So, your dentist says you need your wisdom teeth removed. Here’s everything you need to know before you go in for surgery. And how to ensure a speedy recovery.
How Necessary Is Wisdom Teeth Removal?
Simply put, there isn’t enough room for wisdom teeth because our jaws don’t grow to be big enough to have enough space for them to come in. Since there isn’t not enough room for them to erupt properly, wisdom teeth come in at an angle, or they don’t fully emerge, which causes problems for the rest of the mouth. Third molars (the wisdom teeth) routinely damage the teeth right next door, called second molars. Dentists recommend removing wisdom teeth before they become a problem and to avoid a more complicated surgery.
Will I Need Mine Removed?
Try this right now: get a mirror and look at your bottom teeth. First, count how many of the big teeth you have at the back of your mouth—these are called molars. By age 12, you should see two molars in place. Wisdom teeth are your “third molars.”
To see if you have room for your wisdom teeth, put your finger behind either second molar. If you feel a flat pad of tissue, then you may have enough room! If you feel the tissue curving upwards, chances are you don’t have room for your wisdom teeth. Of course, this is a rough estimation and you’re going to need your oral surgeon to measure this space. This quick and dirty test is just to give you some idea of what your dentist is doing to measure the space back there.
What to Ask at the Consultation:
- Do all of my wisdom teeth need to be removed?
- What are my options for anesthesia?
- What complications do you expect to see during the procedure? What is the worst case scenario?
- Compared to all of the other cases you have done, how does my case rank in terms of difficulty?
- What are the risks of doing this surgery?
- Will my face get puffy? How long will it be until my appearance is normal and I can return to school or work?
- What will happen if I leave my wisdom teeth in?
What Happens If I Don’t Have Them Removed?
The reason we remove wisdom teeth is to prevent them from damaging other healthy teeth. Often, wisdom teeth erupt perpendicularly to the teeth next door (your second molars). When wisdom teeth come in sideways like this, it throws off your bite, creates an area where food gets caught and decays both of the teeth, and can even cause a painful infection. So, if you skip the surgery today, it’s likely to cause complications and issues down the road.
But what if the wisdom teeth never come in? If your wisdom teeth don’t erupt and you leave them in, there is a 25% chance that the epithelial lining around the wisdom tooth will become cancerous. I found this in my mom in dental school and it was successfully removed, but it was a complicated procedure. This is one of the many reasons that you get your wisdom teeth out earlier, rather than later, in life.
Of course, if you were born without wisdom teeth, then you can skip the rest of the article because you’re all good! This is not to be confused with people who still have wisdom teeth in the bone that haven’t erupted yet. A limited percentage of the population is born without wisdom teeth and those people never have to get surgery.
What’s the Best Time to Get Wisdom Teeth Removed?
Before the root is fully formed: If the roots develop fully, it becomes way more difficult to do an extraction than when only the crowns (molars) have developed. Teeth grow from the crown down to the root, so if you get it done before the root develops, then the surgery is easier with less recovery time. To imagine what this is like, think of a skateboard or a tennis ball buried in the sand—which is easiest to remove? The skateboard has to be dug out, but the tennis ball can be rolled out — this should give you some sense of why it’s better to do the surgery before the roots come in.
At the start of summer break: we always recommend getting it done when life is simple, your health is good, stress is low, have someone to take care of you, and have time to find a great surgeon (and not settle for a last minute choice). For most people, this time is during one of the summer breaks in high school. If you’re not lucky enough to have already had it done in high school, that’s okay—try to stick to the same guidelines when finding the ideal time. We will say that we have noticed, wisdom teeth complications always happen right before a major life event, like a big exam, date, or wedding—so don’t delay!
How Long Can I Wait to Get Them Removed?
The thing you need to consider is: will things get worse if you wait? Wisdom teeth removal gets more complicated if the teeth become impacted, and you and your dentist need to assess if waiting might make for a more complicated surgery.
Is there such a thing as getting it done too early? This is a tricky one, because there’s always a chance that if you had waited a little longer to see how the teeth erupt, you could have enough room for them to come in. You have to trust and rely on your surgeon to be able to predict whether there will be space for this wisdom tooth—there’s a bit of an art to doing this. This is the reason we refer to certain surgeons whose work we trust. Talk to family members, people in your community, and read reviews online.
How Long Is Wisdom Teeth Recovery Time?
Typically about one week. Occasionally, it’ll take as short as four days to recover, but that’s usually just for straightforward surgery cases with no impaction or other complications.
Your recovery time will depend on:
- What type of anesthesia you choose: You’ll be able to bounce back a lot faster if you have just local anesthesia or nitrous than if you have to go under.
