Latest / Oral Surgery Answers with Dr. Juan Lopez / Wisdom Teeth Removal: When Should You Take Them Out?

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Wisdom Teeth Removal: When Should You Take Them Out? · Oral Surgery Answers with Dr. Juan Lopez

• 0:00
  SPEAKER_00: Parents just wait until the wisdom teeth are hurting to do anything about it.
• 0:04
  SPEAKER_00: But pain is one piece of the decision.
• 0:07
  SPEAKER_00: The timing of wisdom teeth removal changes the surgery itself.
• 0:11
  SPEAKER_00: What are we looking at is how the roots are developed, is the crown there, is the nerve in relation with the wisdom teeth, and how much bone has to be removed.
• 0:21
  SPEAKER_00: I'm Dr.
• 0:21
  SPEAKER_00: Juan G.
• 0:22
  SPEAKER_00: Lopez, I'm an oral and maxillofacial surgeon in South Florida.
• 0:26
  SPEAKER_00: I'm a board diplomate of the American Association of Oral and Maxillofacial Surgeons, and I remove wisdom teeth every week, day after day.
• 0:34
  SPEAKER_00: So I want you to show how I decide when a wisdom tooth should come out.
• 0:38
  SPEAKER_00: When can we leave it alone?
• 0:41
  SPEAKER_00: And why waiting for symptoms can sometimes be worse or make the decision harder.
• 0:47
  SPEAKER_00: We usually start telling the parents that the best age to remove wisdom teeth is at 13 years of age.
• 0:54
  SPEAKER_00: When I say this, a lot of parents will be concerned.
• 0:58
  SPEAKER_00: But I'm gonna tell you, at 13 years of age, the crown is sitting up the bone.
• 1:03
  SPEAKER_00: There is no roots, it's just the butt, and it's very subtle.
• 1:07
  SPEAKER_00: So it's not as hard as removing a wisdom tooth when you're 25, 30, 35.
• 1:13
  SPEAKER_00: At that time, on their 20s, the roots are fully grown.
• 1:16
  SPEAKER_00: And on the lower jaw, they go into the nerve.
• 1:19
  SPEAKER_00: In the upper jaw, they can go into the maxillary sinus.
• 1:23
  SPEAKER_00: That makes the surgery itself more difficult.
• 1:27
  SPEAKER_00: Recovery is also be an impact when you're in your 20s.
• 1:30
  SPEAKER_00: It's different to recover when you're 13 years old.
• 1:33
  SPEAKER_00: And yes, you're gonna have some days of swelling, but usually they recover very well.
• 1:38
  SPEAKER_00: At 20, your bone is harder, is denser, the roots are towards the nerve or towards macillary sinus, and your recovery can take up to one week, one week and a half.
• 1:49
  SPEAKER_00: Now, other issue on the bottom one is working around a nerve.
• 1:52
  SPEAKER_00: If the roots are wrapped on the nerve, it's a more difficult surgery.
• 1:57
  SPEAKER_00: And that nerve gives the sensation to the lower lip.
• 2:00
  SPEAKER_00: So it can be affected.
• 2:01
  SPEAKER_00: And that's the main reason I say 13.
• 2:04
  SPEAKER_00: Now, there's the roots.
• 2:05
  SPEAKER_00: Remember, you have the bone that is very soft, but also is it gives away.
• 2:10
  SPEAKER_00: And the recovery of that hole where the wisdom teeth was can regenerate in bone.
• 2:17
  SPEAKER_00: So the defect that we see there is minimal compared to a patient that is under 20s, in which you're gonna have a lot of soft tissue on that hole where the wisdom tooth was.
• 2:28
  SPEAKER_00: Now, the other important thing that we see is that the teenager at 13, 14, yes, it will go with uh some soft diet, but usually by five days, four days, this patient is doing well, is eating well, and is getting into their recovery.
• 2:48
  SPEAKER_00: Now, if somebody comes with pain or with an infection, that's also a problem.
• 2:54
  SPEAKER_00: Because what happens is that your recovery is gonna be worse.
• 2:58
  SPEAKER_00: So that's why we don't want you to wait until the tooth hurts.
• 3:02
  SPEAKER_00: And usually when they go to the dentist, they don't go and take a what we call a panoramic.
