Wisdom teeth removal in Richmond: when it's needed and what to expect

Quick answer: Wisdom teeth are the third molars at the very back of your mouth. They usually come in between ages 17 and 26, and they may not have enough room to grow in properly. When a wisdom tooth is stuck (impacted), infected, decaying or pushing on the tooth next to it, removing it is usually the simplest fix. If it's healthy, fully erupted and easy to clean, it may be fine to leave it and keep an eye on it. At DTC Dental Treatment Center in Richmond, BC, most wisdom teeth are removed in-house under local anesthetic, with oral sedation available for nervous patients.

What are wisdom teeth?

Most adults have 32 permanent teeth, and wisdom teeth are the last four to arrive: one in each corner at the back of the mouth. According to the Mayo Clinic, they "usually emerge sometime between the ages of 17 and 26."

Some people get all four with no trouble. Many don't. By the time these molars start moving, the jaw is often already full, so the tooth gets stuck under the gum, in the bone, or at an angle against the neighbouring molar. The American Academy of Oral and Maxillofacial Surgeons reports that 90% of people have at least one impacted wisdom tooth.

Types of impacted wisdom teeth

Dentists describe an impacted tooth by how deep it sits and which way it's pointing. Both affect how straightforward the removal will be.

By depth

• Soft tissue impaction: the tooth has come through the bone but is still partly or fully covered by gum. Food and bacteria get trapped under the gum flap, which is a common source of infection.
• Partial bony impaction: part of the crown has come through, but the rest is still held in the jawbone.
• Complete bony impaction: the whole tooth is still inside the jawbone. These usually take more time to remove.

By angle

• Mesial: tilted forward toward the front of the mouth. This is the most common type.
• Vertical: upright, but still trapped under the gum.
• Horizontal: lying on its side, often pressing into the roots of the second molar.
• Distal: tilted backward. This is the rarest type.

Signs your wisdom teeth may be causing problems

An impacted wisdom tooth can be completely silent for years. When it does cause trouble, the Mayo Clinic lists these common symptoms:

• Red, swollen, tender or bleeding gums at the back of the mouth
• Jaw pain or swelling around the jaw
• Bad breath or a bad taste that won't go away
• Trouble opening your mouth fully

If your gums hurt in one spot behind your last molar, or you've noticed jaw tightness on one side, a partly erupted wisdom tooth is a common cause. A dental checkup with x-rays is the fastest way to find out.

What happens if you leave a problem wisdom tooth alone?

Not every wisdom tooth has to come out. The trouble starts when one is impacted or hard to clean. Here are the complications:

• Damage to the second molar. A wisdom tooth pushing against the molar in front of it can damage that tooth or raise the risk of infection in the area.
• Decay. Partly erupted wisdom teeth appear to be at higher risk of cavities because they're so hard to reach with a brush and floss.
• Gum infection (pericoronitis). The gum around a partly erupted wisdom tooth can become inflamed and painful.
• Cysts. The sac around a developing wisdom tooth can fill with fluid and form a cyst that damages the jawbone, teeth and nerves. This is uncommon.

You may have heard that wisdom teeth cause crowding of the front teeth. The evidence on this is mixed, so it usually isn't a reason on its own to remove them.

Should healthy wisdom teeth be removed?

This is a fair question, and the research doesn't give a clear yes or no. A 2020 Cochrane review looked at impacted wisdom teeth that weren't causing symptoms or disease and found there was not enough evidence to say whether they should be removed or kept. The reviewers suggest the decision be made together by the patient and dentist, and that anyone who keeps their wisdom teeth have them checked regularly.

That's how we approach it at DTC Dental. If your wisdom teeth are healthy and easy to keep clean, we'll tell you so and track them at your regular checkups. If they're causing problems, or the x-rays show they're likely to, we'll explain why we'd recommend taking them out.

How wisdom tooth extraction works at DTC Dental

Here's what a typical visit at our Richmond dental clinic looks like.

1. Exam and x-rays. We start with an exam and low-radiation digital x-rays to see how each tooth is positioned and how close the roots sit to the nerve in your lower jaw and to your sinuses. This tells us whether the tooth can come out in one piece or needs to be sectioned into smaller pieces. For lower wisdom teeth that sit very close to the nerve, a 3D scan such as a cone beam CT (CBCT) can give a more exact picture of the risk. A CT scan may be used when x-rays suggest a higher risk of nerve injury.

2. A written estimate. Once we've seen the x-rays, you get a written fee estimate before you commit to anything.

3. Numbing. The area is fully numbed with local anesthetic. You'll feel pressure during the extraction, but you shouldn't feel sharp pain.

4. Removal. A single wisdom tooth usually takes 20 to 40 minutes. In many cases all four can be removed in the same appointment.

5. Aftercare instructions. You go home the same day with written instructions and a way to reach us if something doesn't feel right.

Who does the extraction?

Most patients don't need a referral to an oral surgeon. At DTC Dental:

• Dr. Sara Ghadiri removes both routine and impacted wisdom teeth.
• Dr. Michael Ho helps with simpler cases.
• Dr. Jason Park, who focuses on surgical and implant dentistry, sees more complex cases. These cases are booked ahead of time.

Sedation for nervous patients

If the idea of having a tooth pulled makes you anxious, you're not alone, and you don't have to push through it. We pace the appointment around you and explain each step before we do it.

For patients who need more help, we have oral sedation. You take a prescribed medication before the appointment that makes you feel relaxed and sleepy, and many people don't remember much of the visit afterward. If you choose sedation:

• A responsible adult needs to come with you and drive you home.
• You can't drive for the rest of the day.
• You shouldn't walk home alone.