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Wisdom Teeth Extractions


Wisdom Teeth

Most people start getting their third molars (also called wisdom teeth) when they reach their late teens or early twenties. In many cases, the jaws are not large enough to accommodate these teeth and they remain under the gum (impacted).


When a tooth develops, it travels to its appropriate position in the dental arch. If the path to eruption through the gum is prevented due to the size of the jaw, the tooth will become partially or totally blocked (impacted).


Serious problems can develop from partially blocked teeth such as infection, and possible crowding of and damage to adjacent teeth. More serious complications can develop when the sac that surrounds the impacted tooth fills with fluid and enlarges to form a cyst, causing an enlargement that hollows out the jaw and results in permanent damage to the adjacent teeth, jawbone and nerves. Left untreated, a tumor may develop from the walls of these cysts and a more complicated surgical procedure would be required for removal.

The Extraction Process

  • An incision is made in the gum tissue to expose the tooth and bone.

  • If any bone is blocking access to the tooth root, it is removed.

  • The tooth is divided into sections - if it's easier to remove in pieces.

  • The tooth is removed.

  • The site is cleaned of any debris from the tooth or bone.

  • The wound is stitched closed to promote healing, though this isn't always necessary.

  • Gauze is placed over the extraction site to control bleeding and to help a blood clot form.



Generally, after surgery the patient experiences some swelling and discomfort. However, with personalized postoperative instructions and medications, Dr. Skigen can reduce the possible discomfort following surgery. If you should have any problems such as excessive bleeding, discomfort, or difficulty in opening your mouth, call our office immediately for further instructions or additional treatment recommendations.

Four Different Types of Impacted Wisdom Teeth:

When a wisdom tooth erupts through the gums and into the open it is known as an eruption. However, when a tooth doesn’t fully grow in, it is “impacted” – usually unable to break through the gums because there isn’t enough room.

There are four common types of impaction we see at First Coast Oral Surgery. Understanding the different types of impacted wisdom teeth is helpful. Depending on which type you experience, it may or may not require surgery and removal.

Vertical Impaction


This happens when your third molar puts pressure on the underside of the molar in front. Vertically impacted wisdom teeth can normally be extracted using a local anesthetic. IV sedation would only be required in the case of an extremely nervous patient.

Distal Impaction


Distal impaction is the least common of the four types of impactions and is the exact opposite of a mesial impaction – the tooth is angled toward the back of the mouth. Depending on the severity of the impaction, IV sedation or even general anesthesia may be required to undergo the surgery.

Mesial Impaction


Mesial impaction is the most common type of wisdom tooth impaction, in which the tooth is angled toward the front of the mouth, pushing against the molar in front of it.  Mesial impactions most often lead to a partial eruption, where only the bottom of the tooth pokes into the gums.

Horizontal Impaction


This is the most painful type of impaction as the tooth or teeth grow in sideways, fully beneath the gums, pushing forward on the molar in front of it. This type of impaction will likely cause damage to surrounding teeth and unbearable pain if it isn’t taken out. 

If you have been putting off wisdom teeth surgery, give us a call – we can give you the calm, safe, comfortable experience you are looking for!

Type of Impaction

Choosing the Right Doctor for You

As oral surgery specialists with extensive training and experience, we are able to offer a different kind of “wisdom teeth experience” to our patients and their families. We are with you every step of the way and pay extra attention to the most critical parts of your child’s care, including:

  • We offer multiple forms of Anesthesia and IV Sedation.

  • Compassion and comfort to make the experience as pleasant as possible.

  • Home care and after-hours contact information.

  • A thoughtful surgical strategy to minimize the need for invasive techniques.

  • Careful consideration of timing to ensure the easiest recovery possible.

Learn more about our doctors:

What is the right time to remove your Wisdom Teeth?

