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About Wisdom Teeth

Wisdom Teeth – More Harm Than Good?

People naturally have thirty-two (32) teeth—four of which are wisdom teeth or third molars.  These wisdom teeth usually cause more harm than good because of the position they occupy within the jaws.  

Wisdom teeth are not always problematic and in some groups of people they still do not pose any large-scale problems within the population.  However, in many Americans there exists a situation where the teeth are proportionally larger than the bone structure of the jaws, which ultimately results in impacted or malposed teeth.  

The cause for this size discrepancy is unknown, but it probably is a result of the melting pot that exists within our society.  A malposed tooth is one that is merely crooked or misplaced in the dental arches relative to the other teeth.  Impacted teeth are either below the gum tissue of bone and are classified as tissue, partial bony or complete bony impactions.  The cost and the amount of the discomfort involved with wisdom tooth removal is traditionally based on or related to the classification of the impaction.

            There is a debate as to whether or not wisdom teeth should be removed.  Is they are a problem, I say definitely.  It is in the asymptomatic situation that confusion exists.  Some experts say let “sleeping dogs lie”.  I believe that this theory is acceptable in certain instances.  However, often pain is a poor indicator of problems as the damage done may be more insidious. 

1) Wisdom teeth may cause bone loss around the adjacent molar teeth, which may ultimately result in the loss of the second molars. 

2) Wisdom teeth may cause damage to the adjacent molar teeth themselves resulting in the need for extensive repair work or loss of the adjacent tooth. 

3) Wisdom teeth may become infected.  Occasionally there are cysts associated with impacted wisdom teeth, which in a very low percentage of cases may become aggressive benign lesions or malignant lesions with local aggressiveness. 

4) Most often wisdom teeth just cause discomfort and disruption in a person’s life. 

5) Recent research data indicates that pockets greater than 5mm between wisdom teeth and second molars confirmed an increase risk of long term problems.

            The ideal solution to the wisdom tooth situation is early evaluation. (14-15 years of age is often not too early).  A panorex x-ray will show whether or not teeth will be useful.  If they fall into the non-useful category early removal is best as the risk of post-operative problems is at its lowest.  Dry socket the most common problem is at a minimum in this age group as well as the other minor risks of numbness in the lip/chin/tongue or sinus involvement.  Recovery time is also shortest.  Most children can return to school the next day.  Older people may require additional recovery time. 

            If the decision is made for removal, then it is usually best to remove all the impacted or non-functional wisdom teeth at once as recovery is generally not prolonged by multiple extractions.  The procedure can be don’t under local anesthesia alone or with IV sedation or general anesthesia—usually as an office procedure.  If the case is done under IV sedation/general anesthesia, then pulse oximetry, ECG and intermittent blood pressure determinations should monitor the case.  The total time for the removal of all four wisdom teeth is usually 20-40 minutes including anesthesia.  Recovery room time is variable. 

            In summary, early evaluation is best followed by early removal if indicated.  Pain as a symptom does not begin until 17-18 years and it peaks in the mid 20’s.  Gum disease problems begin in the mid to late 30’s, as do cystic problems.  Of course there is the usual human variability with timing. 

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About Dental Implants

This section will answer many of the questions you may have about implants.  You may scroll down to read each section or click on any topic to jump to that topic.

Dental implants - something for you?

Dental Implants Defined

What is a dental implant?

How long does a dental implant last?

How many appointments are required?  

Is it painful?

How do I know if I am a candidate?

Will my insurance cover implants?  

May I finance my dental implant? 

Dental Implants: Are They Right For You?

Check with this Self Test to see if implants are for you?

Dental implants - something for you?

Just as a knee can be surgically reconstructed or a hip joint replaced, so too can missing teeth be replaced.   Those with implants experience the ability to speak, laugh, chew and socialize with the confidence of permanent teeth. 

Bioscience has fine-tuned the dental implant to allow placement of compatible materials within the bone to anchor one or more teeth.  This process eliminates the need for bridges and even dentures.  The procedures are ADA approved and the materials are FDA approved. 

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Dental Implants Defined

An implant is an alternative to portable dentures, partials and bridges.  A Dental Implant can offer stabilization for loose fitting dentures, support for existing bridgework, replacement for a single tooth or can be placed for a complete denture.  

