Wisdom Teeth FAQ.

Or: "It is characteristic of wisdom not to do desperate things."(Henry David Thoreau)

Extract? Don't extract? It's not always so clear cut...

Q: I have some small teeth coming though my gums at the back of my mouth, I presume these are my wisdom teeth. They aren't painful but uncomfortable and a bit sore. What are wisdom teeth and what should I do about this?

A: The term "wisdom tooth" refers to what we in the profession call a "third molar", which is the tooth that is situated immediately behind the second molar. Time of eruption, position, size, and shape of these teeth are highly variable.

Because these teeth sometimes erupt into an improper position, problems frequently result. A tooth that is severely tipped or largely submerged beneath the gum is prone to infection in the surrounding gum tissue. Additionally, such a tooth may cause damage or decay to the tooth immediately in front (second molar). If a wisdom tooth is fully impacted (completely submerged beneath the gum), there is a remote possibility of cyst formation.

There is controversy regarding the wisdom tooth issue. Because these teeth usually aren't logistically important for chewing or other purposes, and because of the problems that commonly result from the presence of these teeth, oral surgeons frequently recommend that they be extracted when they fail to erupt properly. If you are of a cynical nature, you might conclude that the surgeons have a financial incentive to make such a recommendation, but there are legitimate arguments to be made. Counterbalancing the arguments for extraction are the potential problems resulting from extraction: postoperative pain, dry socket, bleeding, infection, or injury to the nerve supplying the lip.

We take a conservative approach. If symptoms are mild, we allow the patient to wait a period to see whether the pain disappears, persists, or worsens. If the frequency or severity of painful episodes merits it, we will recommend extraction. Similarly, if pathological change (decay, severe infection, cyst formation, etc.) occur, we will recommend extraction, even in the absence of symptoms.

If you are younger than age 20, you should know that your wisdom teeth may not have yet assumed their final position. Further eruption of these teeth may bring an end to your symptoms. Then again, it may not. We would advise you to consult with your dentist, since specific factors that you may present may render our treatment philosophy inappropriate for you.

Q: I have an abscessed/impacted wisdom tooth on the right bottom. Can a lower tooth abscess make your top teeth hurt and cause cheek/eye pain and swelling?

A: Pain from an abscessed lower wisdom tooth can indeed radiate to the top teeth and cause swelling of the cheek, as well as other neighboring areas. It's less likely to cause swelling or pain of the eye unless the infection is very severe and is spreading (cellulitis). We sincerely hope this is not the case, since this is a serious complication and demands immediate attention. We would advise you to play it safe and to visit a dentist ASAP!

Q: I think I'm going to need to get at least one of my wisdom teeth pulled because its pushing against the gums and it doesn't have enough room to completely come out. I take Toprol XL 50 mg for high blood pressure and I'm wondering if that will pose a complication with the surgery. Also, about 2 years ago I had a root canal done on one of my teeth and while playing basketball I was elbowed in the mouth and my tooth broke. All of the tooth is now level with my gums except for one side. My question is how will they grip that tooth to extract it and will my blood pressure medication pose a problem. Thank you for your help, I'm very nervous about going to get this done. Also, I don't have dental insurance, do you know where I can go to get this done affordably.

A: The removal of wisdom teeth is a somewhat contentious issue; there is no clear consensus among dentists under what circumstances wisdom tooth extraction is necessary. Sure, there are clear-cut situations when most dentists would recommend extraction: infection around a partially impacted wisdom tooth, cyst around impacted wisdom tooth, root resorption of an adjacent tooth caused by contact with an impacted wisdom tooth, etc. Just because there is insufficient room for a wisdom tooth to come in doesn't necessarily mean it must be extracted. You did not mention that your dentist recommended it be extracted, and we're not going to dispute any dentist who has had the opportunity to examine you in person. In all things we do, we must evaluate whether in our zeal to intervene, we create more risk than if we do nothing. Ask your dentist if you haven't already, rather than guessing that you may need to have the tooth extracted. As far as taking Toprol XL, this will not present a problem. If he is conscientious, your dentist will have taken a medical history and be aware of your high blood pressure. (If he has not taken a history make sure you tell him of your medical background.) He will avoid the use of vasoconstrictors in any local anesthetic he uses to avoid antagonizing your medication. You may want to consider conscious sedation or general anesthesia if this episode is unduly stressful for you. Toprol XL has no interaction with any other medication your dentist is likely to give you.

As far as extracting the broken tooth, we'd advise this only if the tooth cannot be fixed as determined by your dentist. You'd be surprised just how broken-down a tooth would have to be in order to be considered non-restorable! Keep in mind that replacing the tooth will in the long run be more expensive than fixing it up.

Extracting a fractured tooth that has broken to the bone can be readily done in most cases by the use of tools that can lever the root out by prying against the rim of the socket. It's quite routine, and there's nothing unusual your situation will present to your dentist.

As far as doing it inexpensively, we're afraid you'll have to do the same thing you do when you want to buy anything inexpensively--shop around (if it's not an emergency). I think that health care is sufficiently important, though, to consider quality before price. Ask a good friend for a referral!

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