Wisdom Teeth

By the age of 18, the average adult has 32 teeth; 16 teeth on the top and 16 teeth on the bottom. Each tooth in the mouth has a specific name and function. The teeth in the front of the mouth (incisors, canine, and bicuspid teeth) are ideal for grasping and biting food into smaller pieces. The back teeth (molar teeth) are used to grind food up into a consistency suitable for swallowing.

The average mouth is made to hold only 28 teeth. It can be painful when 32 teeth try to fit in a mouth that holds only 28 teeth. These four other teeth are your third molars, also known as "wisdom teeth."

Why Should I Have My Wisdom Teeth Removed?

Wisdom teeth are the last teeth to erupt within the mouth. When they align properly and gum tissue is healthy, wisdom teeth do not have to be removed. Unfortunately, this does not generally happen. The extraction of wisdom teeth is necessary when they are prevented from properly erupting within the mouth. They may grow sideways, partially emerge from the gum, and even remain trapped beneath the gum and bone. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to successfully erupt.

These poorly positioned impacted teeth can cause many problems. When they are partially erupted, the opening around the teeth allows bacteria to grow and will eventually cause an infection. The result: swelling, stiffness, pain, and illness. The pressure from the erupting wisdom teeth may move other teeth and disrupt the orthodontic or natural alignment of teeth. The most serious problem occurs when tumors or cysts form around the impacted wisdom teeth, resulting in the destruction of the jawbone and healthy teeth. Removal of the offending impacted teeth usually resolves these problems. Early removal is recommended to avoid such future problems and to decrease the surgical risk involved with the procedure.

Oral Examination

With an oral examination and x-rays of the mouth, Dr. Brousell can evaluate the position of the wisdom teeth and predict if there are present or may be future problems. Studies have shown that early evaluation and treatment result in a superior outcome for the patient. Patients are generally first evaluated in the mid-teenage years by their dentist, orthodontist or by an oral and maxillofacial surgeon.

All outpatient surgery is performed under appropriate anesthesia to maximize patient comfort. Dr. Brousell has the training, license and experience to provide various types of anesthesia for patients to select the best alternative.

Removal

In most cases, the removal of wisdom teeth is performed under local anesthesia, laughing gas (nitrous oxide/oxygen analgesia) or general anesthesia. These options, as well as the surgical risks (i.e., sensory nerve damage, sinus complications), will be discussed with you before the procedure is performed. Once the teeth are removed, the gum is sutured. To help control bleeding, bite down on the gauze placed in your mouth. You will rest under our supervision in the office until you are ready to be taken home. Upon discharge, your postoperative kit will include postoperative instructions, a prescription for pain medication, antibiotics, and a follow-up appointment in one week for suture removal. If you have any questions, please do not hesitate to call us at (732) 747-0993.

Our services are provided in an environment of optimum safety that utilizes modern monitoring equipment and staff who are experienced in anesthesia techniques.

What are Wisdom Teeth?

Wisdom teeth, also known as third molars, are the last teeth to develop. They are located in the very back of your mouth, behind your second (twelve year) molars. Their development is complete between the ages of 15 and 20, a time traditionally associated with the onset of maturity and the attainment of wisdom.

What Is An Impacted Tooth?

Most people develop 32 teeth in their adult dentition (16 in the upper and 16 in the lower jaw). For most of us, there is not enough room in the mouth for all of these teeth to adequately erupt and become fully functional and cleansable. When this occurs they are said to be impacted because they are unable to erupt into a position for chewing. Most importantly, impacted teeth can not be cleaned properly. This makes it difficult to clean the second molars, the teeth just in front of them. Tooth decay, gum and bone disease and other disorders can result from poor hygiene.

At Dr. Gary Brousell’s office, they will take a special x-ray of your mouth and jaws to determine if your wisdom teeth are impacted.

There are Several Types of Impactions:

Soft Tissue Impactions:

There is not enough room to allow the gum tissue to retract as it does for your other teeth when they erupt into a normal position. This prevents you from cleaning your wisdom teeth and possibly the adjacent second molars just in front of your wisdom teeth. A Soft tissue impacted tooth is covered only by gum tissue.

Partial Bony Impactions:

There is even less room for the wisdom teeth to erupt. A partial bony impacted wisdom tooth is covered by excess gum and part of the jaw bone. The impacted wisdom tooth cannot function in the chewing process and can not be cleaned, and can lead to serious infections.

Complete Bony Impactions:

There is NO space for the tooth to erupt. A complete bony impacted tooth is covered by gum and bone, remaining totally below the gum and jawbone. Dr. Brousell is specially trained and equipped to perform the specialized surgical and anesthetic techniques necessary to remove your impacted teeth in complete comfort.

