What You Need to Know Before Removing Wisdom Teeth

[00:00:18] Eon Engelbrecht E-Radio-SA: Eon Engelbrecht E-Radio-SA: Welcome to
another “Save Your Money, Save Your Teeth”, the go-to podcast where curiosity meets
dentistry, straight from the experts. I am Eon Engelbrecht, and every week, I’ll be
chatting with Doctor Clifford Yudelman, taking a nice deep dive into the world of dental
care from a consumer’s perspective. Whether you’re looking to brighten that smile or
protect your wallet, we’ve got you covered with practical advice and the latest insights.
So stick around as we uncover the secrets to maintaining both your dental health and
your finances. Doctor Yudelman, welcome once again.
[00:00:54] Dr Clifford Yudelman OptiSmile: Hi. Thank you. Thanks for having me
back.
[00:00:57] Eon Engelbrecht E-Radio-SA: So today, we’ll discuss the myths and
realities of wisdom teeth. Let’s get into it. What are some common myths about wisdom
teeth? And what facts debunk these myths?
[00:01:11] Dr Clifford Yudelman OptiSmile: Oh, that’s a great question. So, first of all,
one of the myths is that everyone has wisdom teeth. And the fact is not everyone
develops wisdom teeth. We often see patients that don’t have any wisdom teeth and
then other people have one. Sometimes, we even see patients that have all four
wisdom teeth plus an extra tooth called a supernumerary. So you can even have 5 or 6
wisdom teeth. Um, so if you were born without wisdom teeth, then you’re very lucky.
The other one is that wisdom teeth always need to be removed. So that’s not true at all.
A lot of patients we see have space, and their wisdom teeth come in, and they’re able to
keep their wisdom teeth clean, and they use them for chewing. And function normally.
So, I don’t like to refer patients to get their wisdom teeth out just because they’ve got
wisdom teeth. I do have a few rules of thumb that we’ll probably cover later today, but
removal is only necessary if they’re causing pain if they’re impacted or if they could lead
to other dental complications.
[00:02:30] Dr Clifford Yudelman OptiSmile: And the last myth that’s probably one of
my favourites is the myth that wisdom teeth cause crowding of the front teeth. There are
a lot of studies now that show that wisdom teeth do not exert enough pressure to cause
the shifting of your front teeth. We see that shifting around the same age that the
wisdom teeth come in. So between age 18 and 21, people naturally have shifting, even
if they had their wisdom teeth out when they were 17. Those lower front teeth can still
shift with or without wisdom teeth, and getting your wisdom teeth out to avoid crowding
is definitely a myth. Some dentists listening to this might disagree with me, but I’m here
for the consumer, not to protect the dental profession. I’m not here to knock any other
dentists, and people should always listen to whatever their own dentist tells them. So,
you can also Google this. Um, I use https://Perplexity.ai And look up only published
articles. Not what people have on their websites.
[00:03:40] Eon Engelbrecht E-Radio-SA: Doctor Yudelman, when should one consider
having their wisdom teeth removed? How do you know?
[00:03:46] Dr Clifford Yudelman OptiSmile: So most people know when the wisdom
tooth is giving trouble because generally it’s we see it when people are going in for their
matric exams around that age or in their first year or second year of university when
they’re under stress. So maybe the wisdom tooth is poking in. Often it’s a lower wisdom
tooth that’s poking through the gum, and it’s taking its time coming in. And then if you
take an x-ray, that wisdom tooth is actually tilted forward, and there’s not enough space
for the wisdom tooth. The gum around the wisdom tooth would get very irritated. It’s
called pericoronitis, and it can actually turn into a very serious infection. So, the very
first time you get a pericoronitis, the dentist can prescribe a warm salt water rinse or a
medicated mouthwash. If your face is swollen or, you can’t open your mouth, or if you’ve
left it a little bit too long, we often will give Augmentin or Amoxicillin. And if that doesn’t
work on its own, we’ll give other antibiotics. If you keep it very clean, you can wait until
after exams or until it flares up the next time.
[00:04:57] Dr Clifford Yudelman OptiSmile: But if that tooth is not going to come in on
its own, that would be a good time to get a panoramic x-ray or, in some cases, even a
CBCT, which is a 3D x-ray. At OptiSmile, if we do a panoramic x-ray and see impacted
wisdom teeth, we’ll go ahead and take a Cbct. That’s an R3500 x-ray. We do these at
no charge because the patient has already had one x-ray. So we don’t like to charge for
both of them. But we want to see where the wisdom teeth are and whether we need to
refer them. So, as I said, you’ll get pain and discomfort, gum inflammation. Your gums
will be red, swollen or infected behind your last molar, and sometimes it will be on an xray; the dentist would see a cyst or something that is affected the the wisdom tooth,
which would definitely mean that it needs to come out. And there are times where this
can affect the nerve in the jawbone and lead to other problems.
[00:05:58] Eon Engelbrecht E-Radio-SA: Why is it often recommended to remove
wisdom teeth that aren’t currently causing problems?