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What is a dental implant?

  The Dental Implant can be of many different designs.  The most popular is a small metal (titanium) screw, which is surgically placed into the jawbone, much like an artificial hip or knee surgical replacement.  After adequate healing time, a replacement tooth or teeth are made to fit into the implant.  In selected cases, the implant can even be inserted at the time of tooth removal. 

  What are the advantages of a dental implant?

1) Stabilize removable dentures

2) Replace removable dentures

3) Replace removable partial dentures

4) Strengthen existing bridgework

5) Single tooth replacement without crowning teeth on either side of the space to hold a crown

6) Renewed confidence in your smile

7) Clearer speech

8) Increased ability to chew food

9) Preserves bone through internal bone stress

10) Increased sex appeal

11) Teeth do not need to be removed at night

12) Dental implants do not decay like teeth

 

Click on the implant for more information on Implant Procedure

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How long does a dental implant last?

  Longevity cannot be guaranteed, though some patients have had their implants for more than 25 years.  

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How many appointments are required?

  Usually there is a consultation appointment to diagnose the nature of your problem.  If you have a straightforward situation, then the implants can be inserted the next appointment.  Occasionally additional studies are necessary before the surgery to insert your implants.   I would like to see you for a Post Operative Visit to make sure everything is OK and you may wish to see your restorative dentist for any adjustment to your existing partial or full dentures.  Three to six months need to elapse after your surgical insertion, and then I will expose you submerged implants through your gum tissue.  You will then need several visits to your restorative dentists.  To have your new teeth made to fir your new dental implants.  I would like to see you when your new teeth are fabricated so that I may see your new smile. 

I would like to point out that dental implants are best done through a team approach and that my responsibility is for the implant or foundation portion of your teeth.   Your restorative dentist is responsible for the teeth.  I will be happy to work with your dentist as a team, or I can recommend a restorative dentist based on your particular needs. 

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Is it painful?

Generally the discomfort of having an implant placed is less than having a tooth removed.  For your comfort most procedures may be don’t in my surgical facility, wither under local anesthesia or local anesthesia and IV sedation.  

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How do I know if I am a candidate?

Many people are candidates for dental implants if they are missing teeth and are tired of full or partial dentures or do not wish to have a traditional bridge.  A panorex X-ray and study models are usually all that is necessary.  Sometime a CT scan is necessary to determine if adequate bone exists.  In the case of inadequate bone synthetic bone substitute or a graft from your own hip will often provide the support necessary for your implants or different types of implants my be used. 

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Will my insurance cover implants?

In most cases, we bill your medical insurance for the implants and your dentists will bill your dental insurance for the teeth.  At the present time, many insurance companies will not cover the cost of implants.  In some cases insurance has covered the entire cost of implants.  Dental insurance will often cover the cost of the teeth on your dental implants, even if your medical insurance does not pay for the implant.  If you have a severe medical problem, such as reconstruction for an oral cancer or severe weight loss, we are better able to obtain coverage for you.  My office will be happy to predetermine insurance coverage for you.  

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May I finance my dental implant? 

Generally fees are due the date of service,  We will accept assignment of verified insurance as partial payment.  We accept Visa and MasterCard.  Financing is available through a credit company. 

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Dental Implants: Are They Right For You?

The Problem

More than 40 million Americans over the age of 55 have lost some of all of their teeth.  As Americans live longer, more active lives, many of these people face up to 30 or 40 years of toothlessness, according to the American Association of Oral and Maxillofacial Surgeons.  

Tooth loss results in an inevitable shrinkage of gums and jawbones which can lead to pain from ill-fitting dentures, decreased chewing function, subtle malnutrition, social withdrawal and emotional distress.  Dentures place constant pressure on the jawbones, thereby acceleration shrinkage and causing dentures to fit poorly because they no longer have a solid foundation on which to rest securely and comfortably.  

The Solution

Oral and maxillofacial surgeons, however, are providing a more permanent solution to toothlessness with oral implants.  Oral implants are permanent tooth root substitutes which are surgically placed in the jawbone and act as anchors to stabilize artificial teeth.  The result is improved function, without the pain, frustration or other problems associated with conventional dentures and a restored self-confidence, which may have deteriorated as a result of tooth loss.  