What is The Best Age To Have Wisdom Teeth Removed?

In some patients it is as early as 11 or 12, whereas in others it may not be until 17 or 18. You will heal faster, more predictably and have fewer complications when you have your wisdom teeth removed during your teens and early twenties. Studies have shown that patients recover uneventfully more often when their teeth are removed before problems and infections develop.

Dr. Brousell and his staff will see you for a consultation to determine if removing your wisdom teeth is advisable. They will discuss the reasons why they are recommending the surgery and removal is recommended and will discuss your treatment options. They will also discuss the consequences of treatment and non-treatment. You can be assured that Dr. Brousell and his staff will answer any and all questions you and your family may have.

Why Should I Have Impacted Teeth Removed?

All impacted teeth are considered to be an abnormal condition and prudent care requires either removal, exposure, repositioning or in some cases long-term observation.

If you do not have enough room into which your third molars can erupt, your wisdom teeth are impacted. A number of problems may arise. These problems include but are not limited to infection, damage to the adjacent teeth, gum disease, damage to the jawbone by cyst or tumor formation, and possibly crowding of the front teeth. These problems tend to occur with increasing frequency after 25 - 30 years of age.

Even if you do not have an active problem when you see Dr. Brousell, the reason you are being referred for evaluation and possible surgery is to prevent long-term dental problems. It is much better for you to have your wisdom teeth removed before any problems occur.

What If I Don't Have Them Removed in My Teenage Years?

If you do not have your impacted wisdom teeth removed in your teenage years or early twenties, more extensive problems may arise later in life. When it is necessary to remove impacted wisdom teeth in your late twenties, thirties, forties or beyond, it is usually more difficult for you. The post-operative course can be prolonged and there is a higher complication rate. Also, it is likely that you will have damage to bone and your other teeth if you wait until later in life to have your wisdom teeth removed.

Treating these complications later in life is more difficult and less predictable.

Completely impacted wisdom teeth in patients over thirty 25% do not have to be removed in all cases. Periodic observation after an initial consultation with Dr. Brousell is treatment enough if you have no complaints or symptoms and there is no evidence of a disease process. In cases like this, it may be advisable to wait until a localized problem develops. At that time, treatment would be advisable. Dr. Brousell and his staff will discuss and help weigh your treatment options.

What Happens On The Day They're Removed?

Most people want to be asleep when their Wisdom teeth are removed. Dr. Brousell and his staff are fully trained and licensed to have you go to sleep for your surgery. Dr. Brousell will provide you with appropriate anesthesia options at your consultation. All your questions will be answered about what option is best for you.

On the day of your procedure, you will take medications to help minimize post-operative pain and swelling. A parent or responsible adult must accompany you to the office and stay with you the rest of the day. Your procedure will take about an hour and you will probably be in the office for 1 1/2 -2 hours. Recent advances in medicine and technology allow patients to have their wisdom teeth removed in comfort, followed by rapid healing and minimal post-operative discomfort. State of the art sterilization and infection control techniques are used at all times, including the use of sterile water for irrigation during surgery.

Dr. Brousell's surgical assistants will review your post-operative instructions. When you leave the office you will be comfortable and drowsy. Most patients prefer to go home and rest with no other physical or scholastic activities planned for a few days.

All outpatient surgery is performed under appropriate anesthesia to maximize your comfort. Dr. Brousell has the training and experience to provide a variety of anesthetic options depending on your individual needs. These services are provided in an environment of optimum safety, utilizing modern monitoring equipment and staff experienced in anesthesia techniques. Dr. Brousell, the Surgical Care Team, and the office facilities are evaluated by the New Jersey State Board of Dentistry on a regular basis. Dr. Brousell is re-certified in Advanced Cardiac Life Support every 2 years, as required. Every staff member in Dr. Brousell’s office has a current CPR Certification by the American Heart Association.

After the procedure, we want you to take it easy for a few days. Follow your post-operative instructions closely. There are carefully designed to make you comfortable during the first few days following your procedure.

With any medical procedure, there can be unexpected results. These can include delayed healing, infection and post-operative numbness or tingling in your lip, chin, or tongue. Dr. Brousell will review relevant risks, complications and possible adverse post-operative events with you. All your questions will be answered at your consultation.

What Does It Cost—And Does Insurance Cover It?

Because of the different types of impacted wisdom teeth, it is not possible to give you a realistic estimate of what our services will cost until your x-rays are received reviewed and the best anesthetic option determined. Every insurance company has a different policy regarding the extent of coverage for a given surgical procedure. Dr. Brousell’s Patient Care Coordinators will be happy to help you work with your insurance company.