Wisdom teeth, also called third molars ( 3rds ), are the four back teeth that generally erupt between the ages of 17 and 21. Having your wisdom teeth removed is a procedure that helps to protect oral health. Nearly 85 percent of people have had their wisdom teeth removed by adulthood.
Those who do not remove their wisdom teeth will want to schedule routine dental appointments as the potential for developing problems with wisdom teeth health increases with age.
In this segment Kevin Rieck,DDS, discusses why some people may need to have their wisdom teeth removed and what they can expect from the procedure.
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Wisdom Teeth: Removal and Recovery
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Learn more about Kevin Rieck, DDS, MD
Kevin Rieck, DDS, MD, FACS, Nebraska Oral & Facial Surgery
Kevin Rieck, DDS, MD is an oral surgeon at Nebraska Oral & Facial Surgery.Learn more about Kevin Rieck, DDS, MD
Transcription:
Wisdom Teeth: Removal and Recovery
Melanie Cole (Host): Your mouth goes through many changes in your lifetime. One major dental milestone that usually takes place between the ages of 17 and 21 or so; is the appearance of your third molars. Historically, these teeth have been called wisdom teeth because they come through at a more mature age. My guest today, is Dr. Kevin Rieck. He is an oral and maxillofacial surgeon at Nebraska Oral and Facial Surgery. Welcome to the show Dr. Rieck. So, what are wisdom teeth?
Dr. Kevin Rieck, DDS, MD, FACS (Guest): Thanks Melanie. Wisdom teeth are part of the normal dental development of permanent teeth. We have 20 baby teeth and 32 permanent teeth. These are the last ones that come into position and as you mentioned, it is usually in the late teens or early twenties in sort of the age of wisdom.
Melanie: Okay, so does everybody get them?
Dr. Rieck: Most patients or most people will develop third molars, but interestingly enough, they can be congenitally missing. Some patients don’t develop all of them or they can have variations where they may develop just the top ones or the bottom ones or left or right. There are a number of variations that are possible. In addition to that, patients can also develop extra ones, so some patients can have multiple ones in one area or duplicates in different areas and such, so, there is a lot of variability that can occur with them.
Melanie: So, what are some of the reasons for having them removed? I mean we don’t remove others of our teeth unless they are impacted or something. Why these?
Dr. Rieck: That’s a great question and one that patients frequently ask. Generally, there isn’t adequate room for third molars or wisdom teeth to erupt fully into the mouth. This has to – this frequently leads to problems with localized inflammation or pain. Patients have problems with hygiene in those areas and can develop localized infections. Periodontal problems can start to develop where they develop bone loss associated with those teeth and then subsequently the adjacent teeth. Because they are hard to keep clean; frequently dental decay starts to set in and can compromise certainly that tooth as well as adjacent teeth, frequently associated with the root of the adjacent second molar teeth. When the wisdom teeth remain impacted, where you can’t see them inside the mouth at all sort of hidden underneath the tissue and or bone; they can develop different types of cysts or tumors or other types of pathology can be associated with them. And then removal of those scenarios can be much more involved surgical procedures.
Melanie: So, who should remove them? If someone knows that their child has wisdom teeth or they have some that were never removed, who do you go see?
Dr. Rieck: Well, typically, well in general, wisdom teeth can be removed by a general dentist or other dental professionals. Most, however, should be done by an oral and maxillofacial surgeon. Our training is extensive for six years after dental school where we get surgical training in all aspects of oral and facial surgery and extensive experience and certification with anesthesia as well. Having those types of procedures performed in our offices provides patients the safest and most comfortable option to perform the surgical procedure for them.
Melanie: So, Dr. Rieck, speaking of comfort, what is it like to have your wisdom teeth removed? Back in the day and many years ago, people used to think of this as quite a scary, painful thing. It is probably not that way anymore, is it?
Dr. Rieck: It’s not really. Most of our patients still have some trepidation about having the procedure done but fortunately, with modern advances in anesthetics and surgical instrumentation, it has become much kinder and much easier for patients. One thing that hasn’t really changed is anatomy and so the actual surgical anatomy is all the same, but we are able to provide patients now a very comfortable experience with this during the surgical procedure.
Melanie: So, speak about the procedure a little bit. What’s involved?
Dr. Rieck: Most patients come for the procedure and it varies a little bit regarding having a consultation ahead of time and then scheduling the procedure or doing the consultation and having the procedure the same day. We do a lot of that later aspect, just as a convenience for patients since it is difficult for people with their schedule and things nowadays to come multiple times. Most of the procedures that we do are done under intravenous anesthesia. So, patients would come to the office with an escort. They would have had nothing to eat or to drink for six to eight hours ahead of time and then we discuss the procedure with them and the associated risks etc. They come back to one of the surgical procedure rooms and a number of different monitors are put on. We use the same exact monitors that are utilized in the hospital setting for all of the anesthetic cases there. The patients have some intravenous anesthesia. Their eyes close, they kind of drift off to sleep and then once they are comfortable like that, they still receive a local anesthetic. The bonus of that is that they don’t feel any of local anesthetic injections. Typically, there is going to be ten to twelve injections for a full set of wisdom teeth, so it is nice not to have to experience any of that. The procedure varies in length from twenty to thirty minutes on average and then once the patients are finished, they will come to the recovery area and are recovered by our nursing staff.
