Wisdom Teeth

Often we hear from our patients that they are nervous, or have heard unpleasant stories about having their wisdom teeth removed. Sometimes these stories have even caused them to delay needed care. We understand that for many patients this is their first experience with surgery or anesthesia. Frequently our patients tell us it was much easier than they had anticipated and that this was the most pleasant experience they’ve had in a medical or dental office. At Heritage Oral Surgery and Implant Centers we pride ourselves in doing things differently. We are experts in the removal of wisdom teeth. We remove thousands of wisdom teeth each year and have developed protocols and procedures that will make your visits a positive experience. We not only strive to provide the highest surgical care, but here at Heritage Oral Surgery Center you will also find that our staff is compassionate and caring. They are ready and willing to assist you every step of the way, from making your appointments and answering any questions you may have, as well as processing, and following up with your insurance. Our facilities may be amongst the most modern in all of Southern California but our attention to personalized care is what our patients appreciate the most. An integral part of this outstanding care is the education and the communication process. Please review the information contained here, and feel free to ask questions at your consultation appointment. Again, Welcome to Heritage Oral Surgery and Implant Centers.

What happens when 32 teeth try to fit into a size 28 mouth?

The average adult has 32 teeth; 16 teeth on the top and 16 teeth on the bottom. The teeth in the front of the mouth (incisors and canines) are shaped for biting food into smaller pieces. The back teeth (molars) are best suited for chewing and grinding food up in preparation for swallowing and efficient digestion. In most people, the last of the adult molars, also known as third molars or wisdom teeth, begin to erupt into the mouth during their late teens and early twenties.

Most people have 4 wisdom teeth. Learning how wisdom teeth develop and the potential problems associated with inadequate room for their proper development can help you understand why they often need to be removed.

Just as with other teeth in your mouth, they develop from a tooth bud. Each tooth or tooth bud can be at different stages of development as well as in different positions. Often by 10-12 years of age, the developing wisdom tooth buds can be seen on a panoramic x-ray.

Here is a video example that has the Eruption of Wisdom Teeth without any complications.

When the wisdom teeth have adequate space and they align properly and the surrounding gum tissue is healthy, they do not have to be removed. Unfortunately, this is not what usually happens.

Often the normal pattern of eruption is complicated by a lack of space, which can result in impaction. A tooth is considered to be impacted when it becomes trapped in the jaw under bone and gums.

Here is a video example of the Eruption of Impacted Wisdom Teeth

These poorly positioned impacted teeth can cause many problems such as swelling, jaw stiffness, pain and infection. The most serious problems occur when cysts or tumors form around the impacted tooth, resulting in destruction of the jawbone and adjacent teeth. Fortunately, removal of the offending impacted tooth or teeth usually resolves these problems. Early evaluation of impacted teeth in combination with their timely removal is recommended to avoid such future problems and to minimize the surgical risks involved with the procedure.

The chief causative agent in the delayed eruption and impaction of wisdom teeth is the lack of space.

A Panoramic x-ray shows your dentists a panoramic view of your jaws, teeth and developing tooth buds. These tooth buds or wisdom teeth develop gradually over a period of many years. Because of this slow development, harmful problems or changes may occur very gradually. Regular dental visits and periodic x-rays (Panorex) can help your dentist evaluate these developing teeth and recommend treatment when necessary prior to any damage being done.

Partially Erupted Wisdom Teeth

Teeth that only erupt partially in the mouth create a situation where a portion of the tooth is covered by a flap of tissue. This tissue is referred to as an operculum and often runs the risk of repeated small acute infections, which become chronic and can gradually escalate over the period of months and years to a condition known as pericoronitis. (Fig. A) Some of these cases can result in life-threatening infections of the head and neck region.

The second molars adjacent to these partially impacted wisdom teeth are at risk of bone loss and decay.

Wisdom teeth that remain completely impacted for many years are at risk of developing tooth related cysts and other pathologic conditions.

Horizontal Impactions

Partial Boney Impaction

Horizontal Impactions

Fully Boney Impactions

Another common complaint, often associated with unerupted or impacted wisdom teeth of the mesioangular and horizontal types, is the feeling of pressure during the attempted eruption of these teeth. (Fig. B) Many investigators believe that these anteriorly directed forces or pressure from the erupting wisdom teeth may contribute to crowding of the mandibular (lower) anterior teeth.

