Pearls of Wisdom

When it comes to extracting wisdom teeth, younger is often better, experts say

by Gail Kent | Nov 1, 2022

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With age comes wisdom—and wisdom teeth. When they need to come out, it’s best to get them out when young, experts say.

​Wisdom teeth, the third molars, are the last permanent teeth to appear, usually between the ages of 17 and 25, according to the Mayo Clinic. Experts say between 80 and 90% of young adults require extraction due to “impaction” or failure to grow properly, causing pain, infection and other dental problems.

“If the wisdom teeth have erupted fully above the gum tissue and the individual is able to keep them clean and free of cavities, and the wisdom teeth are occluding with another tooth, the patient is more likely to keep them,” says William “Tad” Coker, DDS, of Coker Dental in Newport News. “If the wisdom tooth is not erupted and is located in such a way that there are high risks with taking it out, the decision may be made to leave it in place.” 

Dentists typically refer their patients to oral surgeons for a wisdom tooth consultation, Coker says. They can expect the oral surgeon to discuss the advantages and disadvantages of removing them, such as the risk of nerve damage, damage to the bone surrounding the wisdom teeth, and—in the case of upper teeth—potential damage to the sinus cavity.

“Although many patients needing wisdom teeth removal are referred by their dentist, many of our patients come directly to our practice for an evaluation,” says Shaun Rai, DMD, of Rai Oral Surgery and Dental Implants in Virginia Beach. “Patients should trust their care for management of their wisdom teeth to a board certified oral and maxillofacial surgeon.”

Rai says an oral surgeon will first take a full medical history and appropriate x-rays of the patient and determine if removal is necessary. If so, the surgeon will then decide whether the removal will be surgical, involving cutting them out, or if a non-surgical extraction can be performed.

“Based on these factors, the oral surgeon will discuss anesthesia or sedation options, along with the risks and benefits,” Rai explains. Options range from local anesthesia—being awake—with or without nitrous oxide to oral or IV sedation.

After surgery, patients are provided written and verbal instructions, Coker says. “The patient may be provided with ice packs to help with swelling, and if necessary, antibiotics and the necessary pain medications.” Smoking is discouraged because it affects the healing process and can cause severe pain from a dry socket. 

Coker notes the patient may be given a device to irrigate the extraction sites to help with cleaning out food particles and told to rinse with salt water the next day. “It is also vital the day after the procedure for the patient not to use a straw or spit, since this creates suction forces that hinder the blood clotting process.”

Both Coker and Rai say dental providers today are very cautious about prescribing addictive medications such as opiates for pain. 

​“Rai Oral Surgery is an opiate reduction practice,” Rai explains. “In light of the opiate crisis in our country, we are having more conversations with our patients and their guardians about the risks and benefits of using postoperative opiate pain medication.”

​Most patients are comfortable and can manage pain successfully using non-opiates such as Tylenol and prescription-strength NSAIDs such as Motrin, Rai says.

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