Will My Wisdom Teeth Be Hard To Remove?

It is helpful to understand the basics of tooth anatomy.  Teeth consist of several parts. The part usually visible above the gum is the crown of the tooth. The part of the tooth normally hidden from view underneath the gums and lodged in the jaw bone is the root. The crown has two layers protecting the nerve and blood supply in the center of the tooth. The first is the enamel layer, a hard, shiny, dense armor-plate like substance. The second, thicker layer is dentin, a softer and slightly more flexible material. The root is dentin, has no armour-plate covering and is normally protected by bone.

Image of a Tooth Crown and Root

Basic Parts of a Tooth
Courtesy of Craig Sommer DDS

Graphic Image of the Internal Anatomy of a

Internal Anatomy of a Tooth
Courtesy of Craig Sommer DDS

As your dentist plans to remove a wisdom tooth he will look at several different factors. He will consider how much of the tooth crown is above the gum line. If it is completely buried under gum and bone, it will require one approach. A different approach is required for a wisdom tooth that is badly decayed down to bone level and has fully developed roots. He will observe the position of the tooth compared to its neighbors. He will also consider how extensively the tooth has been compromised as a result of decay or cavities. All of these considerations will affect how easily the tooth can be removed.

Graphic Image of a Badly Decayed Wisdom Tooth

Badly Decayed Wisdom Tooth
Courtesy of: Craig Sommer DDS

Your dentist’s goal is to keep you comfortable and safe during the entire procedure. So he or she will usually sit down with you and outline the procedure. He will discuss the risks and benefits of removing or retaining the wisdom tooth.  He may not go into great detail about how the tooth will be removed, if you don’t want to hear about it. But he will let you know the potential problem associated with tooth removal.

Some of my patients don’t want to hear anything, don’t want to see anything and don’t want to feel anything. They want to be put “completely out,” is the term they often use, to help them through the procedure. If that’s your desire, your doctor may use IV sedation. IV sedation is a technique where a relaxing medication is placed into a vein in your arm allowing you to comfortably sleep through the entire procedure. Then you can awaken afterwards with very little recollection of what went on.

Some of my patients don’t want to go through the IV sedation process because it, in itself, has some significant risks associated with it. An alternative would be the use of local anesthetic, plus nitrous oxide-oxygen sedation (laughing gas) or a anti-anxiety medication. It really is a balancing act between your comfort level and not wanting to see, hear or feel anything and the risks associated with the sedation process. It is, ultimately, your choice so discuss this thoroughly with your dentist.

Your current general health also influences the timing of any surgical procedure. If you are in excellent health then your dentist has more flexibility in scheduling your procedure. By reviewing your health history he may uncover some health issues that may call for a modification of your treatment timing. Be complete and honest with your answers to all health questions as your safety is of utmost importance.

A classification system exists for the risk of surgical procedure safety. Your dentist will explain to you which category you fit into, as far as the medical safety risk, for the different types of procedures. He’ll explain whether or not, because of your overall age and general health, you fall into any higher risk categories for surgery. The greater the risk the more likely he would consider referring you to an oral surgeon, who typically sees higher risk patients more often than your general dentist.

One example would be high blood pressure and your ability to keep it under control with diet and medications. Another would be high blood sugar if you are a diabetic. Your blood sugar needs to be at a safe level and well managed by you. And another concern is whether you’ve had a stroke or heart attack recently. With any serious medical condition it is appropriate to step back and evaluate whether you are currently considered to be in good enough health to undergo this type of procedure.

There are many factors that need to be considered before any type of surgery is contemplated. And this is where your dentist’s experience and his comfort level will determine whether or not he will complete the procedure or he may make a referral to an oral surgeon for more complicated patient health situations.

Look for more articles on wisdom teeth in the series: Questions You Must Ask Your Dentist Before Having Your Wisdom Teeth Removed.