• 3:07
  SPEAKER_00: Pain is the last thing a wisdom tooth does, not the first.
• 3:11
  SPEAKER_00: If you're in South Florida and your kid is at the age where this is coming up, there's a link in the description to set an assignment, a consultation, and get a real look at what is happening, where are those roots, is the nerve involved, etc.
• 3:26
  SPEAKER_00: etc.
• 3:27
  SPEAKER_00: Now, parents they say, well, my grandpa has their wisdom teeth for at least until he was 90 and nothing happens.
• 3:33
  SPEAKER_00: Yes, that's true.
• 3:34
  SPEAKER_00: It can happen, but it's not the norm.
• 3:37
  SPEAKER_00: Most of the time, the patient that has wisdom teeth because the diet itself has changed.
• 3:42
  SPEAKER_00: Your grandpa 90 had a more fibrous diet.
• 3:46
  SPEAKER_00: Now the diet is completely processed, so we don't need the wisdom teeth.
• 3:50
  SPEAKER_00: And we're seeing that that manible is getting smaller.
• 3:53
  SPEAKER_00: So you have to consider factors other than age, food, nutrition, and body composition.
• 3:59
  SPEAKER_00: Now, but in general, wisdom teeth, we see a lot of problems.
• 4:03
  SPEAKER_00: What else can it happen when there is no pain?
• 4:06
  SPEAKER_00: Well, wisdom teeth harbor cyst.
• 4:09
  SPEAKER_00: A cyst is a tumor that is benign, but it's very destructive.
• 4:14
  SPEAKER_00: And what happened is that if you don't take a panoramic x-ray and see what is the situation with that wisdom tooth, that cyst is gonna continue to grow.
• 4:24
  SPEAKER_00: Imagine a balloon filled with water.
• 4:27
  SPEAKER_00: It expands, expands, and creates destruction of the adjacent bone.
• 4:34
  SPEAKER_00: We see this and we see it pretty, pretty frequently.
• 4:37
  SPEAKER_00: So at 13 is the age that you should start looking into this with an x-ray to see what is happening with the teeth, what is happening with the wisdom teeth, and how they're grown.
• 4:48
  SPEAKER_00: Most of the time they grow either sideways or halfway, or it never comes through all.
• 4:54
  SPEAKER_00: And it's common because, as I was saying, the diet is exactly change.
• 4:59
  SPEAKER_00: And at 2021, you've already completed your jaw growing.
• 5:04
  SPEAKER_00: Now, not every wisdom tooth has to come out.
• 5:07
  SPEAKER_00: If a wisdom tooth is in the right position and you have a mandible that can harbor those wisdom teeth, yeah, you can leave them.
• 5:15
  SPEAKER_00: But the problem is that most of the time they will give you either food accumulation, you cannot clean it as well as if you didn't have those wisdom teeth, and eventually it's gonna give you a problem.
• 5:27
  SPEAKER_00: Now, when we talk about uh wisdom teeth that are partially out, it can harbor an infection, but it also can create decay into the next tooth.
• 5:37
  SPEAKER_00: And the reason is there is a communication between the oral cavity and that tooth.
• 5:42
  SPEAKER_00: So just imagine a trap of food getting between the wisdom tooth and the second molar.
• 5:47
  SPEAKER_00: That can cause decay to the second molar.
• 5:51
  SPEAKER_00: When decay or cavities or damage to that second molar is because of wisdom teeth, it goes really fast.
• 5:58
  SPEAKER_00: So you can lose the second molar as well, then removing the third molar.
• 6:03
  SPEAKER_00: So you have to be a little aware about the prevention for wisdom teeth.
• 6:08
  SPEAKER_00: Did you know that wisdom teeth can be the cause for in the top, in the upper maxilla, of maxillary sinus problems and in the bottom headaches, constant headaches and headaches and clicking on the jaws?
• 6:21
  SPEAKER_00: And it's because the wisdom teeth they don't have the space to be there.
• 6:26
  SPEAKER_00: Now, teenagers that go into braces, when they remove the wisdom teeth before starting the orthodontic treatment, it has shown that the orthodontic treatment is gonna be faster than if you had your wisdom teeth.