What are the advantages of early removal of wisdom teeth versus just waiting until they create a problem?

Undeveloped Roots

Younger patients (14-21 yrs.) generally heal with a shorter recovery time and less complications. This is in part due to the lack of development of the roots of the wisdom teeth. Often, wisdom teeth that do not have sufficient space to erupt normally will have roots that have grown into close proximity with the sinuses in the upper jaw and the inferior alveolar nerve (IAN) in the lower jaw. In these cases, their removal can be more traumatic resulting in additional discomfort and a prolonged recovery. In these cases a three dimensional x-ray or CT scan may be useful to fully evaluate the risks associated with their removal.

The wisdom teeth of younger patients have undeveloped roots which do not compromise either the sinuses or the nerves. Compare Fig. A with Fig. C. Our experience has shown that early evaluation and treatment result in a superior outcome for the patient.

Why should I have my wisdom teeth removed if they’re not bothering me right now?

If they’re impacted, you may not even know you have wisdom teeth – until they become painful due to pressure or infection. You may not know that your developing wisdom teeth are pushing on the roots of adjacent teeth – until those teeth start to shift. If your wisdom teeth do erupt, they may be hard to clean, so the odds of decay or infection of the surrounding gum tissue are high. The results of expensive orthodontic work can even be ruined if your wisdom teeth contribute to crowding of adjacent teeth, causing them to shift position.

Consultation appointment

A consultation appointment is necessary to evaluate each patient’s individual conditions and needs. This is accomplished with the help of a panoramic x-ray and a thorough oral evaluation. At your consultation, all surgical and anesthetic options will be discussed. It is most common for patients having their wisdom teeth removed to have either intravenous sedation or a general anesthetic.

You will be given a prescription for pain medication, antibiotics and a mild steroid. These medications can be picked up at your convenience and in most cases should not be started until after surgery.

All insurance questions and financial arrangements will be discussed in consultation with one of our well trained front desk staff. They can help you schedule your surgical appointment and post-operative follow up appointment at this time if you so desire.

Surgical appointment / anesthesia

All outpatient surgery is performed under appropriate anesthesia to maximize patient comfort and safety. Our surgeons have the training, license and experience to provide various options. Most commonly, the removal of wisdom teeth is performed under conscious sedation (“twilight sleep”) or general anesthesia.

When having a sedation or general anesthetic, you should not have anything to eat or drink for at least 6-8 hours prior to surgery.

On the day of surgery, you should wear loose, comfortable clothing. A short sleeve shirt or top is preferable. Please refrain from wearing jewelry.

Patients under the age of 21 should be accompanied by a parent or guardian.


Our surgeons are experts in the use of Micro-Incisional Dento-Alveolar Surgical techniques or ‘MIDAS’. Using these skills they successfully decrease the total time for surgery and thereby significantly decrease and often eliminate post-operative pain and swelling altogether. MIDAS surgery, also referred to as minimally invasive dental alveolar surgery, employs smaller incisions, less bone removal and less retraction of the cheeks during tooth removal. The ‘MIDAS touch’ results in improved recovery and more rapid return to normal activity.

Post operative

After your wisdom teeth have been extracted, and the gums carefully closed you will be gently awakened and find yourself biting on gauze while being cared for by one of our highly trained surgery nurses.  You will rest under our supervision in the office until you are ready to be taken home.

Prior to leaving the office you and your parent, guardian or ride will be given thorough written home after care instructions. These instructions will also be reviewed verbally with you by one of our certified oral surgery assistants. Your personalized post-operative kit will include extra gauze, a soft bristled toothbrush, two ice packs, Chap Stick, and a card with the nurse who cared for you throughout the procedure. You should not operate or drive an automobile for the remainder of the day.

With the combination of improved surgical and anesthetic techniques the level of patient comfort is enhanced from the preoperative experience until complete recovery.

In conclusion, whether your wisdom teeth are symptomatic or not, you can rely on your dentist / orthodontist’s expertise to diagnose any existing or potential problems. Normally, with the aid of a panoramic x-ray the decision to remove or observe your wisdom teeth can be easily made.