Do I Need My Wisdom Teeth Taken Out?

I have wisdom teeth that are beginning to hurt and I am worried about feeling pain and having a bad experience. Do I need them out? What do you recommend?

Wisdom teeth, often times, have to be removed for several reasons such as inability to keep clean, more prone to getting cavities, can cause shifting of teeth, can develop unusual pathology such as tumors, and can cause diffuse pain in the jaw as well as the jaw joints. Wisdom teeth can fully erupt through the gums, or partially erupt, or never erupt (called an impacted wisdom tooth). Depending on the level of eruption, a general dentist may be able to take the wisdom teeth and often times I refer to an oral surgeon who specializes in taking out more difficult teeth.

Because wisdom teeth are typically more difficult to take out, one can experience more discomfort and pain following. Again the level of eruption will determine how difficult it will be to remove which further determines how much discomfort afterwards. I typically recommend sedation for wisdom teeth in 3 different options:

1. Nitrous oxide (laughing gas during procedure)
2. Oral sedation(oral medication before procedure)
3. IV sedation (“put to sleep” with medications through an IV). Ask your dentist what is most appropriate for you.

The advantage to oral and IV sedation is also that it can cause amnesia which prevents the patient from remembering the procedure. Most patients wake up without any recollection of what happened, how long it lasted and how the procedure went. So yes I would recommend removing wisdom teeth ~85% of the time and I would recommend sedation for the procedure.

Why do I need a crown over a root canal tooth?

Almost always when a posterior (back) tooth has to receive a root canal for whatever reason (cavity, broken, infected), a crown is typically recommended following completion of root canal therapy. The reason is that the tooth is compromised from previous factors such as cavity, fracture lines, big filling, etc. The foundation of the tooth has been greatly compromised not to mention a root canal is essentially creating a hole down the middle of the tooth further weakening an already compromised tooth. A root canal also involves removing the nerve from the teeth which cuts away some of the blood and nerve supplies which can lead to desiccation or "drying out" of the tooth. Put this all together and a tooth with previous work + root canal= a tooth that will potentially fracture.

Unfortunately when these teeth fracture, they tend to do it catastrophically and sometimes to the point where they are not fixable and need to be extracted. A crown provides additional protection to the tooth as it helps splint the remaining tooth structure together and offsets some of the stresses that occur while eating, chewing, grinding, clenching etc. Depending on the situation, there are different kinds of crowns that can be used and will be discussed at a later date. Ultimately, a crown is very important following root canal therapy to minimize the changes of breaking and fracturing.

What is a bridge?

What is a bridge?

A bridge replaces one or more teeth. It often follows after a hopeless tooth has been extracted(removed).

To put in a bridge, I have to prepare and reshape the teeth on both sides of the missing tooth. The bridge consists of the replacement tooth and two crowns (caps) on each side. The crowns will fit over the prepared teeth to support the replacement tooth. This typically requires two appointments and you will be placed in temporaries at the end of the first appointment until the lab fabricates your bridge.

Types of Dental Sedation

Sedation is a common treated administered nowadays in dentistry and extremely beneficial to the fearful, anxious, or time constrained patient who desires extensive work in a comfortable, short amount of time. Please see below to learn about the different types of sedation offered.

Types of Sedation

There are 3 different types of sedation:

1. - The lightest form of sedation is nitrous oxide (laughing gas). This produces a mild sense of relaxation.

2. - Oral sedation is a moderate form of sedation. This form of sedation typically uses two pills taken before the dental visit to produce a deep state of relaxation. It is best used for short appointments, because once the drug reaches its peak state of relaxation it slowly begins to wear off.

3. - The deepest form of sedation is IV sedation (sleep dentistry). This form of sedation uses pain relieving and sedative drugs to create a sleep like state where the patient is virtually unaware of the dentistry being preformed. Most patients have little or no memory of the visit.

Only about 4% of dentists have the training and licensing to provide IV Sedation.

Some dentists have access to all of the above forms of sedation to help a patient feel comfortable before, during and after treatment.