Tooth Extraction

Removing teeth to restore health.

What is oral surgery?

teenage girl smiling after a great experience removing wisdom teeth at crabtree dental in katy texasOral surgery procedures include tooth extraction; bone grafts; removal of soft tissue, tumors, and cysts; corrective jaw surgery; gum trimming for aesthetic and functional concerns; and implant placement. The most common oral surgery procedure is tooth extraction. These days when something is difficult we say “it’s like pulling teeth”, but in reality tooth extractions are a simple procedure in our office and can be an excellent service provided to patients when necessary.

Why would I need teeth extracted?

The goal of modern dentistry is to save your teeth, not extract them. Yet sometimes the best course of treatment involves tooth removal or extraction.  A tooth may need to be removed if it is broken, abscessed, or has sustained significant decay. Sometimes teeth need to be removed for orthodontic alignment and sometimes a primary or baby tooth doesn’t fall out as expected because the replacement permanent tooth is growing in at a different angle or “crooked”. Chief among the candidates for extraction are crowded or impacted wisdom teeth (third molars). An impacted tooth is not able to break through the gums because there isn’t room for it to come in. While it is always our goal to do everything we can to save your natural teeth, there are times when removing a potentially harmful tooth will prevent more serious dental problems from occurring in the future. Our dentists routinely perform oral surgery under local anesthesia.

Should I see a specialist for extractions?

Each dentist in Texas is licensed to perform oral surgery, so going to a specialist for the most common oral surgery procedures isn’t necessary. Dr. Foust, a general dentist on staff at Crabtree Dental, limits his practice of dentistry almost exclusively to providing oral surgery services using local anesthesia and IV sedation. This means that while our other dentists are performing restorative, cosmetic, and other general dental procedures, Dr. Foust is likely extracting teeth. Dr. Foust has had additional post-graduate training in oral surgery and is skilled and efficient in extractions due to his career focus on oral surgery. He has completed over 7,000 wisdom tooth extractions. Because he provides oral surgery and IV sedation services within our office, you can have oral surgery procedures performed in an environment in which you already feel comfortable and confident. If at any time the doctor determines that your oral surgery needs are of the complexity that your case should be managed by an oral surgeon, we will not hesitate to refer you to one of several excellent Katy or West Houston area oral surgeons.

studious teenager sitting on the grass holding a bookWhat are wisdom teeth?

First molars erupt in the mouth around age 6, second molars around age 12, and third molars come in typically during the later teenage years. Third molars were nicknamed “wisdom teeth” as far back as the 17th century because they appear so much later than the first and second molars, presumably when one is “wiser”. Wisdom teeth appear as the last tooth in corner of each quadrant of the mouth, usually erupting around 16-17 years of age and occasionally as early as 14 years. They continue to grow and form through about the age of 25.

Historically, first and second molars often had to be removed due to decay; so the third molars came in handy in the absence of the others; thus garnering the reputation as an “extra set” of molars. Due to advancements in modern dentistry and particularly because of a fluoridated water supply, first and second molars are now usually retained into the adult years and typically for life. In the presence of these molars there often is not enough room for the third molars to fully erupt. Now instead of being associated with “wisdom”, they are more often associated with pain, infection, and crowding.

Why are wisdom teeth removed?

In general the dental community is in agreement that third molars should be removed if the teeth are malaligned; cause pain, infection, or damage; or have decay or are causing decay or other problems to other teeth. Third molars are typically removed for one or more of the following reasons:

  • The gum tissue over the crown of the tooth is infected (pericoronitis).
  • The tooth is erupting in an abnormal position, affecting the tooth adjacent to it.
  • The teeth are impacted or “trapped” below the gumline due to lack of space. A trapped state increases the possibility of infection.
  • The erupted tooth is difficult to clean and as a consequence the tooth becomes decayed.
  • Orthodontists recommend wisdom tooth removal before, during, or after orthodontic treatment to avoid crowding and interference with the orthodontic outcome.
  • The teeth need to be removed due to periodontal disease
  • Although rare, retained wisdom teeth have the potential to cause cysts or tumors.

What happens if there is not enough room for wisdom teeth to fully erupt?

Up to 90% of the population does not have enough room for wisdom teeth to erupt into a position which is accessible for good oral hygiene. Since the average mouth is made to hold only 28 teeth, several problems can occur when your wisdom teeth try to fit into the upper and lower corners of your mouth. It is very unusual to have all 32 teeth aligned and functional in a single mouth. Most commonly your wisdom teeth may become impacted (unable to fully emerge) and may grow in sideways, towards the tongue, away from the tongue, or may remain trapped beneath the bone and gum. Their position can compromise the health of a neighboring tooth. Even if the wisdom teeth do erupt fully, their location at the very back corners of your mouth make it extremely difficult to keep them clean and healthy over the course of your lifetime. Your wisdom teeth can become decayed and/or infected if you are unable to keep them clean.

teen-wisdom-teeth-removalIf wisdom teeth are recommended for removal, why is it best to remove them during the teenage years?

As a person ages, the roots of the wisdom teeth grow longer and anchor themselves to the jaw bones. This gives the roots more opportunity to wrap around a major nerve that give sensation to your teeth, lip and chin. The longer and more anchored wisdom teeth roots are to the jawbone, the more complex the oral surgery and corresponding complications become. The more complicated the surgery, the greater the risk of nerve injury and post-operative complications to the patient. Decreasing the surgical difficulty decreases the problems associated with the surgery. When a patient is younger the roots of their wisdom teeth are not fully formed and the bone that surrounds them is softer. Extractions during the teenage years mean there is a decreased possibility of damage to the adjacent nerves and other structures of the mouth.

Early removal of impacted wisdom teeth is recommended by the American Association of Oral and Maxillofacial Surgeons. At Crabtree Dental, we begin screening our patients for third molar complications around 16 and 17 years of age, though some dentally mature patients will be evaluated as early as 14 years old. A digital panoramic x-ray is taken to assess the position of the molars. The molars are evaluated for things such as size, direction of eruption, available space, and root formation. The panoramic image also provides a view of the jaw and the molars in relationship to it. If our dentists determine that it is in the best interest of the patient to remove their third molars, oral surgery will be recommended. If third molar development is delayed, the patient will be re-evaluated in a couple of years.

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