Bill Klaproth: This is OMS Voices, an AAOMS podcast. I’m Bill Klaproth. And with me is Dr. Caitlyn McGue, who is here to discuss recovering from wisdom teeth surgery. Dr. McGue, thank you for being here.  

Dr. Caitlyn McGue: Thank you for having me. Nice to meet you guys. 

Bill Klaproth: Yeah, thank you so much. So, first of all, what are wisdom teeth?

Dr. Caitlyn McGue: So, wisdom teeth are basically the third set of molars. They are the last teeth to come in inside the mouth. Well, theoretically, they’re the last teeth to develop. They may not always come in. So that’s part of what we’ll be talking about today, I guess. But wisdom teeth are often impacted, and that’s why we often need to get them removed. 

Bill Klaproth: Why do we call them wisdom teeth? I’m just curious. 

Dr. Caitlyn McGue: Good question. So, wisdom teeth usually come in between the ages of 17 and 25. And at some point, that used to be called the “age of wisdom.” And that’s where that came from, not because they make you smarter by any means. 

Bill Klaproth: Well, you’re a historian, too. We’re learning so much already. I love it. So, when do they come in, and why do we have them? 

Dr. Caitlyn McGue: So, like I mentioned, they start to develop around the ages of 17 to 25. Although we definitely see variations in that. Sometimes people are younger, sometimes they’re older, and sometimes people are lucky and don’t even get all of them, or any of them. But they are kind of an old relic of a time when we used to need them. Obviously nowadays, most people don’t, and that’s why we often see them getting impacted or not fully coming into the mouth. 

Bill Klaproth: Do they always have to come out? 

Dr. Caitlyn McGue: Not always. We typically want to have a plan by the time the patient is 25, whether or not we’re planning to keep them or remove them. It seems that if they do fully erupt into the mouth and they are functional, oftentimes we can allow patients to hang onto those teeth. But we do tend to see later on, as patients get older or patients start to have problems with dexterity, that hygiene becomes a big issue and eventually patients often need those taken out, even if when they’re younger, they’re functional and no issues are happening. 

Bill Klaproth: So generally, they’ll cause problems if you don’t get them out? 

Dr. Caitlyn McGue: Typically, not always. You know, everyone’s different, and there are definitely cases where people will keep them for their lifetime. 

Bill Klaproth: Is it generally our teenage years when they come out? 

Dr. Caitlyn McGue: Typically, if they’re going to start to erupt, it will be kind of late teenage years, early twenties. Sometimes, like I said, a little bit later, sometimes a little bit earlier. But usually, like I was saying, we will have made a decision about whether or not we’re going to remove them or keep them by the time a patient is 25, just because patients tend to heal better and recover quicker when they’re younger. So, if we’re going to remove them, we try to do it when that healing is going to be at its best. 

Bill Klaproth: Absolutely. So, do you know ahead of time that these are going to have to come out, or is it symptomatic? When a person is feeling pain, like, “Uh oh, it’s time.” How do you judge that? 

Dr. Caitlyn McGue: That’s a good question, too. So ideally, we would want to get them out before a patient becomes symptomatic. Unfortunately, we will often see patients show up in the emergency room or coming in for urgent dental appointments because of pain, or in even worse case scenarios, infections that have led them to get swollen or have systemic symptoms like fever and nausea, and things that we don’t really want our patients to experience. So oftentimes, we’ll try to recommend getting them out before they become a problem, for everyone’s benefit. And again, in the setting of infection or pain or symptoms, it changes the recovery and the surgery. 

Bill Klaproth: So, you mentioned eruption of the tooth. Is that when it breaks the skin, or the gum, I should say? 

Dr. Caitlyn McGue: Exactly. So, erupting or coming into the mouth is basically when the tooth starts to come through the gums. And then if it’s “fully erupted,” that means it’s basically fully out through the gums, into where it should be in alignment with the other teeth. 

Bill Klaproth: Okay, got it. So, for a parent listening to this, what should a teen do to prepare in the days before the surgery to help have a smooth recovery? 

Dr. Caitlyn McGue: So, it really depends on how far out from your consultation appointment to your extraction appointment or your surgical appointment. If your presurgical or consultation appointment is weeks out, probably not going to need to make a lot of changes right at that point in time. But always listen to what your oral and maxillofacial surgeon is telling you. Follow their recommendations. That’s probably the most important piece of information. Sometimes oral surgeons will prescribe medications prior to the surgery appointment. If that’s the case, always recommend picking those up beforehand. Saves you time on the day of surgery. It’s one less stop you have to make on the way home. And you can kind of work out any problems that you may have with picking up those prescriptions beforehand as well, which can be really helpful for patients and parents on the day of surgery. 

Bill Klaproth: So, on the day of surgery, how should the teenager or child prepare? 

Dr. Caitlyn McGue: Again, most of it revolves around paying attention to what your oral and maxillofacial surgeon is telling you. Big things that I really think are important on the day of surgery though, are really adhering to the food and drink guidelines that your surgeon gives you, because depending on the type of anesthesia that you’re having, you may or may not be able to eat or drink anything the day of surgery and that’s really a big safety issue. And that’s why your surgeon is making those recommendations. Not because we’re mean, not because we’re worried about you having food in your teeth. It really comes down to safety. So that’s one of the big things. The other one that we often talk about is medication management. There are certain medications that patients are taking at home that we will either recommend that they continue or that they discontinue on the day of surgery. And again, that comes down to safety issues. 

