- The Washington Times - Monday, March 29, 2004

Trevor Lott says he believes having his wisdom teeth removed was an intelligent decision. After investing a lot of money in orthodontic work, Mr. Lott, 20, of Northwest, decided to have his “third molars” extracted as a preventive measure.

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When his wisdom teeth started to come through his gums, he was concerned they might disrupt the straightening his braces provided.

Mr. Lott had the surgical procedure done in January during holiday break from college. He is a sophomore at the University of Pennsylvania in Philadelphia.

“I was nervous because I had never undergone surgery before, but everyone told me it wasn’t that big of a deal,” Mr. Lott says. “The last thing I remember before the surgery is the anesthesiologist said, ‘You’re going to start to feel a little sleepy.’ … I don’t remember any of the surgery.”

For most teenagers and twenty-somethings, the removal of wisdom teeth has become one of the rites of passage from adolescence to adulthood, although some persons wait until later in life for the surgery. Younger patients who have the surgery tend to heal quicker, with fewer side effects.

Though many people opt to have the third molars extracted, not everyone needs them taken out. In fact, because of genetics, a small number of people don’t have any wisdom teeth.

“Each case is different and requires a collection of the facts,” says Dr. Matt Messina, spokesman for the American Dental Association. “In general, if we can tell the third molars are positioned in such a way that they will erupt into the mouth with not enough space, the earlier we make that discovery, the better.”

If the wisdom teeth come into proper position, they don’t need to be taken out and give the person an extra set of teeth, says Dr. Messina, a general dentist from Cleveland. However, people shouldn’t decide by default not to have the third molars extracted.

“This is a bridge you will cross at some point in your life,” he says. “It’s important to discuss. In current thought, it’s not an automatic that all the wisdom teeth are removed, but more than not are removed. Certainly it’s being done on a more individualized and actively debated and decided manner.”

The key sign that wisdom teeth need to be extracted is pain, says Dr. George Obeid, chairman of oral and maxillofacial surgery at Washington Hospital Center in Northwest. Infection or swelling are other signals that the procedure is necessary. Removing the third molars also can prevent damage to adjacent teeth, decay or gum disease. Most prospective candidates for the surgery have consultative appointments to discuss the risks and benefits.

“If patients already have symptoms, it’s an easy decision to make,” he says. “When you don’t have symptoms, it’s more difficult. That’s when you depend on the expertise of the surgeon. No one can really tell when trouble will arise.”

In addition to swelling and infection, some wisdom teeth can be associated with cysts and tumors, says Dr. Stewart Bergman, vice chairman of the department of oral and maxillofacial surgery at the Baltimore College of Dental Surgery at the University of Maryland.

Although cysts or tumors can occur with all teeth, it happens most frequently with teeth that cannot take their proper place in the mouth. When teeth successfully erupt, the soft tissue around the teeth at their formation disappears. However, with impacted teeth, the soft tissue remains and could degenerate into a cyst or tumor. In rare instances, the cyst or tumor becomes malignant.

Also, because the wisdom teeth are in the back of the mouth, they are hard to keep clean, which makes them prone to cavities.

“You usually can’t fill a wisdom tooth,” Dr. Bergman says.

The procedure to remove third molars is a routine surgery, usually performed by a specialist, says Dr. Hamid Ryan Kazemi, an oral surgeon at the Center for Oral and Facial Enhancement in Bethesda. Erupted wisdom teeth can be pulled from the mouth in a more simple procedure. If surgery is needed because of impacted teeth, all four teeth most likely can be extracted in 30 minutes under sedation, which keeps patients from hearing the sound of the drill or cracking teeth.

The intricacy of the surgery depends on the degree to which the teeth are impacted because of bone or gum, Dr. Kazemi says.

“Most people don’t want to be awake,” he says. “Usually by talking and explaining the procedure, the anxiety of patients really comes down quite a bit.”

Complications after surgery might include infection and the numbness of the sensory nerve in the lower jawbone, Dr. Kazemi says. Although tingly feelings in the jaw usually are temporary, in rare instances, the condition can be permanent.

“If the tooth is removed gently, even if it’s touching the nerve, it doesn’t cause any problems,” he says.

Also, because the roof of the upper jaw and floor of the sinus are the same, sometimes the roots of the upper wisdom teeth are close to the sinus floor. Occasionally, when the teeth are extracted, a hole forms between the sinus and the mouth, says Dr. Peter Smith, oral and maxillofacial surgeon at Fairfax Oral Surgery. The condition usually heals without a problem.

Regardless of complications, patients can expect to wake up with gauze packed in their mouth after surgery, Dr. Smith says. The stitches in the mouth usually dissolve without needing the dentist to take them out. Pain relievers and ice for swelling are postoperative measures that can be used to ease pain. Patients should eat soft food for at least 48 hours.

On certain occasions, people develop “dry sockets” on the third or fourth postoperative day, which can be particularly painful. A dry socket occurs when the blood clot degrades, leaving exposed bone. This complication occurs more often in smokers and women who take birth control pills.

For at least a week after surgery, all patients should refrain from sucking through a straw, spitting or smoking, which could expel the clots, causing dry sockets. If dry sockets occur, patients should return to the dentist immediately to receive a soothing dressing.

“I do a lot of wisdom teeth surgeries on Friday, so people can be at school or work on Monday,” Dr. Smith says.

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