What are Impacted Teeth?

      Impacted teeth are those teeth that do not erupt into their normal position into the mouth, whether it is totally or partially embedded.      

      The last teeth to develop and erupt into the jaws are called the third molars. Third molars usually erupt in the late teen years, which coincides with passage into adulthood and is referred to by some as the age of wisdom; hence "wisdom teeth". Unfortunately, the wisdom teeth are now usually trying to erupt into a jaw that is too small.

       By approximately age 16, Dr. Tan can determine whether your wisdom teeth will be impacted or not.

What causes Wisdom teeth to be Impacted?

·          Due to gradual evolutionary reduction in the size of human jaws. Thus, jaws are too small to accommodate the teeth.

·          Diet. If you noticed long time  ago, people  have large  jaws, it’s because they chew hard foods, thus the jaw developed into a larger bone enough to accommodate third molars or wisdom teeth. While today we eat  processed  foods that we don't need much force to chew, resulting to smaller jaws.

·          Good Oral Hygiene. Modern dentistry has pretty much eliminated significant loss of permanent teeth at an early age. This leaves us with too many teeth and not enough jaw. The wisdom teeth still develop as they always have, but they have no where to go. When this happens, the teeth are considered "impacted," meaning that they are not in normal position and function.

Reasons Why you should have it remove?

·          As a general rule, all  impacted  teeth  should  be  removed unless removal is contra-indicated.       

·          Preventive dentistry dictates that impacted teeth be removed before complications arise.

·          Early removal  reduces post-operative complications and allow for best healing.

·          For facilitation for orthodontic treatment.

Impacted Wisdom teeth may cause……

·          Pain at the back of the jaws and near the ear area.               

·          Infection. Because it’s an area where bacteria wants to  live due to its dark, warm and moist environment.

·          Development of cyst or tumor around the impacted tooth.

·          Pericoronitis (on and off history of pain and swelling in the area.)

·          Tooth decay of the impacted teeth and its adjacent tooth because it’s hard to properly brush the area.

·          Root resorption.

·          Periodontal diseases. ( bone and gum diseases)

·          Fracture of the jaw.

·           Constant headache.

When should Impacted Wisdom teeth be remove?

        The best time to remove impacted wisdom teeth is when its roots are only 2/3rds yet are formed. And this is between 16-18 yrs. of age. Because it will be a lot easier to remove rather than a fully developed roots.

         Remember, the younger the patient the better the healing. It has a shorter period of recovery and lesser complications after surgery.

         Although any age will do , but a thorough evaluation  will be done by Dr. Tan whether it is indicated or contra-indicated for removal.

How are Impacted Teeth remove?

         Treatment of impacted wisdom teeth requires skill on the part of the dentist, a well trained staff and a surgical facility equipped for emergencies. Oral surgeons are specifically trained to perform these dentoalveolar procedures and have the knowledge and experience to handle any situation which might arise pre-operatively, intra-operatively and post-operatively. Most importantly they have the supportive staff and facility to accomplish the surgery safely and expeditiously. The removal of wisdom teeth is commonly performed in the oral surgeon's office. 
          Impacted  teeth  are  done  usually  in  a dental office under local  anesthesia, it’s like a feeling of having a simple extraction but the procedure is a little longer and complicated. Local anesthesia is administer first, an incision is done (when indicated), bone removal, remove the tooth and a suture is then place. Post-operative medications and instructions will be given. After 1 week sutures will be remove and post operative evaluation will be done by Dr. Tan.

         Sometimes, removal  of impacted teeth can be done under Conscious Sedation in a dental office, medications for sedation will be given thru a running intravenous fluid on the patient. Patient is more relax and groggy during surgery but still conscious. General anesthesia can also be another option for cases indicated for this. Patient will be admitted to the hospital and surgery will be done in an operating room. Patient may stay for several days after the surgery.