[00:06:06] Dr Clifford Yudelman OptiSmile: Generally, if a patient… The rule of thumb
that I’ve been using and I’ve been in practice for over 40 years now, in fact, 41 years, is:
If wisdom teeth are very impacted, they are completely covered in bone, and the patient
is over the age of 30, and the tooth has never given problems and looks like it will never
give a problem, there’s no sign of any cyst starting. I’ll generally tell the patients that
we’ll monitor this. We’ll take an x-ray every 3 to 5 years and not recommend that they
have these teeth out. If a person has had 1 or 2 episodes with one or more wisdom
teeth, and it looks like the other wisdom teeth are going to give problems in the future,
and they’re younger, I will try and refer them as early as possible. When I was practising
in the US and Australia, we were referring patients for wisdom teeth extractions as
young as 16 or 17. I tend to see, since I’ve been back in South Africa for ten years, as
we’re getting, uh, patients that are already 27, 28, and they’ve had a number of flareups or the bone around the wisdom tooth or the second molar is being destroyed by the
wisdom tooth, and so we would always refer those. Generally, the younger you are, the
quicker the recovery. So, by younger, I mean under 30. But a 20-year-old will recover
quicker than a 25-year-old in general. And also, it’s less complicated surgery. If you
remove a wisdom tooth before the roots are fully developed, then it’s a much simpler
surgical process, and the tooth is almost got like a little sac around it. And I tell patients
it’s like a, it’s like a watermelon seed, it just wants to pop out. If you see an oral surgeon
or if a general dentist does a lot of wisdom teeth, it can be done quite quickly and easily.
[00:08:05] Eon Engelbrecht E-Radio-SA: When we come back, we will be talking
about the potential risks or complications associated with leaving wisdom teeth in place.
Stay tuned.
[00:08:16] Eon Engelbrecht E-Radio-SA: Welcome back to “Save Your Money. Save
Your Teeth” on the radio with Doctor Clifford Yudelman from OptiSmile. We are talking
about wisdom teeth. Doctor Yudelman, what are the potential risks or complications
associated with leaving your wisdom teeth in place?
[00:08:39] Dr Clifford Yudelman OptiSmile: So, thanks for that. So infection and
decay. So wisdom teeth are very hard to reach and clean, which can lead to decay and
gum disease. So often, I’ll see a patient where the whole mouth is very clean and their
teeth are perfect, there’s no cavities, but they struggle to keep a partially erupted or a
wisdom tooth right at the back, say, on the upper that’s come in a little bit crooked. They
struggle to keep that clean, and they get a bad taste or smell. There’s some gum
disease there, and we find when the patient gets that wisdom tooth out, or if there’s
more than one, they get them out. Their whole mouth is much easier to clean than their
breath is fresher, often on a lower wisdom tooth that’s leaning forward. We’ll find, not
that often, but certainly maybe once or twice a year. I’ll see a patient who comes in
where the dentist has left a wisdom tooth alone, and food gets stuck on the lower
between the wisdom tooth and the second molar, and the root of the second molar gets
a cavity. Sometimes, the patient can end up with a root canal or even lose a perfectly
good second molar.
[00:09:53] Dr Clifford Yudelman OptiSmile: You know, cysts and tumours are not that
common, but it is something that can happen and also damage to adjacent teeth. You
know, if you leave wisdom teeth in place and you wait too long and you get it out when
they eventually do give a lot of problems when you 50 or 60, there’s more chance of
damage to your nerve when the surgeon takes the tooth out. Every dentist has got their
own guidelines or philosophy, depending on what courses they’ve taken and and what
journals they’ve read. I would recommend that anytime someone is looking at having
any type of surgery, you get more than one opinion. If you have a general dentist who
recommends taking out the wisdom teeth and he wants to do it himself, you know,
sometimes getting a second opinion from an oral surgeon isn’t a bad idea. If the oral
surgeon says yes, they need to come out, then at least that’s two opinions right there. I
don’t want to upset too many dentists by sprouting too many of my own philosophies on
that. So I think, let’s leave it at that.
[00:11:05] Eon Engelbrecht E-Radio-SA: Is it best to have wisdom teeth removed
under general anaesthesia or local anaesthesia? What factors influence this decision?
[00:11:16] Dr Clifford Yudelman OptiSmile: So let’s say, for instance, you’ve got lower
impacted wisdom teeth, meaning they’re leaning forward or they’re leaning backward,
and there’s not enough space. And it’s going to be quite a job for the oral surgeon to
remove those two teeth. And the upper wisdom teeth will then also need to be removed,
because they will just keep growing down and cause gum issues or cavities like what
we discussed. So, if you’re going to be considering getting four wisdom teeth out, my
general advice would be to go to an oral surgeon and get them done under general
anaesthesia in the hospital. If you’re on medical aid, they generally will cover the
procedure as an in-hospital, procedure, you get better coverage. It ends up being a lot
cheaper if you get it done in a dentist’s chair. It’s a lot of numbing and a lot of
unpleasant drilling and removing of bone and suturing. This is the type of stuff it was
me, myself. You know, I got my wisdom teeth out when I was in second-year dental
school, and I think I was knocked out for all of about 20 minutes. And once you’re out,
the oral surgeon can go to work and do a very good job. If you’re awake it will definitely
take longer if you’re awake. And as I say, lots of injections and even with the numbing it
can still be unpleasant. If you’re in your 20s or 30s and you’ve got just one wisdom tooth
that’s partially erupted, or maybe it’s an upper wisdom tooth that’s over-erupting, maybe
you had your bottom ones out, or they’re fully impacted. It can be quite a straightforward
and simple procedure to just get one wisdom tooth numb and and to get it pulled out in
a traditional fashion. So, it varies from case to case. I think for me the best, the best
thing is to get a general anaesthetic. That’s what I would always advise in most cases.
