Bill Klaproth (host): This is OMS Voices, an AAOMS podcast. I’m Bill Klaproth, and with me is Dr. Nicole Eisenberg, who is here to discuss using digital imaging for wisdom teeth management. Dr. Eisenberg, thanks for being here. 

Dr. Nicole Eisenberg: Hey, thanks so much for having me. 

Bill Klaproth (host): You bet. This is an important topic because I’m sure you get a lot of questions on it. So first off, let’s start there. What are wisdom teeth, and when do they come in, and why do people have them? 

Dr. Nicole Eisenberg: Good question. So, wisdom teeth, which we also call third molars, are the last teeth to develop and come into the mouth. They usually come into the mouth between the ages of 17 and 25, which is why they’re sometimes referred to as wisdom teeth. We can see how they’re developing by the use of X-rays and by clinical exam. 

Bill Klaproth (host): So, the third molar. So, when you hear that, you’re like, "Oh yeah, it sounds like those shouldn’t be there." But why is it so important then to monitor wisdom teeth and diagnose when it’s time for removal? 

Dr. Nicole Eisenberg: Yeah, so a lot of people don’t have enough room or length in their jaws for these teeth to come in and be good, healthy, useful teeth. So, we try to do an assessment either clinically or with X-rays to determine if these teeth are going to be able to come in and be good, healthy teeth, or if we might need to take them out before they cause a problem. 

Bill Klaproth (host): When you say cause a problem, what are some of the problems that can happen if wisdom teeth are left in? 

Dr. Nicole Eisenberg: So, some of the problems that might occur would be crowding of the teeth, swelling, infection, sometimes even cysts and tumors can develop around where the teeth are coming in, and we want to try to prevent that from happening. 

Bill Klaproth (host): So, removing wisdom teeth, I mean, that’s one of the most common things, or I don’t want to say one of the most common things, but that is a common thing you do, is that correct?

Dr. Nicole Eisenberg: It is. It’s very common.

Bill Klaproth (host): So, Dr. Eisenberg, how should patients work with their dentist to determine when it’s time to make an appointment with an OMS? 

Dr. Nicole Eisenberg: So, a lot of times, a dentist will do a comprehensive dental exam. They will look at the teeth, they will take X-rays and imaging to see what’s happening, and a lot of time on those images, they will see these wisdom teeth or third molars developing and decide it’s time to see an oral surgeon and see if these teeth need to be taken out or not. 

Bill Klaproth (host): Okay, so then. You just mentioned digital imaging. What are the different types of digital imaging that can be used? 

Dr. Nicole Eisenberg: So, dental imaging we normally use are panorex X-rays, which is a common type of X-ray that’s used to give a two-dimensional broad view of the jaws, teeth and facial bones. And then we can also get a cone beam CT or CBCT, where we can see three-dimensional imaging of the teeth and the jaws and give a much more detailed description of the tooth or how it’s developed and where it’s near to other structures such as nerves and the sinuses. 

Bill Klaproth (host): Right. So then, how does an OMS use the X-rays a dentist provides?

 Dr. Nicole Eisenberg: Yeah, so a lot of times we will get an X-ray, typically a panorex image sent to us so we can get a good idea of what the teeth may look like, and then if we feel like they may be near some of these structures such as the sinus or the nerve or we want to get a little bit more definitive look at where the tooth is in the bone, we can get the CBCT or the cone beam CT to look at in three dimensions. 

Bill Klaproth (host): Okay, so you’re getting a well-rounded view then of exactly what needs to be done, is that right? 

Dr. Nicole Eisenberg: Absolutely. 

Bill Klaproth (host): So, then how closely do you work with the dentist? Can you tell us more about the relationship, how a dentist and an OMS work in tandem to ensure comprehensive care? 

Dr. Nicole Eisenberg: Absolutely. Oral surgeons usually rely on general dentists by referring patients that have had a screening exam and seen that wisdom teeth or other teeth may need to be extracted. They will then send the patient with an X-ray image for us to review, and then we can decide do we need more enhanced imaging such as a CBCT. We talk to the patient more in-depth about the risks and the benefits. And then how that surgery is going to be accomplished. 