The following are tips to help you prepare for your surgical appointment:     Clothing - Wear loose, comfortable clothing with sleeves that are easily rolled up.  Jewelry - Remove watches and bracelets.  Transportation - An escort is mandatory for surgery. The patient must be escorted to the office and the escort must stay at the office during the surgery. Surgeries may take more or less than 60 minutes but it will depend on the case.  Diet - Patients must refrain from EATING and DRINKING from midnight the night before. This includes WATER…..  Medications - Patients must adhere to their normal medications prior to surgery. All maintenance medications such as high blood pressure, diabetes and thyroid medications must be taken on schedule. Take medicine with a small amount of water or juice.  After surgery, a 48 to 72 hour recovery is expected. Patients are reevaluated after one week to remove sutures and to assess healing and to intercept any complications that may occur.  Bleeding is expected post operatively and can continue up to 10 hours after any procedure. Even a little blood seems like allot in the mouth due to a mixture with saliva. Saliva can increase what appears to be high concentrations of blood by 10 times. Pressure on the surgical site is most important for bleeding control. If sutures were placed at the time of the surgery, pressure will almost always stop bleeding. A tea bag wrapped in a piece of gauze is also helpful. The tannic acid in the tea constricts tiny blood vessels in the wound and helps to form a clot. Swelling is to be expected post operatively. Swelling can last for several days and can be significant in some patients. Ice is helpful in keeping the swelling to a minimum, 20-30 minutes on and 20-30 minutes off --after the day of the surgery is very helpful. Elevating the patient's head the first couple of nights while sleeping may also help. Steroids given at the time of surgery are a most effective weapon in the battle against swelling.  They are routinely used intravenously unless medically contraindicated.  An interesting phenomena can occur when intravenous steroids are used however. Some patients experience what is called rebound swelling from the medications. In this scenario, patients will experience no swelling following the surgery or the following day but wake up two days after surgery with swelling. Not to panic, this condition responds quickly to ice.  Another complication following wisdom tooth removal is pain in the muscles surrounding the jaws which affects the function of the jaw joint. This post operative problem may need treatment. Infection following the extraction of wisdom teeth is not a common complication. Natural immune mechanisms help to protect the surgical site. Antibiotics are also  prescribed. Some patients will experience localized inflammation and infection in the tooth socket 48-72 hours after surgery. This has commonly been called a dry socket. It is not dry, however, and the name is derived from the clinical appearance of the socket which is commonly void of a normal blood clot or granulating (healing) tissue. This post operative complication is best treated with a medicated dressing placed in the extraction site. It typically contains local anesthetic ointment that soothes the surgical site. If this is ineffective, it usually means the pain is originating in another tooth (most commonly the tooth in front of the wisdom tooth site), or from the muscles surrounding the surgical region. These muscles are used during opening and closing of the jaw and can be aggravated post operatively by overeating, grinding, and heavy chewing. Treatment of this type of pain requires not only a dressing in the surgical site but also anti inflammatory medications, muscle relaxants and in some cases post operative physical therapy for the muscles.

Removal of wisdom teeth is a common procedure. Complications can occur, however. The following are potential complications that the patient should understand: 1. Infection - Infection following the surgical removal of wisdom teeth is an uncommon complication. Any infection, however, should be taken seriously and reported to the oral surgeon. Signs of infection include fever above 100 degrees orally, abnormal swelling, pain or a salty or prolonged bad taste, with or without evidence of discharge from the surgical site.  2. Injury to teeth - Damage to fillings and adjacent teeth, to bridgework or to surrounding bone can occur during the removal of impacted wisdom teeth. Even the best surgeon will occasionally have this type of complication.  3. Dry Socket - This term is used to describe a condition that can develop in the empty tooth socket. If a blood clot does not form properly in the socket or is lost prematurely, the bone can be exposed. Exposure of the bone to the oral cavity, foods and saliva, can result in a localized inflammation or infection called alveolitis. The pain of a dry socket generally starts about 3 days after the surgery. It is acutely painful but responds immediately to proper care. Dry sockets are easily treated with the placement of a medicated dressing into the surgical site. Smoking and improper diet after surgery increases the odds of a dry socket.  4. Numbness - In some cases major sensory nerves serving the mouth are in close proximity to the wisdom teeth. It is possible that one or more of these nerves can be bruised or permanently damaged during surgery. if this occurs, numbness to the tongue, lip or chin may occur.  This numbness or tingling sensation is usually temporary. Uncommonly,  permanent numbness can occur.  5. Sinus complications - Upper wisdom teeth roots are in very close proximity to the maxillary sinus. in some cases the roots even penetrate into the sinus cavity. An opening into the sinus after the removal of wisdom teeth occurs on occasion. By and large, small perforations into the sinus are uneventful and heal without being noticed. Occasionally, bacteria from either the sinus or the oral cavity can hinder healing and a hole can develop from the sinus into the extraction site. Drainage can ensue along with the passage of food and air from the mouth into the sinus. If this occurs, the opening or communication between the mouth and sinus needs to be closed. 6. Root fragments - Occasionally root tips remain after the removal of wisdom teeth. Usually the fragment is close to a nerve or adjacent sinus. Removal of the root tip could jeopardize adjacent structures. The oral surgeon uses his clinical expertise to determine the benefit to risk ratio of removing a root tip. Since root tips uncommonly cause post operative infections or pain, their removal is not an absolute necessity. The fragments can be monitored using x-rays. Fragments can be removed in the future if they become clinically symptomatic.  7. Jaw fracture - In very rare cases, the removal of a wisdom tooth will weaken the jaw bone. This is due to the obligatory removal of bone to obtain access to the impacted tooth. It is very rare for the jaw to fracture during the removal of a wisdom tooth. It is very rare of the jaw to fracture after the removal of a wisdom tooth due to weakening and chewing normal foods. Your surgeon, however, may indicate that a large amount of bone was removed to gain access to the wisdom tooth. he may recommend the patient avoid eating hard foods which may place undue stress on a weakened jaw.  8. TMJ pain - Temporomandibular joint dysfunction following the removal of wisdom teeth is also unusual and universally temporary. If treatment is required, it is usually conservative in nature and includes anti-inflammatory medicines, physical therapy and in some cases short term bite splint therapy.

         If you have further questions regarding this condition, wish to consult further, please feel free to ask your oral surgeon.