My first exposure to wisdom teeth was actually my own. My father, Dr. Clyde F. Hurst, was a dentist and he removed mine for me. His technique was to do one side at a time and just use local anesthetic. I had one side done one week and then a couple of weeks later, the other side. Everything went well with me. I didn’t feel anything going through the procedures and recovered was non evenful. He had developed his technique over the years and was very good at it. At that time sedation and general anesthetic were becoming more popular with tooth extraction so when I came from dental school and started working with him, I added the sedation component to the procedure.

In dental school, along with the regular rotations, I did extra rotations at the LA county hospital to get more experience with wisdom tooth extraction and general oral surgery. That was a good stepping off point when I came to work with my father for my first eleven years of practice. Wisdom teeth extractions were and still are one of my favorite things to do. I took and still take extra courses on all aspects of wisdom teeth extraction and related subjects. Over the years I have developed a system of taking out wisdom teeth that I feel works very well and that the patients have been very satisfied with. For most patients we use local anesthetic and sedate them with oral medications. This has the effect of sedation, relaxation, and forgetting the procedure. The patient is numb for several hours after leaving and by the time everything has worn off the main discomfort has dissipated and they are fairly comfortable. Some people will only need to use one or two of their pain pills. Some have not used any.

Some patients don’t want to be sedated and we just use local anesthetic like when I had mine done and this still works very well also. We can also add nitrous oxide gas to the procedure which helps them “float” as it is described. But the effects of relaxing and forgetting the procedure are not there as with sedation.

I am not in a rush to get done when I do the extractions. It is not a race to see how fast I can do it. I like to take my time and be exact in every aspect. There is not the need do get done quickly as when a person is under a short acting general anesthetic or IV sedation.

Another aspect that I feel is much different than most is the fact that I treat a dry socket before it happens. Some people do not heal quickly and the lower sockets do not line with healing tissue very fast and this is called a dry socket. Dry sockets can be very painful. This is more prominent with smokers and people who do not heal fast. The nationwide figure is that about 20% of all people get this. There is one thing I do that I learned from my father that makes a big difference. I pack the lower sockets after the surgery with a special gauze saturated with a medication that stops the dry socket from occurring or limits it’s occurrence. What I have found is that most patients come back after four to five days and I just remove the packs and they are feeling perfectly fine. There are a few who have a little ache or feeling present. On those I just take out the old pack and put a new one in. Usually they are fine in three to four days. It takes a little more time to do these packs but basically I have eliminated the dry socket problem from my office by doing this.

Since my first exposure to oral surgery I have had a great interest in it. The human body is an amazing creation and it is a great privilege to be able to perform operations such as wisdom teeth removal on individuals. I feel that my techniques of packing the sockets immediately after the extractions, taking my time, and using my method of sedation is an excellent mix that provides the patient with an ideal experience in the removal of their wisdom teeth.

Call and have us take a look at your wisdom teeth if you are having problems or have concerns. Mention this article and the exam will be on us.

Thanks.

Edwin S. Hurst, D.D.S.


Did you know
…wisdom teeth are the last set of molars. They usually come in when you are a teenager, though many start to come in when you are in your twenties.

Common Problems

Wisdom teeth can be very useful, but more often than not they are misaligned.

Wisdom teeth can come in facing many different directions. They sometimes come in horizontal. They can grow into the second molars. These misaligned wisdom teeth can damage your other teeth if they grow into them and can also cause damage to your nerves and jawbone.

Another common problem is when wisdom teeth become impacted. Impacted teeth have trouble coming through the gums. Sometimes wisdom teeth come through partially, which allows bacteria to grow around the tooth and gums. This can cause a lot of problems.

Many dentists recommend the removal of wisdom teeth. Most prefer to take them out before you have any problems. The surgery and recovery are easier if you get your wisdom teeth removed before you start having issues. Surgery and recovery are always easier the younger you are as well.

Don’t hesitate to contact us today at (435) 752-4533 if you have any questions about your wisdom teeth or would like to be seen.

Wisdom Tooth Extraction

Impacted wisdom teeth (or impacted third molars) are wisdom teeth which do not erupt fully into the mouth because there is not enough room for them to erupt in or they become caught under the tooth in front of them as seen in the x-ray above.

