normal activities can be resumed within a few days to a week depending on the degree of impaction and the number of teeth removed. Consultation Before the surgeon can determine if your wisdom teeth should be removed, he or she will conduct an examination of your mouth and discuss the results with you. This examination will include x-rays, which show the presence of the impacted teeth and reveal such important things as curved roots, proximity of the tooth roots to nerves, and other vital surgical information that cannot be determined by visually inspecting the mouth. A complete health/medical history will be taken, with particular attention to allergies, medications or health problems that might affect surgery and/or administration of anesthesia. The surgeon will examine your mouth for any signs of swelling or infection, and will check your blood pressure and certain other vital signs in order to determine the type of anesthesia to use during surgery. It is important that you provide complete information, particularly about medications you may be taking, so the surgeon has an accurate assessment of your health prior to recommending surgery. Anesthesia Modern anesthesia technology now makes it possible to perform even complex surgery in the dental office with little or no discomfort. During surgery, one or more of the following is used to control pain and anxiety: local anesthesia that numbs the surgical area; nitrous oxide-oxygen (sometimes called ³laughing gas²) to relax you; intravenous sedation for relaxation; and general anesthesia that puts you to sleep. Your surgeon will fully explain the type of anesthesia that is most appropriate for your needs. Post Op Your surgeon and/or the office staff will give you specific instructions to follow after surgery is completed. You can expect some bleeding for a while, and you will probably be asked to bite gently on gauze for a few hours after surgery to allow a blood clot to form in the extraction site(s). Even a little blood can seem like a lot to you, so don¹t be alarmed by gentle oozing of blood for a few hours after surgery. However, if bleeding is excessive after you return home, contact your surgeon immediately for instructions. Ice packs applied to the face following surgery will help to reduce swelling, but expect some swelling to occur during the normal healing process. This swelling may increase for the first 48 to 72 hours and then begin to subside. There may be some discoloration of the skin during healing, first black-blue in color, then turning yellow and disappearing in a few days. There may also be pain for several days following surgery. Your surgeon will prescribe the appropriate pain medication for your needs. Diet For the first two days following surgery, eat soft foods and drink fluids, but avoid using a straw. The suction could disturb clotting. Do not rinse your mouth vigorously until clotting is complete, although gentle rinsing with salt water may be recommended by your surgeon to aid healing. It’s also important to remember that smoking can disturb blood clots and the healing process. Clean your mouth gently with a toothbrush after the first day following surgery.