The key to timely attention to third molars is regular x-rays of the mouth. With the help of these pictures Dr. Skigen can frequently predict if the wisdom teeth are going to cause trouble, either in the near future or later in life. If so, chances are Dr. Skigen will recommend their removal rather than wait for trouble to occur. Removal is easier in younger patients. Roots are not yet fully developed and the bone is less dense. Recovery is also easier if the surgery is done at an earlier age. Please call us with any questions! We have three conveniently located First Coast Offices around North Florida, Jacksonville, FL, Amelia Island, FL, and Lake City, FL - every office is dedicated to the success of your oral health!

Anesthesia and Sedation Options

The vast majority of patients have their wisdom removed right in one of our offices - Jacksonville, FL, Lake City, FL, or Amelia Island, FL. Improvements in surgical technique and sedative medications allow patients to have their impacted wisdom teeth removed comfortably and efficiently in a pleasant environment that is far less costly and intimidating than the hospital setting. There are several anesthetic options available to provide patients with the optimum in comfort during their surgery and minimize the postoperative side effects. You will have the opportunity to discuss these options, as well as your individual needs and concerns

with Dr. Skigen at the consultation appointment.


General Anesthesia | General Anesthesia affects the brain as well as the entire body. It is for patients who are extremely anxious or for procedures that can be uncomfortable. It is given thru an IV and combinations of medications provide the effects. With general anesthesia, you are completely unaware and wake up with the procedure being finished. Patients who choose this option are required to not eat or drink anything for eight hours prior and have a responsible adult to care for them and drive them home.


Local Anesthesia  | Without a doubt every patient’s anxiety starts with “the shot”. Of course, it is better to be numb than not during the procedure, so we make every effort to alleviate any discomfort. We start with a topical anesthetic that pre-numbs the injection site. We wait adequate time for the anesthetic to work and test the area before beginning any procedure. When the lower jaw is anesthetized the patient should feel tingling or numbness in the lower lip. When the upper jaw is anesthetized, the upper lip or nose might feel numb or tingling.

Learn more about our Anesthesia and Sedation Options!


The Trouble with Wisdom Teeth

There are unhealthy circumstances that might prompt your dentist to recommend removing your impacted wisdom teeth:



Impacted wisdom teeth often become decayed or infected because they're hard to reach with your toothbrush. Bacteria around the impacted tooth can lead to gum disease and enter your bloodstream, adversely affecting your heart and other organs of your body.

Cysts and Benign Tumors:


Fluid-filled cysts or tumors occasionally form around the bottom of an impacted wisdom tooth, causing damage to the jawbone, nerves in the area and nearby teeth.

Crowding and Alignment Issues:


Impacted wisdom teeth crowd your mouth, causing misalignment issues as they erupt and mature, even if you have had braces

Damage to Nearby Teeth:


Healthy teeth can be damaged as impacted wisdom teeth push against your neighboring second molars.

If you have been putting off wisdom teeth surgery, give us a call – we can give you the calm, safe, comfortable experience you are looking for!