Melanie: So what is recovery like and do they have pain for many days? Do they go home with pain medication? What happens after?
Dr. Rieck: After the procedure, patients will be numb for several hours. We discuss with them postoperative wound care, diet, medications and things. We typically would have patients on some type of an anti-inflammatory medication like ibuprofen and then may include also a mild narcotic. We typically have them alternate those medicines on a scheduled basis and that way they are not having peaks and valleys in regard to their pain management. It does a very nice job for pain control with that. Patients can expect to have some focal discomfort for a couple of days, but usually after a couple of days, their pain is very under control and aren’t requiring any extensive pain medications. Swelling does occur with this procedure frequently and that peaks around the second or third day as well and then kind of tapers down from there. As a result of that, the patient’s diet may be affected where they might not be able to open as wide as normal and so can’t have a standard diet. Although, otherwise we don’t have significant restrictions on their diet postoperatively.
Melanie: So, then once these – would you remove them all if they have more than one, you would do it all at the same time or do you do one at a time?
Dr. Rieck: Most typically, we do them all at the same time. I believe that’s the best way to manage this. It doesn’t take significantly longer to do them all versus the single one and then patients have just one time of having a recovery period, one time of taking medications, etc.
Melanie: So, wrap it us for Dr. Rieck, with your best advice about wisdom teeth and keeping our teeth healthy and our mouths healthy and what you want people to know about wisdom teeth and their removal.
Dr. Rieck: Well, yes exactly. I think it’s important that everyone have them evaluated. Clearly, not every individual needs to have them all removed. There are some individuals where the wisdom teeth erupt and can become functional teeth just like your other teeth. But frequently, there isn’t quite enough room and they can and do cause problems. They are easier to remove when the patients are younger than when you get to be in your more adult years and can more difficult at that time, the recovery can be more complicated. So, we recommend the patients monitor their oral health with their general dentist at their frequent visits and then certainly if any pathology or any symptoms are developing with the wisdom teeth, then clearly having a referral and evaluation further is indicated.
Melanie: Thank you so much for being with us today, Dr. Rieck. It is great information. People always have questions about wisdom teeth and if you have questions about your wisdom teeth, you can call 402-327-9400. That’s 402-327-9400. Or you can go to nebraskaoralfacialsurgery.com. That’s nebraskaoralfacialsurgery.com. This is Brian Health Radio, I’m Melanie Cole. Thanks so much for listening.
Wisdom Teeth: Removal and Recovery
Melanie Cole (Host): Your mouth goes through many changes in your lifetime. One major dental milestone that usually takes place between the ages of 17 and 21 or so; is the appearance of your third molars. Historically, these teeth have been called wisdom teeth because they come through at a more mature age. My guest today, is Dr. Kevin Rieck. He is an oral and maxillofacial surgeon at Nebraska Oral and Facial Surgery. Welcome to the show Dr. Rieck. So, what are wisdom teeth?
Dr. Kevin Rieck, DDS, MD, FACS (Guest): Thanks Melanie. Wisdom teeth are part of the normal dental development of permanent teeth. We have 20 baby teeth and 32 permanent teeth. These are the last ones that come into position and as you mentioned, it is usually in the late teens or early twenties in sort of the age of wisdom.
Melanie: Okay, so does everybody get them?
Dr. Rieck: Most patients or most people will develop third molars, but interestingly enough, they can be congenitally missing. Some patients don’t develop all of them or they can have variations where they may develop just the top ones or the bottom ones or left or right. There are a number of variations that are possible. In addition to that, patients can also develop extra ones, so some patients can have multiple ones in one area or duplicates in different areas and such, so, there is a lot of variability that can occur with them.
Melanie: So, what are some of the reasons for having them removed? I mean we don’t remove others of our teeth unless they are impacted or something. Why these?
Dr. Rieck: That’s a great question and one that patients frequently ask. Generally, there isn’t adequate room for third molars or wisdom teeth to erupt fully into the mouth. This has to – this frequently leads to problems with localized inflammation or pain. Patients have problems with hygiene in those areas and can develop localized infections. Periodontal problems can start to develop where they develop bone loss associated with those teeth and then subsequently the adjacent teeth. Because they are hard to keep clean; frequently dental decay starts to set in and can compromise certainly that tooth as well as adjacent teeth, frequently associated with the root of the adjacent second molar teeth. When the wisdom teeth remain impacted, where you can’t see them inside the mouth at all sort of hidden underneath the tissue and or bone; they can develop different types of cysts or tumors or other types of pathology can be associated with them. And then removal of those scenarios can be much more involved surgical procedures.
