Wisdom Teeth Removal

Oral Examination for Extraction of Wisdom Teeth

Wisdom Teeth Presentation

To provide you with a better understanding of wisdom teeth, we have provided the following multimedia presentation. Many common questions pertaining to wisdom teeth are discussed.

Wisdom Teeth Presentation

With an oral examination and x-rays of the mouth, Dr. Rotwein can evaluate the position of the wisdom teeth and diagnose if there are present problems.  Dr. Rotwein will also give the prognosis for future potential problems. Studies have shown that early evaluation and treatment result in a superior outcome for the patient. Patients are generally first evaluated in the mid-teenage years by their dentist, orthodontist, or by an oral and maxillofacial surgeon.

All outpatient surgery is performed under appropriate anesthesia to maximize patient comfort. Dr. Rotwein is credentialed, highly trained and thoroughly experienced in safely providing intravenous anesthesia for qualifying patients.

Do You Want Your Wisdom Teeth Removed?

If your wisdom teeth are causing you pain or you want to avoid future problems, contact our office to schedule an appointment.

Why should I have my wisdom teeth removed?

If you do not have enough room in your mouth for your third molars to fully erupt, a number of problems can happen. Impacted wisdom teeth should be removed before their root structure is fully developed. In some patients it is as early as 12 or 13, and in others it may not be until the early twenties. Problems tend to occur with increasing frequency after the age of 30. Some of the possible problems related to not removing your wisdom teeth include:

A representation of a pericoronitis infection on a wisdom tooth


The most frequent clinical problem we see is pericoronitis, (a localized gum infection). Without enough room for total eruption, the gum tissue around the wisdom tooth can become irritated and infected, resulting in recurrent pain, swelling, and problems with chewing and/or swallowing.

An example of a cyst formation on a wisdom tooth

Cyst Formation:

Non-infectious diseases may also arise in association with an impacted wisdom tooth. Cysts are fluid-filled “balloons” inside the jaw bone that develop as a result of impacted teeth and slowly expand destroying adjacent jaw bone and occasionally teeth. They can be very difficult to treat if your wisdom teeth are not removed in your teenage years. Although rare, tumors can be associated with the delayed removal of wisdom teeth.

An illustration of teeth crowding caused by a wisdom tooth

Possible Crowding:

It is not a scientific fact that Impacted wisdom teeth  contribute to crowding of your teeth.  This is the most common misconception with which patients present.  It may be secondary to the fact that shifting of teeth occurs naturally with age and a patients symptoms tend to arise when they reach an age where has becomes noticeable.  This is especially the case in patients with previous orthodontic care who have had relapse of teeth back to their pre-othodontic position.  The bone of the jaw housing the teeth has an elastic quality, and unless a patient is thorough wearing a retainer, the teeth may have a tendency to shift after braces are removed.  The feeling of pressure from the affected wisdom tooth coupled with signs of crowding is the typical situation leading to this assumption that the wisdom teeth are the cause.  When a patient is pain free without symptoms from the wisdom teeth the recommendation for removal is primarily to prevent foreseeable problems that occur from improper positioning which causes an inability to perform adequate oral hygiene.  This can lead to localized, chronic gum disease, bone loss, and decay of the wisdom teeth as well as compromise and loss adjacent molars.

A visual of a wisdom tooth damaging an adjacent tooth

Damage to Adjacent Teeth:

When a patient is pain free without symptoms from the wisdom teeth, a recommendation may still be to have them removed.  This recommendation is primarily to prevent foreseeable problems that occur from improper positioning.  This causes an inability to perform adequate oral hygiene.  Over time bacterial toxins cause chronic gum disease, bone loss and decay of the wisdom teeth as well as compromise and loss of adjacent molars.   This pattern of dental disease caused by misaligned wisdom teeth is completely predictable and completely avoidable by simply removing the wisdom teeth in mid to late teens and early twenties.

What if I don’t have my wisdom teeth removed as a teenager or young adult?

As wisdom teeth develop, the roots become longer and the jaw bone more dense. When it is necessary to remove impacted wisdom teeth in your thirties, forties or beyond, the post-operative course can be prolonged and there is a higher complication rate. Treating these complications is often more difficult and less predictable than with a younger patient. Healing may be slower and the chance of infection can be increased. If your impacted wisdom teeth are not removed in your teenage years or early in your twenties and they are completely impacted in bone, it may be advisable to wait until a localized problem (such as cyst formation or localized gum disease and bone loss) develops. In general, you will heal faster, more predictably and have fewer complications if treated in your teens or early twenties.