  • How Many Implants Do I Need?
    Most frequently, one implant per missing tooth is placed. Because many of the larger teeth in the back of your jaws have two or three roots, the most common approach is to replace missing back teeth with larger implants.
  • What will I use for teeth while the Implants heal?
    Many options are available, and they are tailored to your specific requirements. If you need a replacement tooth while the implants are healing, temporary removable teeth or a temporary bridge can be made. If all of your teeth are missing, we can usually modify your present complete denture or make you a new temporary denture. If you would prefer non-removable teeth during the healing phase, temporary transitional implants usually can be placed along with the permanent implants, and temporary teeth may be made and inserted the same day. Depending on your particular situation, some implants can be placed and “loaded” immediately. This means a temporary or permanent replacement tooth can be placed on, or shortly after, the day the implant is placed.
  • What are the potential problems with Implants?
    Although it is natural to be concerned about the pain that may be caused by these procedures, most patients do not experience severe or significant post-operative pain. Pain medication and antibiotics will be prescribed for you to make your recovery as easy as possible. Occasionally, some people develop post-operative infections that require additional antibiotic treatment. Even though great care is taken to place the implant precisely, occasionally adjacent teeth are injured in the placement process. In addition, there is a chance that the nerve in the lower jaw, which provides sensation to your lower lip and chin, may be affected. If you are missing quite a lot of bone, it might be difficult to place an implant without infringing on the nerve space. Although we take great care to avoid this nerve, occasionally it is irritated during the procedure, resulting in tingling, numbness or a complete lack of sensation in your lip, chin or tongue. Usually these altered sensations will resolve within time, but they can be permanent and/or painful. If you notify us of post-operative numbness as soon as possible, it will allow us to manage your care in the most appropriate way.
  • How long will Implants last?
    Implants usually last a long time. When patients are missing all of their teeth, long-term studies (more than 30 years) show an 80 to 90 percent success rate. For patients missing one or several teeth, recent studies show a success rate of greater than 95 percent, which compares favorably with other areas in the body that receive implant replacement (such as hips or knees). However, if one of your dental implants either doesn’t heal properly or loosens after a period of time, you may need to have it removed. After the site heals (or on occasion at the time of removal), another implant usually can be placed.
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    The replacement teeth are usually attached to the implant when adequate healing has occurred and your jawbone is firmly fused to the implant. Depending on a variety of factors, it may be possible to begin this phase of your treatment immediately or shortly after implant placement. We will review the most appropriate treatment sequence and timing for your particular situation. The dental work required to complete your treatment is complex. Most of the work involves actually making the new teeth before they are placed. Your appointments are considered more comfortable and more pleasant than previous methods of tooth replacement. Frequently, this process can be performed without local anesthesia. Your restorative treatment begins with specialized impressions that allow us to produce a replica of your mouth and implants. We will also make “bite” records so that we see the relationship of your upper and lower jaws. With this information, we will make the abutments (support posts) that attach your replacement teeth to your implants. Various types of abutments exist. Frequently, we can use “off the shelf” abutments. Other times, custom abutments must be made of gold or a tooth-colored ceramic material. As you can imagine, these custom made abutments add to the cost and treatment time involved. Which abutment to use is a decision that often cannot be made until after healing is complete and impressions have been made.
  • How do I clean my Implants?
    As with natural teeth, it is important that you clean implant-supported restorations regularly with toothbrushes, floss and any other recommended aids. You should also visit your dentist several times each year for hygiene and maintenance. As with regular dentures and other tooth replacements, your implants and their associated components are subject to wear and tear and eventually will need repair, including clip replacement, relines, screw tightening, and other adjustments.
  • Will one Doctor do the entire Implant procedure?
    Usually, a dental surgeon places the implant(s) and performs other necessary surgical procedures – your general dentist provides the temporary and permanent replacement teeth. Both doctors are involved in planning your dental treatment. Also, depending upon a variety of factors, different dental specialists may help with your dental care.
  • How much do Implants cost?
    Before treatment begins, every effort will be made to give you an accurate estimate of all the expenses involved in placing the implants and making your replacement teeth. In many cases, there is an initial charge for the diagnostic work-up, including study models, x-rays, and the fabrication of a surgical template to ensure the best possible result. In addition you will be charged for the abutment or support post(s), plus the crown, dentures, or anything else that will be placed over the implants, including temporary restorations. Periodic maintenance such as hygiene visits, tissue conditioners, denture relines and other repairs will also incur additional charges. When different doctors are involved in your treatment, you will be charged separately for their services. We will try to assist you in estimating what your actual payments will be after we evaluate your insurance coverage or other third party payments. Also, you should consider your personal financial investment in each treatment option as some insurance companies provide limited or no coverage. Each patient is unique, and it is not possible for us to discuss every option and every contingency for treatment outcome. This booklet is intended to help you understand the general treatment options available to you. If your specific treatment options are not clear, please contact us. We will be happy to answer any questions you have about your dental care.
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    There are several reasons: A dental bridge can sacrifice the structure of surrounding good teeth to bridge the space of the missing tooth/teeth. In addition, removing a denture or a “partial” at night may be inconvenient, not to mention dentures that slip can be uncomfortable and rather embarrassing.

Do you still have questions? Schedule an Appointment Today!

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