Wisdom Teeth Removal

Wisdom teeth come in between 17 and 25, and some of them cause trouble. At Pearl32 Dentistry and Wellness in Laguna Hills, we take a 3D cone beam scan before we decide, because the lower roots can sit against a nerve. Some wisdom teeth are left alone and watched. Others are removed because they are impacted, decayed or infected. Simple cases are done here under local anesthetic with sedation available, and an oral surgeon visits the office for complex cases.

Why are wisdom teeth removed?

Because they cause a problem, or a scan shows one coming. Impaction is the common reason: the tooth is angled into the molar in front and cannot come through, so a pocket forms where a toothbrush cannot reach. Decay follows, often on the back of the second molar rather than the wisdom tooth itself. Repeated infection of the gum flap is another reason, with swelling and a bad taste, and that kind of swelling needs to be seen quickly through our same day emergency slots. Cysts around an unerupted tooth are less common but show on a cone beam scan.

When can wisdom teeth be left alone?

More often than people expect. A wisdom tooth that has come through straight, bites against an opposing tooth, and can be cleaned is a working tooth. We leave it and watch it with x-rays. We also leave teeth alone when the risk of removal is greater than the risk of keeping them, which can be the case with deep roots wrapped around the nerve in an older patient with no symptoms. Removing healthy wisdom teeth to prevent front tooth crowding is not supported by the evidence, and we do not recommend it.

What does the cone beam scan show?

Where the roots sit in relation to the nerve. The inferior alveolar nerve runs through the lower jaw and supplies feeling to the lip and chin. On a flat x-ray, a root that overlaps the nerve canal might be beside it or wrapped around it, and you cannot tell which. A 3D cone beam scan answers that in millimeters, in our own office. When the root is against the canal, we change the plan: a different sectioning technique, or leaving a root tip in place deliberately, which avoids nerve damage.

Who does the surgery, and what sedation is available?

Straightforward cases are done here by your own dentist under local anesthetic. Dr. Masih Rezaei, DDS, an Assistant Professor at Loma Linda University School of Dentistry, is one of the three general dentists in the office. For complex cases, including deep impactions and roots against the nerve, an oral surgeon visits our office and operates in the same chair, with your records and your scan already on the screen.

Sedation is available either way: nitrous oxide, oral sedation or IV sedation. IV sedation suits longer cases. You will need a driver and fasting instructions, which we give you when you book.

What does recovery look like day by day?

Day one: bite on gauze, ice twenty minutes on and twenty off, cool soft food, no straws, no smoking, no rinsing. Day two and three: swelling peaks and the jaw is stiff; keep using ice on day two, then switch to warm compresses and warm salt water rinses. Day four to seven: swelling falls, bruising can appear on the cheek or neck, and most people return to normal food on one side. Week two: stitches dissolve or are removed, and the sockets are closing. Bone fills in under the gum over three to six months.

What does wisdom teeth removal cost?

We do not publish prices. The number depends on how many teeth are removed, whether each one is erupted or impacted in bone, and which sedation you choose. Your cost is quoted in writing, itemized, after an examination and a scan.

We are in network with most major PPO plans and Delta Dental HMO, and we check your benefits before the appointment. Third party financing is available and the practice is not the creditor, through CareCredit, Cherry, Sunbit and Happen Bank (formerly LendingClub). See financing or contact the office.

Questions people ask about wisdom Teeth Removal

What age is right for wisdom teeth removal?

Between 17 and 25 if they need to come out. At that age the roots are only two thirds formed and the bone is less dense, so the surgery is quicker and healing is faster. After 35 the roots are complete, the bone is harder and recovery takes longer. Age alone is not a reason to remove them. The scan and the symptoms decide.

Can all four be taken out at once?

Yes, and many patients prefer it: one recovery instead of four. Removing all four suits IV sedation and a clear week without heavy commitments. Some people choose one side at a time so they can chew on the other, which is reasonable if two are simple and two are impacted. We plan it around your work and family schedule.

How much discomfort should I expect afterward?

Most of it sits in the first three days and responds to ibuprofen with acetaminophen taken on a schedule rather than waiting for pain to build. Impacted lower teeth are sorer than upper ones. Pain that increases on day three or four, with a deep ache toward the ear, suggests dry socket, and we can treat that in one visit with a dressing.

Could I lose feeling in my lip?

It is the main risk with lower wisdom teeth, and it is uncommon. Temporary numbness of the lip or tongue happens in a small percentage of cases and usually recovers over weeks to months. Permanent change is rarer still. The cone beam scan is how we lower that risk, because it shows exactly where the nerve runs before we start.

Do I have to have them out if they do not hurt?

Not automatically. Pain is not the only signal, though: decay on the second molar, bone loss behind it, or a cyst can all be silent. We take an x-ray, look at the gum around the tooth and decide with you. If the tooth is clean and doing a job, we monitor it at your checkups rather than remove it.

This page is general information, not a diagnosis. What is right for you can only be decided after an examination.