• 6:41
  SPEAKER_00: Mobile never happened, meaning that they start the orthodontic treatment and they remove the wisdom teeth at the end of the orthodontic treatment or the braces treatment.
• 6:52
  SPEAKER_00: It's better to do it before.
• 6:53
  SPEAKER_00: Not only will you have the space to move those teeth in a better way, but imagine your orthodontic treatment, your braces, is gonna go faster.
• 7:02
  SPEAKER_00: And you know, kids don't wanna be on braces forever.
• 7:06
  SPEAKER_00: So we recall infection, we recall decay, we recall insystic or tumor lesions that would require uh more surgery when you remove it.
• 7:18
  SPEAKER_00: And we recall also age.
• 7:20
  SPEAKER_00: It's very different to remove a wisdom tooth at age 25, 30, or 35 because your post stop is gonna be different.
• 7:29
  SPEAKER_00: It's a bigger operation at 30 or 35, and it will need better planning.
• 7:33
  SPEAKER_00: And the reason you already have fully developed roots, and those roots are probably sitting right on the nerve.
• 7:40
  SPEAKER_00: What happened then?
• 7:41
  SPEAKER_00: Well, there's an option to remove the crown only and leave the roots.
• 7:45
  SPEAKER_00: That's called caronectomy.
• 7:47
  SPEAKER_00: That's an option, it's valid.
• 7:49
  SPEAKER_00: What can happen?
• 7:50
  SPEAKER_00: Well, most of the time we're not dragging or touching the nerve, but most of the time when we remove the crown and leave the roots, what's called caronectomy, what's gonna happen is that probably you won't have a problem with the nerve, with the sensation to the lip.
• 8:04
  SPEAKER_00: In my hands, I rather remove the pool tooth because a lot of times those roots that get left behind will get infected later.
• 8:14
  SPEAKER_00: And if it gets infected later, now you're going back for surgery the second time.
• 8:19
  SPEAKER_00: Now, can the nerve be affected?
• 8:21
  SPEAKER_00: It can, but it happens between 2% to 6%.
• 8:25
  SPEAKER_00: There are some decisions to make if in reality the nerve is crossing the roots of the wisdom tooth.
• 8:32
  SPEAKER_00: And that's done with a combine CT.
• 8:35
  SPEAKER_00: But remember, at 12 or 13 or 14 years old, you don't have roots.
• 8:39
  SPEAKER_00: So it's the best option to remove them.
• 8:41
  SPEAKER_00: But when you go to your dentist, always tell the dentist to take a panoramic x-ray.
• 8:46
  SPEAKER_00: The panoramic x-ray is not a scan, but it will tell you one, do you have the room for those teeth to come out?
• 8:54
  SPEAKER_00: And two, is the nerve involved with the roots?
• 8:58
  SPEAKER_00: Now, 13 isn't a random age.
• 9:00
  SPEAKER_00: Stage where they're old enough to do the surgery, where there are no roots to work around, and when the bone still gifts.
• 9:08
  SPEAKER_00: That's important.
• 9:08
  SPEAKER_00: Although most parents are shocked when I tell them 13 is usually the right age to get their wisdom teeth.
• 9:14
  SPEAKER_00: Besides, when you're impromptu, you won't have wisdom teeth.
• 9:18
  SPEAKER_00: But again, so I can make myself clear.
• 9:21
  SPEAKER_00: Every time, week after week, I see patients that didn't remove wisdom teeth at 13 and come with infections at 18 or come with tumors at 20 and never had pain.
• 9:33
  SPEAKER_00: And the reason is they went for braces, they took a panoramic, and then they saw there's a big cystic lesion.
• 9:40
  SPEAKER_00: So I make a video comp on that.
• 9:42
  SPEAKER_00: And that's the one I will watch after this.
• 9:45
  SPEAKER_00: It's important that you make your decision.
• 9:47
  SPEAKER_00: But if nobody has explained the timing on this to you before, hit subscribe.
• 9:52
  SPEAKER_00: That's what the channel is for.
• 9:54
  SPEAKER_00: And if you're in South Florida, there's a link in the description for an assessment or to set an assessment or consultation, will give you a better view and will give you a better plan for the future.