[00:13:22] Eon Engelbrecht E-Radio-SA: And doctor, can the removal of wisdom teeth
improve one’s oral health? Or is this purely a preventative measure?
[00:13:30] Dr Clifford Yudelman OptiSmile: I definitely think it can improve your
health. If you’ve got wisdom teeth that are very, very difficult to clean. They bleed when
the hygienist cleans your teeth, you can’t floss them. Maybe you’ve already had a filling
and a wisdom tooth, and now the filling is broken or fallen out, because the dentist
struggles to get all the way back there. Even with a microscope, sometimes we can
barely see all the way back to the back of the mouth to fill a cavity in a wisdom tooth.
You you generally wouldn’t get a root canal or a crown on a wisdom tooth. We’re talking
about where there’s not enough space. If somebody’s got perfectly erupted wisdom
teeth that are in perfect alignment, and you’ve got your first, second and third molars,
and you’re chewing on them, we definitely would recommend, you know, hanging on to
them and keeping them as long as possible. But in the cases that I’ve spoken about is,
there’s a real benefit to removing them sooner rather than later if they’re not going to
stay there for the rest of your life and they’re going to give you problems when you’re
older. When I practised in America, I had a lot of patients in their 70s and 80s and back
in those days in 1989, 1990, most people who were in their 70s were on blood thinners,
and they’d had a bypass or some kind of heart issues, or patients that had had breast
cancer or some other kind of skin cancer had been on chemotherapy. People’s health
back in the 90s wasn’t as good as it is now. And a wisdom tooth that you’ve kept your
your whole life and you’ve managed to keep clean now all of a sudden can become a
life-threatening problem. Because if you’re on blood thinners to prevent strokes or heart
attacks, you have to stop the blood thinners. You know, I think this type of thing is best
to do while you’re fit and healthy if you need it, if you need to have it done at all.
[00:15:27] Eon Engelbrecht E-Radio-SA: And then, finally, doctor Yudelman, what
should patients expect during and after the removal of wisdom teeth? Can you give us a
nice heads-up there as to what we can expect?
[00:15:41] Dr Clifford Yudelman OptiSmile: So it varies from person to person.
Generally, if your lower wisdom teeth are impacted, depending on the severity of the
impaction, the dentist or the oral surgeon would be able to advise you how much pain or
swelling to expect. Sometimes, we don’t expect patients to have pain or swelling, and
they have a big reaction, and they can look like a chipmunk for 2 or 3 days afterwards.
And other times, patients can get their wisdom teeth out on a Thursday, and they, you
know, they in their early 20s, they can be out partying with their mates by Saturday. It’s
not generally recommended after a general anaesthetic. You should take it easy. But
we have seen that. Personally, myself, I was fine a few days later. Both of my daughters
had their wisdom teeth out and they both had quite severe swelling. They were in bed
for a couple of days with ice packs. It is you know, the oral surgeon generally would
prescribe strong painkillers. Personally, I don’t like things that have codeine or these
addictive types of painkillers that are shown on Netflix. I think one was called
“Painkiller”. I like patients to take Ibuprofen and Panado alternating. And I think, for
most cases, that works very well. You take Ibuprofen with food, and you try to eat and
drink as much as you can after your wisdom teeth are out, and you rinse with warm salt
water. You use a Chlorhexidine mouthwash for a few days, and the swelling and the
pain goes away quite quickly. Most people, if you get them out on a Thursday or Friday,
you can be back at school or work on the Monday in most cases. And as I said, if you’re
getting a general anaesthetic, you might it might take 20 minutes to an hour to take all
the wisdom teeth out. If you’re getting it done in the chair and you’re getting injections, it
could take much longer.
[00:17:47] Eon Engelbrecht E-Radio-SA: And that’s another edition of “Save Your
Money, Save Your Teeth”, doctor Yudelman, as always, a big thank you to you for
sharing your expertise with us.
[00:17:58] Dr Clifford Yudelman OptiSmile: Well, thank you, and I guess in this case,
it’s. Save your money, and don’t save your wisdom teeth if they give you trouble.
[00:18:09] Eon Engelbrecht E-Radio-SA: That’s it. Absolutely. Thank you to our
listeners for tuning in. Remember, while we strive to provide valuable insights, always
consult with your own dental professional for advice tailored to your personal health.
Also, don’t forget to subscribe for more enlightening discussions and then join us again
next week as we continue to explore the fascinating intersection of dental, health, and
financial savvy. Until then, keep smiling and taking great care of your teeth.
[00:19:01] Speaker4: Discover the world of dental excellence with OptiSmile. Join us for
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