- Your nutrition during recovery: In just about every case, I see people who have a straight diet of Jell-O and ice cream recover more slowly.
- Preventing a dry socket: A lot of people delay recovery several weeks by not following proper protocol after the surgery—including using a straw, not keeping the head elevated, or brushing their teeth too soon after surgery. See good tips for how to speed up wisdom teeth recovery and how to prevent a dry socket.
What to Expect the First Twelve Months After Surgery
- Thinning of the face, thanks to the lack of the presence of the wisdom teeth, which support the cheeks and muscles. Over time, it’s the lack of bone as it resorbs over many years. After many years, the muscular forces can also undergo a physical reprogramming, creating facial changes as well. It’s all three of the above happening at different times, but it’s amazing how visible the change is right away.
- Cold sensitivity on your second molars, to things like cold drinks or ice cream. This sensitivity goes away eventually as the teeth recalcify, but could take several months. Use a fluoride toothpaste designed for sensitive teeth.
- You may feel little folds in the gum-line. This is caused by the bone remodelling and flattening out as part of the healing process. This can take up to a year.
- Don’t be surprised if, up to 5-10 years later, you feel a flake or sharp thing sticking out— that’s exfoliating bone fragments. It’s your body rejecting a small flake of bone left over from the surgery. If you feel that, see your dentist and they can flick it out.
- A little bone ache occasionally. No one knows what that is, but it is perhaps caused by the process of bone remodelling.
- You may have TMD pain upon opening, jaw clicking, or it’ll be hard to keep your mouth open. This is likely caused by the oral surgeon having your mouth open for too long or too wide. Ice and rest your jaw, following these TMD treatment guidelines.
Who Should Perform a Wisdom Teeth Removal Surgery?
We always recommend seeing a specialist. Specialists have seen it all, and if the unexpected comes up during your surgery, it won’t be a surprise to them. But having said that, there are a lot of general dentists who do wisdom teeth removals routinely and are excellent. Just make sure you see a dentist or oral surgeon who does this kind of surgery all the time. Wisdom teeth surgery has a high complication rate if not done in the hands of an expert.
Make sure your dentist is using a dental drill specifically for oral surgery. The same drill that general dentists use for fillings and crowns should not be used for wisdom teeth surgery, as it can cause an air embolism, a serious complication. Ask your dentist, “are you using an electric/pneumatic handpiece that is designed for oral surgery?”
How to Prepare for Wisdom Teeth Surgery
Wisdom teeth removal is an outpatient procedure, meaning that you get to go home on the same day as the surgery. Ask your dentist or oral surgeon these questions beforehand:
- Are you willing to do a bone graft? If you’re over 25 years old, we usually recommend getting a bone graft. When you take out an adult wisdom tooth, the tooth next to it has a level of bone that it’s accustomed to, but when you take out the tooth next door, you get some shrinkage. When the bone shrinks, that makes the tooth next door sensitive to sugar and cold drinks months after the surgery. Bone grafts prevent this. Usually, people under age 25 don’t need this, but it doesn’t hurt to ask!
- Should someone drive me home? This will depend on the type of anesthesia used. In the majority of cases, plan on having someone there to drive you home.
- Should I fast before the surgery? If so, when do I begin the fast? For local anesthesia, it’s good to have a light meal in your stomach a few hours before the procedure to keep blood sugar levels up. For any other kind of anesthesia, including nitrous, it’s best not to have a full stomach. Check with your surgeon for exact details on when to stop eating and drinking.
- Can I take my prescription medications before the procedure?
- Are there any nonprescription drugs that I should avoid before the procedure?
If you can, we would recommend scheduling the procedure for earlier in the week and to be the first patient in the morning. That way, you don’t have to wait nervously in the waiting room.
Tips for Staying Comfortable During the Procedure
- Bring a blanket: There are studies out there that say a heavy blanket can help reduce anxiety.
- Ask your surgeon if you can take valium: If you need to, take some valium the night before and the next morning and then go straight to surgery in the morning.
- Avoid hyperventilating: Taking in too much CO2 makes you nervous and lightheaded.
- Bring a friend that has had the procedure done before: Have them hold your hand and be by your side. This helps so much. Parents aren’t necessarily always very good at this.
- Wear comfortable, loose clothing with layers: Short sleeves are helpful for an IV, but bring a blanket or sweater because you could get cold and you’ll want your chest covered to prevent the bib sticking to you. Splurging on some special, cozy sweatpants can make a huge difference.
- Bring in-ear headphones that isolate outside noises: we use these headphones every day and recommend them for dental procedures. They’re the same price as a pair of Apple headphones, but do a much better job of blocking out noise. And they are of higher sound quality.
