The third set of molars, commonly known as wisdom teeth, typically emerge between the ages of 17 and 25. These teeth can often lead to complications because the human jaw frequently lacks sufficient space for their proper eruption. Many individuals must have these teeth removed to prevent future oral health issues, leading to the common question of which dental professional is qualified to perform the procedure.
Who Performs Wisdom Tooth Removal?
The complexity of the wisdom tooth dictates whether a general dentist or an oral and maxillofacial surgeon performs the extraction. General dentists are trained to handle simple extractions, which involve fully erupted teeth that are visible in the mouth and have straightforward roots. In these cases, the dentist uses local anesthesia, and the tooth is removed gently with specialized instruments, often without the need for an incision or stitches.
When a wisdom tooth is impacted, meaning it is trapped beneath the gum tissue or jawbone, the procedure becomes a surgical extraction. Oral and maxillofacial surgeons are specialists who complete an additional four to six years of surgical residency after dental school, focusing on complex procedures involving the jaw and face. They handle impacted teeth, those growing at an angle, or cases where the tooth is close to nerves or other vital structures.
A surgical extraction often requires the surgeon to make a small incision in the gum, and sometimes remove surrounding bone, or section the tooth into smaller pieces for easier removal. Oral surgeons offer a broader range of sedation options, including intravenous (IV) sedation or general anesthesia, allowing the patient to be completely unaware of the procedure. While a general dentist may perform a simple extraction, they will typically refer patients requiring surgical intervention or advanced sedation to an oral surgeon.
Why Are Wisdom Teeth Removed?
The removal of wisdom teeth is often a preventative measure to avoid complications when they do not erupt correctly. The most common issue is impaction, where the tooth is partially or fully trapped beneath the gum line or bone, causing pain and swelling. Impaction creates a space where bacteria can accumulate, leading to an infection of the surrounding gum tissue known as pericoronitis.
Uncontrolled infection can lead to a dental abscess or a fluid-filled sac called a cyst forming around the trapped tooth. These cysts can damage the roots of nearby teeth and the surrounding jawbone. When a wisdom tooth pushes against the adjacent second molar, it can cause crowding, shifting of other teeth, or damage to the neighboring tooth’s structure, including decay or root resorption. Removing the teeth early reduces the risk of these problems.
The Extraction and Healing Process
The process begins with a thorough assessment, including dental X-rays, to determine the exact position of the wisdom teeth and their proximity to nerves. During the procedure, the patient receives local anesthesia and possibly sedation, depending on the complexity of the extraction. The surgeon removes the tooth, sometimes using dissolvable stitches to close the gum. The entire procedure typically takes less than an hour.
Post-operative care is essential for proper healing and preventing complications like a dry socket. A dry socket, or alveolar osteitis, is a painful condition that occurs when the protective blood clot becomes dislodged or dissolves prematurely, exposing the underlying bone and nerve endings. Patients must avoid creating suction in the mouth, meaning they should refrain from using straws, smoking, or forceful spitting for at least a week following the surgery.
Swelling is managed by applying a cold compress to the cheek in the first 24 hours, and pain is controlled with prescribed or over-the-counter medication. Diet must be restricted to soft foods for several days. Starting 24 hours after surgery, gently rinsing with warm salt water can help keep the area clean, but vigorous swishing must be avoided to preserve the blood clot.