Not everyone who is missing teeth, however is a good candidate for oral implants.  Implants are not recommended for persons prone to infections or for people who are unable to maintain stringent oral hygiene.  Additionally, implants may not be appropriate for children and teenagers whose bones have not fully matured. 

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Self test

Y     N

  Have you lost one or more teeth?

  Do you feel differently about yourself because you've lost one or more teeth?

  Do your dentures fit poorly?

  Do you avoid smiling because you wear dentures?

  Do you avoid eating out because you worry about your dentures slipping and/or 

          falling out

  Does good lodges beneath your dentures and pinch your gums?

  Have dentures affected your speech?

  Do you have continuous sore spots?

  Do you have pain in the jaw, chin or lips when biting or chewing with dentures?

  Have you had to change your diet since you lost your teeth?

  Are you using more denture adhesive with less effective results?

  Have you noticed changes in your facial appearance since you began wearing   

          dentures?

  Are you  less confident among others because you wear dentures?

  Are you less interested in exploring options other than dentures?

  Are you generally in good health?

  Are you able to maintain proper oral hygiene?

 If you answered yes to more than five of these questions, you may be a good candidate for oral implants. 

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About Jaw Surgery

Some people have differences in the size of their jaw bones to such a degree that they cannot close their mouth or conventional orthodontics is impractical.  In this case there  are numerous surgical procedures which may be used to reposition the jaw bones into a more appropriate position both for functional orthodontic or cosmetic reasons. 

Surgery is usually an outpatient procedure and is done in conjunction with an orthodontist.  The approximate TIMELINE for care is:

-Evaluation—1-3 months

-Preparatory Braces---6-18 months

-Surgery---1-5 hours

-Observation/Finishing Orthodontics---6-12 months

GOALS of SURGERY

- Improved bite

- Better chewing ability

- Decreased TMJ pain (assumes the biting relationship is the cause)

- Improved facial esthetics

- Improved oral hygiene

Additional detailed information may be found by searching the Web under Jaw Surgery or visit the Center For Reconstructive Surgery (CT)

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About Anesthesia

Different options exist for anesthesia including:

LOCAL ANESTHESIA with or without NITROUS OXIDE, 

IV SEDATION and IV ANESTHESIA (deep sedation or general anesthesia). 

The recommended anesthesia depends of patient preference and the procedure to be done.  The decision is usually made between you as the patient and Dr. Zech.

Dr Zech spent time on Anesthesia Service at the University of Michigan as part of his OMFS training.  He also worked as an anesthetist at the Rainier School for the disabled in Buckley, WA.  Dr. Zech is certified in Advanced Cardiac Life Support (ACLS) and is a member of the American Association of Dental Anesthesiology.  He has a Washington State Class 3 Anesthesia Permit allowing in office general anesthesia.  Full appropriate monitoring is used and the staff is trained is OMSF assisting.  Staff is also ACLS certified.

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About TMJ/TMD (Temporomandibular Disorder)

TMJ/TMD is a complex set of symptoms usually involving pain about the jaw joints. There can be multiple etiologies:

     - INTERNAL DERANGEMENT within the jaw joint.  Approximately 1/3 of studied populations have this condition with no significant symptoms.  There may be popping/ clicking or locking of the jaw with realignment of the jaw-joint structures during jaw use or not. 

     - MUSCLE SPASM is probably the most common cause for TMJD and can be difficult to treat because of the effects that it can have, especially over a prolonged period of time.  Muscle spasm may be from the neck and/ or  jaw muscles.  This may cause a problem remote to the jaw joints and refer pain to the jaw joints. 

     - CHRONIC STRESS is often a precipitator of the problem.  Patients sometimes have symptoms after a rear-end car wreck.  Often this is upper back-neck mediated.          

The most accurate method to treat TMJD is to establish the most likely cause and then to treat  it.  Treatment may include just helping a patient to understand his/her problem; physical  therapy; neurology referral; bite splint therapy or rarely (1% or 2%) involving surgery.

Treatment of TMJD is often a team effort.

Information may be found on a Web search under TMJ or go to the TMJ Association.

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