Impacted wisdom teeth are classified by their direction of impaction, their depth compared to the biting surface of adjacent teeth and the amount of the tooth’s crown that extends through gum tissue or bone. Impacted wisdom teeth can also be classified by the presence or absence of symptom and disease. Screening for the presence of wisdom teeth often begins in late adolescence when a partially developed tooth may become impacted. Screening commonly includes clinical examination as well as x-rays such as panoramic radiographs. The ideal time to remove a wisdom tooth is when the root in 2/3 developed. This allows for the crown to be close to the surface and the roots not completely developed. Roots that are completely developed are more difficult to remove, therefore Dr. Hurst likes to remove these before full development.

Infection resulting from impacted wisdom teeth can be initially treated with antibiotics, local debridement or soft tissue surgery of the gum tissue overlying the tooth. Over time, most of these treatments tend to fail and patients develop recurrent symptoms. The most common treatment is wisdom tooth removal. The risks of wisdom tooth removal are roughly proportional to the difficulty of the extraction. The prognosis for the second molar is good following the wisdom teeth removal with the likelihood of bone loss after surgery increased when the extractions are completed in people who are 35 years of age or older. A treatment controversy exists about the need for and timing of the removal of disease-free impacted wisdom teeth that are not causing problems. Supporters of early removal cite the increasing risks for extraction over time and the costs of monitoring the wisdom teeth that are not removed. Supports for retaining wisdom teeth cite the risk and cost of unnecessary surgery.

Classification

All teeth are classified as either, erupted (into the mouth),or impacted (failure to erupt due to blockage from another tooth). Wisdom teeth develop between the ages of 14 and 25, with 50% of root formation completed by age 16 and 95% of all teeth erupted by the age of 25. However, tooth movement can continue beyond the age of 25.

Impacted wisdom teeth are classified by the direction and depth of impaction, the amount of available space from tooth eruption, and the amount soft tissue or bone (or both) that covers them. The classification structure helps clinicians estimate the risks for impaction, infections and complications associated with wisdom teeth removal. Wisdom teeth are also classified by the presence (or absence) of symptoms and disease.

One review found that 11% of teeth will have evidence of disease and are symptomatic, 0.6% will be symptomatic but have no disease, 51% will be asymptomatic but have disease present and 37% will be asymptomatic and have no disease.

Impacted wisdom teeth are often described by the direction of their impaction (forward tilting, or mesioangular being the most common), the depth of impaction and the age of the patient as well as other factors such as pre-existing infection or the presence of pathology :143–144 Of these predictors, age correlates best with extraction difficulty and complications during wisdom teeth removal rather than the orientation of the impaction.

Impacted wisdom teeth without a communication to the mouth, that have no pathology associated with the tooth and have not caused tooth resorption on the blocking tooth rarely have symptoms.

When wisdom teeth communicate with the mouth, the most common symptom is localized pain, swelling and bleeding of the tissue overlying the tooth. This tissue is called the operculum and the disorder called pericoronitis which means inflammation around the crown of the tooth. Low grade chronic periodontitis commonly occurs on either the wisdom tooth or the second molar, causing less obvious symptoms such as bad breath and bleeding from the gums. The teeth can also remain asymptomatic (pain free), even with disease. As the teeth near the mouth during normal development, people sometimes report mild pressure of other symptoms similar to teething.

The term asymptomatic means that the person has no symptoms. The term asymptomatic should not be equated with absence of disease. Most diseases have no symptoms early in the disease process. A pain free or asymptomatic tooth can still be infected for many years before pain symptoms develop.

Causes

Wisdom teeth become impacted when there is not enough room in the jaws to allow for all of the teeth to erupt into the mouth. Because the wisdom teeth are the last to erupt, due to insufficient room in the jaws to accommodate more teeth, the wisdom teeth become stuck in the jaws, i.e., impacted. There is a genetic predisposition to tooth impaction. Genetics plays an important, albeit unpredictable role in dictating jaw and tooth size and tooth eruption potential of the teeth.

