impacted wisdom teeth / wisdom tooth extractions

There are no firm rules regarding a specific age by which a person's wisdom teeth have to be extracted. Wisdom tooth extractions can be performed successfully and uneventfully at any age. However, from a standpoint of statistics, there are certain factors that do correlate with age that do place the dental patient at greater risk for complications.

As a rule of thumb, the younger the age of the person having the wisdom teeth extractions the less potential they will have for experiencing complications. Studies have shown that the number of complications, related to both healing as well as the procedure itself, that occur in association with wisdom tooth extractions increases once a patient has passed into their mid to late 20's.

At the other end of the scale, a dentist will typically want to delay wisdom tooth extractions until that point in time when about two thirds of the root structure of the teeth has had a chance to form. This stage of development might occur by age 18 or so, but will certainly vary from patient to patient. Dentists typically want to wait for this stage because if the tooth is too underdeveloped it can be difficult for the dentist to manipulate it. Of course if the dentist waits until the tooth’s roots have fully formed, the difficulty of the extraction will be comparatively more complex.

So, in general, an age window of about 18 to 24 years would seem to be an ideal time frame in which to have wisdom teeth extracted. This is an age when there is greater likelihood that the roots of the teeth will not yet be fully formed and the bone surrounding the teeth will be less dense. Also, younger people are typically more resilient than comparatively older persons and therefore the healing process is usually less involved for them.

In most cases, if a dentist can clearly ascertain that there are good reasons as to why a person should have their wisdom teeth removed and they feel the age timing is right for the procedure, then it is usually best to go ahead and have the extractions performed as soon as is reasonably convenient.

What are common complications and risks associated with removing wisdom teeth?

A very important part of the examination and consultation a dentist or oral surgeon will perform before removing wisdom teeth is a discussion covering the potential risks and complications associated with having this dental procedure performed. Cleary the elective removal of wisdom teeth should not be performed if the potential risks associated with the procedure exceed the expected benefits. Some of the complications a dentist usually discusses are listed below.

Paresthesia

A complication that can be associated with the removal of wisdom teeth is that of "paresthesia." Wisdom teeth can be positioned in the jaw in a manner in which they lie in close proximity to nerves. Sometimes during the process of extracting a wisdom tooth these nerves can be bruised or damaged. As a result, numbness of the tongue, lip, or chin may occur. (Having this condition is termed "paresthesia.")

The sensation of paresthesia can be similar to that feeling you have when a dentist uses an anesthetic to "numb up" a tooth, only instead of disappearing in a few hours the numbness persists. In most cases paresthesia is temporary and resolves on its own within a few days or weeks. In more severe cases the healing process may take several months. If the nerve damage has been significant, the paresthesia may be permanent.

Paresthesia is typically a "sensory" as opposed to a "motor" phenomenon. By this we mean that the person does notice an altered state or loss of sensation (touch, proprioception, pain and temperature) in the affected region but does not typically experience nerve/muscle interaction problems such as facial deformities, compromised tongue movements, or speech deficits.

A hope of avoiding the complication of paresthesia is one reason why dentists suggest that wisdom teeth be removed when a patient is "young." As humans age on through their twenties the roots of their wisdom teeth continue to form and develop, making these teeth more difficult to extract without disturbing surrounding tissues (like nerves). The incidence of nerve damage for wisdom teeth removal runs as high as 10% after the age of 35, whereas it is rare for teenagers.

Dry Sockets

One of the most common complications experienced in association with wisdom tooth extractions is that of developing a "dry socket" (alveolar osteitis). It is thought that dry sockets occur when either an adequate blood clot has failed to form in the extracted tooth's socket or the blood clot that did form has been dislodged and lost. Since the formation of a blood clot is an important part of the healing process, the healing of the tooth socket becomes delayed. While a dry socket can be an unfortunate complication associated with wisdom tooth removal, it typically is not considered to be a reason not to perform wisdom teeth extractions but rather a disappointing and transient side effect.

The typical dry socket produces a dull pain that doesn't appear until three or four days after the tooth has been extracted. The pain can be moderate to severe. There is often a foul odor associated with this condition.

A dry socket needs to be treated by your dentist. Usually a dentist will place a medicated dressing in the dry socket that can soothe and moderates the pain. This dressing is typically removed and replaced every 24 hours until the person's symptoms subside. Dry sockets are found to occur more often in women (even more so in those taking oral contraceptives), persons over the age of 30, and smokers.

[Dry sockets are discussed in greater detail on our topic Dry Sockets pages.]