Bill Klaproth: Right. So then after wisdom tooth surgery, what’s the recovery like? What foods should a patient avoid, those types of things? 

Dr. Caitlyn McGue: So, recovery is obviously variable, depending on the person, the situation. But most patients are feeling back to normal in about a week or so. Some patients recover a lot quicker than that, but I would say usually a couple of days, maybe two to three days, you’re going to probably not feel up to doing a whole lot, and you should probably take it easy for that short period of time. I would recommend staying away from hard, sharp, poky foods. Anything that can kind of get down into where the teeth were taken out, we try to avoid those things, or if you have stitches, we want to make sure nothing’s going to get underneath those stitches. And then soft foods are obviously better for people, and that’s a comfort issue. And then I always recommend to my patients just avoid spicy foods. And again, not necessarily because it’s going to hurt anything, besides you feeling more uncomfortable. 

Bill Klaproth: Dr. McGue, after surgery, are there other postsurgery instructions that my teen should know? 

Dr. Caitlyn McGue: Yes. So, I think some of the big ones include no smoking or no smoking in the first couple of days after surgery. 

Bill Klaproth: I mean, ideally, this person isn’t smoking anyways. Can I say that? This is a PSA. 

Dr. Caitlyn McGue: Exactly. I was going to say the same thing. As an oral and maxillofacial surgeon, I always recommend quitting smoking if you are a smoker. It’s obviously a much harder conversation and a much harder thing to do than to just say not to smoke and get someone to quit. But I usually will try to tell patients to avoid smoking for at least the first couple of days after surgery. 

Bill Klaproth: Does that include vaping, too? Because a lot of teens and people in their early twenties vape, is that the same thing, too? 

Dr. Caitlyn McGue: Same thing, yeah. Avoid vaping, avoid e-cigarettes, avoid any type of tobacco or smoking products, I guess is the best way to say it now because all of that creates a change in the environment in the oral cavity, it changes the negative pressure that we create, and it’s the same thing with straws, for different reasons. Tobacco and cigarette use has some other chemicals in it that can affect healing, but also the negative pressure, the actual act of sucking on a cigarette or sucking on a straw can dislodge blood clots, and that’s how you end up with what people call a dry socket. Dry sockets are just really painful. It’s not an infection, it’s not something that needs treatment, it’s just very uncomfortable until that heals, and so we try to recommend avoiding those things to help minimize the risk of getting something like a dry socket. 

Bill Klaproth: So, those things don’t promote healing, basically? Smoking and straws? 

Dr. Caitlyn McGue: Straws might not significantly affect healing, but the negative suction in the mouth can dislodge blood clots, and that can change how things heal, not necessarily if they will or won’t. Tobacco smoking can definitely affect healing. Alcohol can also definitely affect healing. So, I recommend avoiding alcohol for the first few days after surgery. 

Bill Klaproth: So, if you’ve got a kid who smokes and drinks White Claws through a straw, that’s real bad. 

Dr. Caitlyn McGue: And obviously for some parents, we’re happy that they’re able to have these conversations with their kids, but for all the teenagers that maybe are listening to this and don’t want to share that information with their parents, maybe avoid those things. Or for patients who are a little older and doing that on their own, we would recommend avoiding those things. 

Bill Klaproth: Do the stitches then typically dissolve on their own? 

Dr. Caitlyn McGue: Yes, most of us use dissolvable stitches. One, for patient comfort and two, for ease of care. A lot of times, patients may not have any issues and may not feel like they want to come back for a follow-up appointment, and that’s one less reason that they would need to do that. 

Bill Klaproth: Do people generally come back for a follow-up? 

Dr. Caitlyn McGue: It really depends on the provider, it depends on the patient. Often either patients follow up in a week, or if things went really straightforward, and we don’t expect the patient to have any issues, we can tell the patient to just give us a call if they’re having any questions or concerns. Typically when we start to see those is about a week out and that’s often why we will give that one-week follow-up if we’re going to do a follow-up appointment. 

Bill Klaproth: That sounds great. So, thank you so much for talking to us about this. As we wrap up, anything else about recovering from wisdom teeth surgery?

Dr. Caitlyn McGue: Sure. Just a couple of things that I think are important to keep in mind. Sometimes patients are concerned because they’re seeing some bleeding from the mouth, but it’s really very normal to have some slight oozing. I usually will tell my patients blood-tinged saliva for maybe the first 24 to 48 hours, that’s pretty normal and not something to be overly concerned about. Pain and swelling is fairly normal, that’s why you’re often going to be recommended to take either some over-the-counter pain medications, or potentially prescribed pain medications again to help with the pain. Ice can be very helpful for swelling. And we do want you to continue your oral hygiene during those periods as well, so making sure to continue brushing and flossing, using any recommended antibiotic mouth rinses or warm saltwater rinses that your surgeon may recommend. Because what I like to tell people is the best thing you can do to minimize your risk of infections and complications post-operatively or after surgery is to keep your mouth clean, so be gentle but stay hygienic.

Bill Klaproth: Absolutely. Well, Dr. McGue, thank you so much for your time, we appreciate it.

Dr. Caitlyn McGue: Thank you so much.

Bill Klaproth: That was Dr. Caitlyn McGue. For more information and our full podcast library, visit MyOMS.org. If you found this podcast helpful, please share it on your social channels and don’t forget to subscribe. Thanks for listening.