By the age of 18, the average adult has 32 teeth: 16 teeth on the top and 16 teeth on the bottom. Each tooth in the mouth has a specific name and function. The teeth in the front of the mouth (incisors, canine, and bicuspid teeth) are ideal for grasping and biting food into smaller pieces. The back teeth (molar teeth) are used to grind food up into a consistency suitable for swallowing.

The average mouth is made to hold only 28 teeth. It can be painful when 32 teeth try to fit in a mouth that holds only 28 teeth. These four other teeth are your third molars, also known as “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 are the last teeth to erupt within the mouth. When they align properly and gum tissue is healthy, wisdom teeth do not have to be removed. Unfortunately, this does not generally happen. The extraction of wisdom teeth is necessary when they are prevented from properly erupting within the mouth. They may grow sideways, partially emerge from the gum, and even remain trapped beneath the gum and bone. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to successfully erupt.

These poorly positioned impacted teeth can cause many problems. When they are partially erupted, the opening around the teeth allows bacteria to grow and will eventually cause an infection. The result: swelling, stiffness, pain, and illness. The pressure from the erupting wisdom teeth may move other teeth and disrupt the orthodontic or natural alignment of teeth. The most serious problem occurs when tumors or cysts form around the impacted wisdom teeth, resulting in the destruction of the jawbone and healthy teeth. Removal of the offending impacted teeth usually resolves these problems. Early removal is recommended to avoid such future problems and to decrease the surgical risk involved with the procedure.

Having Third Molar Surgery from

Pain Managment: Any surgical procedure is associated with some level of discomfort. We use many forms of pain management. This begins with becoming familiar with the choices that are available and understanding how to use the drugs we prescribe. Prevention is the best pain management tool. We use a number of medications to prevent pain before it starts:
Pre-surgical IV Steroids: These medications help decrease swelling, pain and nausea.

Pre-surgical antibiotics: One dose of antibiotics prior to the beginning of surgery not only helps prevent infection but actually helps decrease post surgical pain.

Long acting local anesthetics: One of the most exciting developments is a drug called Exparel. This non-opioid local anesthetics is injected around the surgical site at the end of surgery. It helps keep the area numb for up to two to three days. This along with the other pain management techniques allows us to avoid the use of narcotics.

Usually with the above mentioned pain management techniques we can limit the analgesics you need to use to over the counter drugs like ibuprofen (Advil) and acetaminophen (Tylenol). The doctors and the staff will go over all your options before surgery.

Recent Advancements

Dynamic Image Guided Surgery for the removal of Complex Wisdom Teeth

The use of cone beam computed tomography (CBCT or iCAT) has allowed Dr. Emery to evaluate the position of the impacted wisdom teeth with three dimensional imaging. This is useful in situations of higher risk, for example in situations in which the sensor nerve to the lip and chin (the inferior alveolar nerve) is tangled up with the roots of impacted lower molars.

These new imaging techniques allow us to locate the nerve with more accuracy. Until recently this information could only be used to evaluate the location of the anatomy. Dynamic image guided surgery now allows us to use this information actively during surgery. Using stereotactic surgical instrumentation, Dr. Emery can visualize the position of your third molar and the instruments used to remove the tooth “live” while they are operating. This allows them to see the position of the nerve and the root tips and avoid damaging the nerve.

Prevention of Dry Sockets

Dry sockets are a common complication of wisdom tooth removal. This usually occurs from 48 to 72 hours after extraction. The symptoms include pain, throbbing, and a bad taste in the mouth. Until recently up to 10% of lower third molars removed resulted in dry sockets or alveolar osteitis. Dr. Emery uses a material indicated for the treatment of periodontal disease to prevent this uncomfortable condition. Arestin has dramatically decreased the incidence of dry socket in our patients.

Oral Examination

With an oral examination and x-rays of the mouth, Dr. Emery can evaluate the position of the wisdom teeth and predict if there are present or may be future 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. Emery has the training, license, and experience to provide various types of anesthesia for patients to select the best alternative.


In most cases, the removal of wisdom teeth is performed under local anesthesia, laughing gas (nitrous oxide/oxygen analgesia), or general anesthesia. These options, as well as the surgical risks (i.e., sensory nerve damage, sinus complications), will be discussed with you before the procedure is performed. Once the teeth are removed, the gum is sutured. To help control bleeding, bite down on the gauze placed in your mouth. You will rest under our supervision in the office until you are ready to be taken home. Upon discharge, your postoperative kit will include postoperative instructions, a prescription for pain medication, antibiotics, and a follow-up appointment in one week for suture removal. If you have any questions, please do not hesitate to call us at (202) 386-7100.

Our services are provided in an environment of optimum safety that utilizes modern monitoring equipment and staff who are experienced in anesthesia techniques.