In certain cases of impacted teeth, where there seems to be adequate space available for eruption, the dental surgeon may advise a pericoronal flap excision (removal of the gum tissue overlying the impacted tooth) and observation. In such cases, the tooth may erupt into place after the procedure. However, in many cases, infection of the overlying gum tissue has been found to recur. Here, there is no other choice other than the removal of the offending wisdom tooth.
In light of the clinical experience that most impacted teeth will ultimately give rise to some type of problem or disease, it is generally felt that preventive removal of impacted third molars is indicated. Because complications are significantly reduced when the impacted tooth has no associated disease conditions, and because difficulty of removal increases with age, it is recommended that impacted teeth be removed early. It is best done as soon as it becomes apparent that there is insufficient space or that they are not positioned for normal eruption. Generally, this will occur somewhere between the ages of 16-18. At this age, the roots of the developing tooth are usually between one half to two thirds formed and the bone is less dense, which makes their removal easier and the post-operative recovery smoother. A young patient usually is also in optimal general health, which facilitates safe anesthesia and rapid, complete healing. In older patients, removal before complications develop is key to shorter recovery and shorter healing time, besides minimizing discomfort after surgery.
Before the removal of the impacted wisdom tooth, the patient is normally put on a course of antibiotics and anti-inflammatory drugs to eliminate existing infection and inflammation in the area. The removal of an impacted tooth is normally a minor surgical operation, lasting 10 – 45 minutes. It often requires incision of the gum, cutting the tooth and probably some removal of bone too. The oral surgeon may provide anesthesia options of local anesthesia, intravenous sedation, or general anesthesia to make the procedure more relaxing for the patient. The surgical wound is often sutured with silk (non-absorbable) or with absorbable suture materials. Some surgeons advise extraction of the corresponding upper wisdom teeth also during the same sitting.