This paid piece is sponsored by Siouxland Oral & Maxillofacial Surgery.

May is often the time of year when we, as oral surgeons, start receiving a lot of questions regarding kids and their wisdom teeth or kids and their dental implants. With summer break quickly approaching, everyone is looking to get these specialized procedures done while their children are out of school.

Let’s start with the easy one: When is the best time to remove wisdom teeth — the third molars — in kids? The straight answer is when there is simply not enough room for the wisdom teeth to come in without disrupting other teeth in the mouth. Usually, the primary reasons for removal are when the roots are about one-third formed, when there is recurrent infection, damage to adjacent teeth or pathology, such as a cyst. In the presence of those circumstances, it is very prudent to have them extracted.

The roots of wisdom teeth are typically one-third formed somewhere from age 14 to 17 in most young people, and the only way to know for sure is with a panorex, or panoramic, X-ray that your dentist or orthodontist can obtain at one of your visits. The reason removal is suggested when the roots are about one-third formed or less is because the wisdom teeth are easier to remove, and the complication risks are the lowest. The teeth are usually under the gingival tissue, or gums, and oftentimes under a layer of bone. Because oral surgeons are specialists and without doubt receive the most certified surgical training, wisdom teeth removal typically takes about 20 to 30 minutes under sedation. Therefore, in most cases, that is the standard of care.

As with anything, these are the general guidelines. There are, however, special cases where the wisdom teeth need to be removed at a younger age or even at an older age. After surgery, you can expect about a week of facial swelling as well as two to three weeks of soreness of the muscles that you chew with. If you are an adult, the true length of the recovery process typically doubles.

Now let’s talk a little bit about dental implants for kids. We typically don’t recommend dental implants in kids who are still growing. When it comes to oral surgery on any child, we recommend a consultation with your local oral surgeon specialist to plan for the right time and setting to perform the surgery.

The reason dental implants in growing kids are not recommended is because significant facial growth usually continues in children up until age 16 or 18. The facial skeleton continues to slowly grow downward and forward until you’re in your 20s. In some individuals, it is a great amount of growth, while in others it is minimal. So one must be very careful when placing a dental implant while the aforementioned growth is still occurring as the implant stays in the same place in three-dimensional space while the bone grows around it.

The bone structure of the mandible and maxilla don’t grow like your typical leg bones would by simply growing longer at the ends. Instead, they grow by adding bone in front and taking away bone in the back. The teeth are surrounded by a ligament; therefore, they get transported with the actual bone whereas the dental implants are fixed in place. It’s similar to that of a glacier. The teeth travel with the glacier, whereas the dental implants are cemented to the underlying rock and get left behind. This in turn makes it quite difficult to fabricate esthetic and functioning crowns, especially for front teeth. It is very poor technique to place dental implants while the patient is in active orthodontic movement, so that should definitely be avoided.

For some children that are missing a lot of teeth because of a genetic or growth disturbance, we do put in dental implants while they are growing. This is because the psychosocial benefits far outweigh the necessity of having to redo everything when they get older. Fortunately, this situation is rare.

When the teenager has stopped growing or the facial growth has slowed so much that any more growth will be minimal, that is when placing dental implants in kids becomes a golden option. Often, kids in need of implant treatment have completed braces or are at the end of their orthodontic treatment. So if you know your child is in orthodontics and you likewise know that they will need dental implants, we recommend getting a consult with an oral surgeon before the braces come off. That way, we can check that there is enough space for the implants before the braces come off or Invisalign treatment stops

Many times, the space that is left after orthodontics is minimally sufficient or simply not sufficient for placing a dental implant. Therefore, it would be much better to continue orthodontics for another period of time to develop space rather than to have to go through orthodontics again later. This in itself brings up a good point regarding orthodontic retainers and space maintainers. It is especially important to wear the retainer or space maintainer so one can have a dental implant later if needed. Otherwise, the space collapses, and the child will have to go through orthodontics all over again to open up the space.

A word on Invisalign treatments. This is a good option for many people, but the movements do not control the roots of the teeth very well. Many times, the tooth crowns that you visualize will look wonderful, but the actual roots will obstruct the necessary position for the desired implant. So if you need dental implants and are undergoing Invisalign treatment, you truly should schedule an oral surgery consult so you can work with your dental team to ensure the best treatment plan. This will end up saving you time and money in the long run.

As previously stated, every case is different. It is custom work, and just like any unique procedure, there are differences, risks and benefits to everything. This is where we come in for you.

Click here to apply for the Wisdom for Wisdom program before May 19 to get your teenager’s wisdom teeth removed at no cost to you.

Siouxland Oral & Maxillofacial Surgery: Oral surgery by real oral surgeons.