- Distract yourself – Music may help, but a podcast may be better: If you go with music, we would recommend going with songs you don’t so much care about.
After the Procedure
- If you receive sedation anesthesia or general anesthesia, you’re taken to a recovery room after the procedure. If you have local anesthesia, your brief recovery time is likely in the dental chair.
- This is an uncommon tip, but it’s important: Ask your surgeon whether sutures were used (or have the person picking you up ask on your behalf). A lot of people, a few days after the surgery, feel the bumps of the sutures in their mouth and think it’s food, so they work at it with their tongue. Or, they look in the mirror and see grey, black, green, or blue sutures and start to worry. Find out so that you know what it is if you see or feel it during recovery!
- After you’ve been observed for a while, your breathing is normal, and bleeding has stopped, you’ll be allowed to go home and your designated driver can pick you up. A note to the driver picking you up: you’ll probably be sent out the back door instead of where you came in from, so as not to freak anybody out in the waiting room.
- Stay elevated the first three days: At home, the most important thing is to keep your head elevated! Never let your head drop below your heart for the first three days. Remember—it’s a wound in your face that is healing, so you need to keep it elevated. This will make a massive difference in your recovery. Constantly propping up pillow is a pain, especially when you’re groggy post surgery, so get a wedge pillow like this one.
- Do not drink out of a straw, swish, or blow: Sip on water, but do not gulp, spit or swish—all those things make you prone to a dry socket. No kissing and no blowing on soup to cool it down.
- Do not spit: You may get some blood oozing on the first day after the procedure, but don’t spit it out! Spitting can cause a dry socket by dislodging the blood clot that forms over the extraction site. Instead, to deal with the blood, continue replacing gauze over the area, as directed by your dentist.
- Don’t smoke at all (tobacco and marijuana included): Smoking can cause a dry socket and of course violates the “no sucking” rule above.
- Ice, Ice, Ice: Ice packs on the outside of the cheek are very helpful. No one has energy to hold up an ice pack and no one is willing to do it for you, so buy something designed for the face. You have to get at least two of them so that one always stays in the freezer while the other is on your face. We recommend this one because it’s comfortable and has ice pockets right where you’ll need them. If the gel packs don’t stay cold for long enough, you can stuff ziploc bags of frozen peas in the pocket instead.
- No brushing: We wouldn’t recommend brushing for 2-3 days after the surgery. You shouldn’t be eating much, so it’ll be okay.
- Use a pill cutter for pain killers: This is rarely mentioned. Just because you’re prescribed a certain amount of pain killer doesn’t mean you have to use it all up. Pain killers disorient you and make recovery more difficult—think of them as a double-edged sword. Start with ice first and then progress with increasing amounts of painkillers as needed (starting with half the recommended dose).
- Drink lots of water: And make sure it’s lukewarm. Staying hydrated is essential to the recovery process.
- No solid foods for the first 24 hours: Broth, smoothies, or juice only, and they should all be lukewarm—not too cold and not too hot. We are not a fan of popsicles because they involve sucking, which increases the chance of a dry socket. Foods high in sugar are bad for healing because they make the pancreas jump up and down. After first 24 hours, you can start to incorporate soft foods like applesauce, yogurt, and pasta. Take it slow with chewing at first.
- Do not rinse your mouth: Many sites recommend rinsing with saltwater after 24 hours. DO NOT DO THIS. You can start maybe on the fourth day, gently. Salt water does promote healing but it can also disturb the site and create a dry socket. Also your immediate urge with salt water in the mouth is to swish, which you should not do.
- Limit activity: Even lifting a backpack should be avoided, ideally. Anything even mildly strenuous can dislodge the blood clot in the wound, causing exposed bone and a painful dry socket. Rest, rest, rest, and, as much as is reasonable, have a friend or family member cook and pick up for you.
When to call your dentist or surgeon
Always, always call your dentist or oral surgeon’s emergency line if you notice the following symptoms, which may indicate a serious complication that requires immediate attention:
- Difficulty swallowing or breathing
- Excessive bleeding (as opposed to oozing)
- Pus in or around the extraction site
- Any tingling, loss of sensation
- Blood or pus in nasal discharge
- Unbearable pain that can’t be made better with prescription pain medication
- Swelling that has gotten worse two to three days later
Contact Family Care Dental Clinic for your consultation today!
We at Family Care Dental Clinic offer our clients a wide range of comprehensive dental services for the whole family. Our dentists can help everyone in your family understand the importance of proper oral hygiene over time and the positive effects it has on your health. At Family Care Dental Clinic, we treat our clients to a soothing environment where they can receive quality dental care no matter what their needs are. Call (604) 987-3545 or write us at firstname.lastname@example.org to schedule an appointment with a member of our excellent team!