Pathophysiology

Impactions completely covered by bone and soft tissue have a low rate of clinically significant pathology – generally small cysts or uncommon tumors that form from the residual epithelial remnants around the crowns of the teeth.

Estimates of the incidence of cysts or other neoplasms (almost all benign) around impacted teeth average at 3%, usually seen in people under the age of 40. This suggests that the chance of tumor formation decreases with age.

For partially impacted teeth in those over 20 year of age, the most common pathology seen, and the most common reason for wisdom teeth removal, is pericoronitis or infection of the gum tissue over the impacted tooth. The bacteria associated with infections include Peptostretococcus, Fusobacterium, and Bacteroides bacteria. The next most common pathology seen is cavities or tooth decay. Fifteen percent of people with retained wisdom teeth exposed to the mouth have cavities on the wisdom tooth or adjacent second molar due to a wisdom tooth. The rate of cavities on the back of the second molar has been reported anywhere from 1% to 19% with the wide variation attributed to increased age.

In five percent of cases, advanced periodontitis or gum inflammation between the second and third molars precipitates the removal of wisdom teeth. Among patients with retained, asymptomatic wisdom teeth, roughly 25% have gum infections (periodontal disease). Teeth with periodontal pockets of greater than 5mm have tooth loss rates that start at 10 teeth lost per 1000 teeth per year at 5mm to a rate of 70 teeth lost per year per 1000 teeth at 11mm. The risk of periodontal disease and caries on third molars increases with age with a small minority (less than 2%) of adults age 65 years or older maintaining the teeth without caries or periodontal disease and 13% maintaining unimpacted wisdom teeth without caries or periodontal disease.

Crowding of the front teeth is not believed to be caused by the eruption of wisdom teeth.

Diagnosis
The diagnosis of impaction can be made clinically if enough of the wisdom tooth is visible to determine its angulation, depth, and if the patient is old enough that further eruption or uprighting is unlikely. Wisdom teeth continue to move into adulthood (20–30 years old) due to eruption and then continue some later movement owing to periodontal disease.

The wisdom teeth are assessed by clinical exam and x-rays.

Where unerupted wisdom teeth still have eruption potential several predictors are used to determine the chance of the teeth becoming impacted. The ratio of space between the tooth crown length and the amount of space available, the angle of the teeth compared to the other teeth are the two most commonly used predictors, with the space ratio being the most accurate. Despite the capacity for movement into early adulthood, the likelihood that the tooth will remain impacted.

Treatment

Wisdom teeth that are fully erupted and in normal function Sometimes need no special attention. But if they are difficult to clean then removal should be considered. Gum disease developing and wisdom teeth can severely effect adjacent healing teeth. It is more challenging, however to make treatment decisions with asymptomatic, disease-free wisdom teeth, i.e. wisdom teeth that have no communication to the mouth and no evidence of clinical or radiographic disease.

Wisdom teeth removal Wisdom teeth removal (extraction) is the most common treatment for impacted wisdom teeth. The absolute indications for removal are either the presence of disease or symptoms around the tooth or likelihood in the future.

The procedure, depending on the depth of the impaction and angle of the tooth, is to create an incision in the mucosa of the mouth, remove bone of the mandible or maxilla adjacent the tooth, section the tooth and extract it in pieces. This can be completed under local anaesthetic, sedation or general anaesthetic.

Recovery, risks and complications Most patients will experience pain and swelling (worst on the first post-operative day) then return to work after 2 to 3 days with the rate of discomfort decreased to about 85% by post-operative day 7 unless affected by dry socket: a disorder of wound healing that prolongs post-operative pain.

Prognosis

The prognosis for impacted wisdom teeth depends on the depth of the impaction. When they lack a communication to the mouth, the main risk is the chance of cyst or neoplasm formation which is relatively uncommon.

Once communicating with the mouth, the onset of disease or symptoms cannot be predicted but the chance of it does increase with age. Less than 2% of wisdom teeth are free of either periodontal disease or caries by age 65. Further, several studies have found that between 30% – 60% of people with previously asymptomatic impacted wisdom teeth will have them extracted due to symptoms or disease, 4–12 years after initial examination.

Extraction of the wisdom teeth removes the disease on the wisdom tooth itself and also appears to improve the periodontal status of the second molar, although this benefit diminishes beyond the age of 25.