Bill Klaproth (host): Right, so you’re working together then to put together the best plan for that individual person. Do you ever get questions, or do parents worry about too many X-rays? Should a patient be concerned about radiation at all, especially if a second X-ray is needed? 

Dr. Nicole Eisenberg: Those are always great questions, and we always welcome questioning patients or parents of patients. The radiation that we use for dental imaging, including the CBCT, is very, very low. It’s very safe, and most people get more radiation from being outside from the sun than they do from our imaging, so they’re very safe. 

Bill Klaproth (host): So, you talked about what happens if a molar is not treated. Does that happen often where you see a 30-year-old, a 40-year-old where the molar wasn’t extracted and is now causing real problems? 

Dr. Nicole Eisenberg: Unfortunately, I do see that, and what happens is it ends up causing a cavity or infection or bone loss around the second molar or the tooth in front of the wisdom tooth. And if we don’t catch it in time, the patient unfortunately loses both the second molar and the wisdom tooth, and as we know, molars are our force of chewing, and losing a molar can be a big complication and problem for patients. 

Bill Klaproth (host): Yeah, I imagine that it’s got to be tough, and I would imagine at that point it’s probably more expensive to go in when a person is an adult, in their 30s, 40s, later years that didn’t get the molar out earlier. I would imagine it’s a more costly, more invasive procedure. Is that right? 

Dr. Nicole Eisenberg: Absolutely. We have greater risks of having complications such as longer duration of pain, more swelling. We have less bone fill where the teeth are taken out. So all the complications of normal surgery are probably doubled or tripled when you’re older trying to get these teeth out. 

Bill Klaproth (host): And what are the telltale signs that a young adult needs to go in to see an OMS about potential impacted wisdom teeth? Is there a sign or a symptom that people should be looking out for? How do you know when it’s time? 

Dr. Nicole Eisenberg: I generally like to recommend before the age of 25 at least getting an assessment by your general dentist, probably a panoramic dental X-ray to look at where those wisdom teeth are. And then if the general dentist feels like an oral surgeon needs to look at the teeth, then a consultation with us would be appropriate. 

Bill Klaproth (host): Right. I know we’ve been talking about X-rays and imaging. How has technology really helped you when diagnosing impacted molars and the subsequent extraction? Can you tell us how technology has improved over the years? 

Dr. Nicole Eisenberg: Absolutely. So, the cone beam CT or CBCT allows us to take these images in our office. We used to have to have them done in a hospital under a big expensive CT image. Now there are lower doses and in smaller areas so that we can focus on these wisdom teeth or other areas in the jaws. I can look at it from the axial, sagittal and coronal imaging so I can get a really three-dimensional view, and I know before I do surgery exactly where that tooth is located, where the roots are, if it’s going to be near the nerve of the tooth. At that point, I may have a conversation with the patient that’s more in-depth about the risk of having some potential numbness or problems from where that root is near to the nerve. 

Bill Klaproth (host): And I would imagine this helps with extraction as well? 

Dr. Nicole Eisenberg: It does. We can do better planning. We know exactly where we’re going. We can almost do a virtual surgery before because we can see it on these images and not just go into a patient and do surgery. 

Bill Klaproth (host): Well, it’s good to know that these technological advances, the use of digital imaging for wisdom teeth certainly has improved, and it’s certainly aiding in the diagnosis and the extraction of these impacted wisdom teeth. Dr. Eisenberg, this has been really fascinating and informative. Anything you want to add before we wrap up? 

Dr. Nicole Eisenberg: I appreciate the time. Thank you so much. 

Bill Klaproth (host): Oh, you’re very, very welcome. And we appreciate your time. And once again, that is Dr. Nicole Eisenberg. For more information and the full podcast library, please visit MyOMS.org. And if you found this podcast helpful, please share it on your social channels. And don’t forget to subscribe. Thanks for listening.