"Most people tend to think that it's more painful than it really is," said William Synan, D.D.S., UI associate professor of dentistry and director of the UI Predoctoral Oral and Maxillofacial Surgery Clinic. "For many people, it's their first exposure to surgery, so being nervous is natural. However, they talk to their siblings and friends, who present scenarios typically filled with embellishments. That leaves the patient expecting the worst.

Called "wisdom teeth" because they emerge later in life, the upper and lower third molars generally cause problems because there is not enough room in the mouth for them to erupt, or break through the gum, into a normal position. As a result, the molars are impacted in the gum or bone.

Wisdom teeth may need to be removed for a number of reasons. The most common reason, according to Synan, is when only a small portion of the tooth breaks through the gum, making cleaning difficult. Bacteria can get under the gum and cause inflammation and infection. When wisdom teeth are in malposition, or come in crooked, they can cause bone loss, tooth decay or loss of the teeth in front of them. Upper wisdom teeth that point outwards can also cause the patient to frequently bite their cheeks, possibly resulting in an ulceration of the cheek tissue.

Routine dental X-rays are generally a good indicator of when wisdom teeth need to be removed. However, people experiencing pain or an ache in the jaw, gum swelling around the wisdom teeth or soreness when swallowing should have their wisdom teeth checked, Synan said.

Not everyone's wisdom teeth must be removed. If the molars are fully erupted and functional, dentists let the teeth remain, but continue to monitor them. If your wisdom teeth do need to be removed, Synan recommends having surgery between the ages of 17 and 21, although the procedure can be performed long after that if necessary.

"As an individual gets older, the bone becomes more calcified and less elastic, and as a result, the post-operative healing period may take a little bit longer," Synan said. "The younger the individual, the better their healing capacity.

While having your wisdom teeth removed is a minor surgery, individuals who need the procedure but choose not to have the surgery place themselves at serious risk.

"If the teeth aren't removed some patients can develop a serious, life-threatening infection," Synan said. "We have a number of cases each year that have to be admitted to the hospital because the infection may compromise the airway.

Other potential complications of not removing wisdom teeth in a timely way include continual bone loss or development of cysts. Synan said an untreated cyst could expand to the point where it creates a jaw fracture.

To prepare for routine wisdom teeth surgery, patients should follow their surgeon's specific orders. Generally, patients will need a person to drive them to and from the surgery and will need to fast for six hours prior to surgery if they are receiving anesthesia.

During surgery to remove impacted wisdom teeth, an incision is made in the gum near the wisdom teeth. Depending on the type of extraction, the tooth can be removed with forceps or the tooth may be sectioned into several pieces in order to be removed. Sometimes, bone adjacent to the tooth may need to be removed in order to extract the tooth. When the surgeon is done extracting the teeth, dissolvable sutures are placed.

"The majority of patients tend to have the most discomfort during the first 24 to 48 hours post-operatively," Synan said. "Meanwhile, the swelling typically reaches its peak 48 to 72 hours after the procedure.

Synan said patients generally are back to their normal routine within three to five days after the surgery. To aid healing and recovery, patients should follow their surgeon's guidelines for diet and oral hygiene.

For the first 24 to 48 hours following surgery, patients should stick to a pureed or liquid diet and then progress to a normal diet over a period of several days. Avoid sharp foods (like potato chips), hard-to-chew foods, foods with seeds or kernels (like popcorn) or any food that could become lodged in the surgical site.

To help control bleeding after surgery, patients are asked to bite on gauze. Ice packs can be used to reduce swelling. Surgeons warn against spitting, gargling or using straws for the first 24 hours after surgery. This allows a blood clot, which aids in healing, to form in the tooth socket.

If a blood clot does not form or is lost prematurely, a dry socket can develop. According to Synan, this may be the most common post-operative complication associated with wisdom teeth removal, especially with the lower wisdom teeth. A dry socket creates a dull, throbbing ache at the back of the jaw. Usually noticed about three to four days after surgery, Synan estimates dry sockets occur in about 10 to 15 percent of third molar cases.

A surgeon can place a sedative medication in the socket to alleviate pain associated with a dry socket.

As with all medical care, it is best to consult with your physician or surgeon before making any changes to your health care routine.

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William Synan, D.D.S.