If you would like to get a consultation about Wisdom teeth or are having problems give us a call today! Dr. Hurst your friendly Logan, Utah Dentist will be happy to help you!

435-752-4533

Surgical Instructions

Pre-Surgical Instructions For Sedated Patient

1 – Do Not eat or drink 8 hours prior to surgery appointment

2 – Do Not wear fingernail polish

3 – Wear comfortable clothing and a short sleeve shirt to allow placement of

Blood pressure cuff.

4 – Take sedation medication ½ hour prior to surgery appointment

5 – Have someone drive you to and from your surgery appointment

Post-Surgical Instructions for Sedation Patients

You must be accompanied by an adult for the next 24 hours.
You must not do anything requiring skill or coordination for the next 24 hours.
You can expect to be drowsy and will probably sleep for the next few hours.
The medication may cause you to forget most of the day.

• Eat lightly until the medication wears off. Avoid eating anything hard or with small pieces such as nuts, chips, hard bread, etc.

When the local anesthetic begins to wear off you may begin taking pain medications as needed. If we gave you a prescription take as directed.

General Post Surgery Instructions

Smoking: Do not smoke for at least 24 hours. Smoking may contribute to post-surgical infection and bleeding complications.

Bleeding: Some oozing is to be expected. If bleeding continues or is excessive, remove all blood clots from your mouth, place a tight ball of gauze or moist tea bag over the bleeding area, and apply firm pressure by biting your teeth together for 45 minutes. Apply ice to the side of your face (No direct contact of ice to skin) and rest with your head elevated on pillows. Repeat if necessary.

Pain: There is discomfort associated with surgical procedures. Take pain medication as instructed. Take tablets or capsules with a whole glass of water or milk (not with a straw).

Swelling: There is swelling associated with surgical procedures. Some people swell more than others, and some surgical procedures cause more swelling than others. This swelling will usually last 5-7 days. Some of the swelling may be prevented by applying ice packs to the face over the area of surgery as often as possible for 24-48 hours after surgery. (Do not apply ice directly on skin. Use a towel or other delivery method which does not allow ice to directly touch skin)

Bruising: There is often bruising or discoloration associated with surgical procedures. Some people discolor more than others, and some surgical procedures cause more discoloration than others. This discoloration may last 7-14 days.

Stiffness: You may experience muscle stiffness and limited opening of your jaws for several days. This will resolve with exercising and increased use of the jaw muscles. Start slow and gradually use the jaw muscles.

Rest: Do not over exert for the first day or two after your surgery.

Oral Hygiene: DO NOT spit, drink through a straw or smoke for 24 hours. These causes a suction in your mouth that can dislodge the forming blood clots and make it difficult for another clot to form. DO NOT rinse your mouth for the first 24 hours. After 24 hours, carefully rinse with warm salt water (1/2 tsp. salt in 8 oz water) to prevent debris from accumulating and to promote healing. Begin brushing carefully whenever it becomes comfortable to do so – but DO NOT spit out the toothpaste.

Diet: A nutritionally balanced diet is essential for gaining strength and healing. Eat a soft diet the first 24 hours if necessary and then return to your regular diet as soon as possible after surgery. Drink a lot of water. Try not to miss a single meal. You will feel better and have more strength and will feel less discomfort and heal faster.

Nausea: Occasionally nausea will occur after surgery. This usually passes within several hours. Nausea later could be related to the pain medication or an antibiotic. Stop using the narcotic, if prescribed, first. If this does not work call this office or Dr. Hurst at home.

Fever: There is usually a slight elevation of temperature for 24-48 hours after surgery. If the fever persists above 100 degrees F, call this office.

Antibiotics: If you have been given an antibiotic prescription, have it filled immediately and take as directed until all pills are gone, unless otherwise directed.

Testimonials

I recently had to have a wisdom tooth extracted by Dr. Hurst. The procedure went so well. I had no pain and no swelling. I have had other extractions by oral surgeons that did not go as well. I am so pleased to have found Dr. Hurst. I love this office! He is so open and friendly and I love his staff! The office is clean and neat. I give them my highest compliments!

-Rene McDonald