What happens on the day wisdom teeth are removed?

Most people prefer to be unaware of the experience when they have their wisdom teeth removed and usually decide to be sedated. You will be provided with appropriate anesthesia options at your consultation. All outpatient surgery is performed under appropriate anesthesia to maximize your comfort. Our office staff has the training, licensing, and experience to provide intravenous anesthesia. These services are provided in an environment of optimum safety, utilizing modern monitoring equipment and a well trained experienced staff. The Surgical Care Team, the office facilities, and the doctors are inspected on behalf of the Board of Dental Examiners on a regular basis.

On the day of your procedure, you will take medications to help minimize post-operative pain and swelling. We ask that a parent or responsible adult accompanies you to the office and plans to stay with you the rest of the day. Recent advances in medicine and technology allow patients to undergo wisdom tooth removal in a manner, which promotes rapid healing and minimal post-operative discomfort. State-of-the-art sterilization and infection control techniques are used at all times.

On the day of your surgery, it is essential that you have nothing to eat or drink (excluding prescription medications with a sip of water) for at least 8 hours (preferably longer). This does not mean you should try to fit in one “last meal” exactly 8 hours before your surgery. Having anything in your stomach can increase the risk for serious anesthetic complications, including nausea and vomiting. Your procedure will be rescheduled if you have not heeded these guidelines. When you are seated in the surgical room, we will make every effort to make you as comfortable as possible, to do so it is best if you wear loose comfortable clothing, closed toe shoes and bring your own blanket.. If you are going to be sedated, we usually will place an IV in your hand or arm. This ensures optimal delivery of your medication. Local anesthesia is given to you once sedated to ensure comfort, and allow adequate time to travel home and rest. You will be sleepy for a significant portion of the day.

smiling teenage son with his mother

The Day of Treatment

Be sure to have an adult 18 years or older with a valid drivers with you with you during your appointment.  Minors must be accompanied by a parent or legal guardian only.  Make sure you have informed your escort that they must stay in the office throughout the procedure so they are available to take you home, get your medications and visually monitor you for the next 24 hours as it may take a while for medication to wear off and you will need help to be safe.

If your surgery requires stitches, these are usually the type that dissolve in 3 to 7 days and do not require removal. You may also notice a sensation of your gums feeling swollen and pulling away from your teeth. This is all part of the normal recovery, and will subside in several days.

Once the local anesthesia wears off, you may require prescription pain medication. Please try non-narcotic anti-inflammatory medications such as ibuprofen (Advil®) first, to see if that adequately treats your pain. If not, begin your other prescription pain medication. The local anesthesia may last until the following day, and longer in extremely rare cases. We recommend starting your post-operative diet with clear liquids such as jello and broths, gradually increasing in substance as your body permits.

We do not recommend eating anything to heavy or greasy on the day of surgery, as nausea and vomiting may develop in conjunction with the anesthetic and pain medication. If you are given antibiotics and you take birth control pills, please be aware that the birth control pills might become ineffective and take appropriate precautions.

What does wisdom tooth removal cost and is it covered by insurance?

The fee for your treatment is determined by a number of factors. These may include the difficulty involved in removing your teeth and which type of anesthesia is best for you. During your consultation appointment, the surgeon will need to review your x-rays, complete an examination and determine the best option for anesthesia, before an accurate estimate can be provided. Every insurance company has a different policy regarding the extent of coverage for a given surgical procedure. The oral surgeon’s office staff will help you obtain maximum insurance coverage for your treatment.

What if I have questions before surgery?

At the time of your consultation, your specific situation will be discussed in greater detail. We encourage you to ask any questions you may have. If new questions arise after your consultation, please call our office at Big Island Oral Surgery Office Phone Number 808-649-5099 to speak to one of our patient care coordinators.

A smiling woman

Before The Day of Treatment

Please thoroughly review the pre anesthesia instructions provided by the office.  If you have misplaced them or if you have any questions please call the office before your scheduled appointment. 

Do You Want Your Wisdom Teeth Removed?

If your wisdom teeth are causing you pain or you want to avoid future problems, contact our office to schedule an appointment.