Melanie: So, who should remove them? If someone knows that their child has wisdom teeth or they have some that were never removed, who do you go see?
Dr. Rieck: Well, typically, well in general, wisdom teeth can be removed by a general dentist or other dental professionals. Most, however, should be done by an oral and maxillofacial surgeon. Our training is extensive for six years after dental school where we get surgical training in all aspects of oral and facial surgery and extensive experience and certification with anesthesia as well. Having those types of procedures performed in our offices provides patients the safest and most comfortable option to perform the surgical procedure for them.
Melanie: So, Dr. Rieck, speaking of comfort, what is it like to have your wisdom teeth removed? Back in the day and many years ago, people used to think of this as quite a scary, painful thing. It is probably not that way anymore, is it?
Dr. Rieck: It’s not really. Most of our patients still have some trepidation about having the procedure done but fortunately, with modern advances in anesthetics and surgical instrumentation, it has become much kinder and much easier for patients. One thing that hasn’t really changed is anatomy and so the actual surgical anatomy is all the same, but we are able to provide patients now a very comfortable experience with this during the surgical procedure.
Melanie: So, speak about the procedure a little bit. What’s involved?
Dr. Rieck: Most patients come for the procedure and it varies a little bit regarding having a consultation ahead of time and then scheduling the procedure or doing the consultation and having the procedure the same day. We do a lot of that later aspect, just as a convenience for patients since it is difficult for people with their schedule and things nowadays to come multiple times. Most of the procedures that we do are done under intravenous anesthesia. So, patients would come to the office with an escort. They would have had nothing to eat or to drink for six to eight hours ahead of time and then we discuss the procedure with them and the associated risks etc. They come back to one of the surgical procedure rooms and a number of different monitors are put on. We use the same exact monitors that are utilized in the hospital setting for all of the anesthetic cases there. The patients have some intravenous anesthesia. Their eyes close, they kind of drift off to sleep and then once they are comfortable like that, they still receive a local anesthetic. The bonus of that is that they don’t feel any of local anesthetic injections. Typically, there is going to be ten to twelve injections for a full set of wisdom teeth, so it is nice not to have to experience any of that. The procedure varies in length from twenty to thirty minutes on average and then once the patients are finished, they will come to the recovery area and are recovered by our nursing staff.
Melanie: So what is recovery like and do they have pain for many days? Do they go home with pain medication? What happens after?
Dr. Rieck: After the procedure, patients will be numb for several hours. We discuss with them postoperative wound care, diet, medications and things. We typically would have patients on some type of an anti-inflammatory medication like ibuprofen and then may include also a mild narcotic. We typically have them alternate those medicines on a scheduled basis and that way they are not having peaks and valleys in regard to their pain management. It does a very nice job for pain control with that. Patients can expect to have some focal discomfort for a couple of days, but usually after a couple of days, their pain is very under control and aren’t requiring any extensive pain medications. Swelling does occur with this procedure frequently and that peaks around the second or third day as well and then kind of tapers down from there. As a result of that, the patient’s diet may be affected where they might not be able to open as wide as normal and so can’t have a standard diet. Although, otherwise we don’t have significant restrictions on their diet postoperatively.
Melanie: So, then once these – would you remove them all if they have more than one, you would do it all at the same time or do you do one at a time?
Dr. Rieck: Most typically, we do them all at the same time. I believe that’s the best way to manage this. It doesn’t take significantly longer to do them all versus the single one and then patients have just one time of having a recovery period, one time of taking medications, etc.
Melanie: So, wrap it us for Dr. Rieck, with your best advice about wisdom teeth and keeping our teeth healthy and our mouths healthy and what you want people to know about wisdom teeth and their removal.
Dr. Rieck: Well, yes exactly. I think it’s important that everyone have them evaluated. Clearly, not every individual needs to have them all removed. There are some individuals where the wisdom teeth erupt and can become functional teeth just like your other teeth. But frequently, there isn’t quite enough room and they can and do cause problems. They are easier to remove when the patients are younger than when you get to be in your more adult years and can more difficult at that time, the recovery can be more complicated. So, we recommend the patients monitor their oral health with their general dentist at their frequent visits and then certainly if any pathology or any symptoms are developing with the wisdom teeth, then clearly having a referral and evaluation further is indicated.
Melanie: Thank you so much for being with us today, Dr. Rieck. It is great information. People always have questions about wisdom teeth and if you have questions about your wisdom teeth, you can call 402-327-9400. That’s 402-327-9400. Or you can go to nebraskaoralfacialsurgery.com. That’s nebraskaoralfacialsurgery.com. This is Brian Health Radio, I’m Melanie Cole. Thanks so much for listening.