Wisdom teeth are the third permanent molars and are the last teeth to develop. They usually erupt or come into the mouth in our late teens and early twenties. In most cases, the tooth-bearing area of the upper and lower jaws are too small to accommodate these wisdom teeth and they remain buried within bone. These wisdom teeth are termed “impacted”.
Wisdom teeth generally cause problems when they erupt partially through the gum. The most common reasons for removing them are:
Saliva, bacteria and food particles can collect around an impacted wisdom tooth, causing it, or the next tooth to decay. It is very difficult to remove such decay. Pain and infection will usually follow.
When a wisdom tooth is partially erupted, food and bacteria collect under the gum causing a local infection. This may result in bad breath, pain, swelling and trismus (inability to open the mouth fully). The infection can spread to involve the cheek and neck. Once the initial episode occurs, each subsequent attack becomes more frequent and more severe.
Pain may also come from the pressure of the erupting wisdom tooth against other teeth. In some cases this pressure may cause the erosion of these teeth.
Many younger patients have had prolonged orthodontic treatment to straighten teeth. Wisdom teeth may cause movement of teeth (particularly the front teeth) when they try to erupt and this will compromise the orthodontic result.
Patients who are to have dentures constructed should have any wisdom tooth removed. If a wisdom tooth erupts beneath a denture it will cause severe irritation and if removed, the patient will need to have a new denture constructed as the shape of the gums will have changed.
A cyst (fluid filled sac) can develop from the soft tissue around an impacted wisdom tooth. Cysts cause bone destruction, jaw expansion and displacement or damage to nearby teeth. The removal of the tooth and cyst is necessary to prevent further bone loss. Rarely, tumors may develop within these cysts or the jaw may fracture spontaneously if the cyst grows very large.
If you are going to an area where specialist dental services are not available and your wisdom teeth are impacted, it may be advisable to have them removed beforehand.
Impacted wisdom teeth are almost certain to cause problems if left in place. This is particularly true of the lower wisdom teeth. Such problems may occur suddenly, and often at the most inconvenient times.
It is now recommended by specialists that impacted wisdom teeth be removed between the ages of 14 and 22 years whether they are causing problems or not. Surgery is technically easier and patients recover much more quickly when they are younger. What is a relatively minor operation at 20 can become quite difficult in patients over 40. Also the risk of complications increases with age, and the healing process is slower.
An incision is made in the gum tissue and the tissue is reflected so that the tooth can be seen. If bone is covering the tooth, it may need to be removed in order to expose and extract the tooth. The tooth may be removed whole, but it is usually necessary to cut it into sections. Each section is then individually removed. The surgical procedure will take about half an hour, although this varies according to each case. You may choose to have the surgery done under local anaesthesia with or without intravenous sedation or under general anaesthesia in a hospital setting.
In most cases normal activities can be resumed within a few days depending on the degree of impaction and the number of teeth removed.
The amount of discomfort will depend on how easy the removal of the tooth was. There is usually some swelling and discomfort for a few days afterwards, and it is important to follow any advice you will be given about mouthwashes etc, to help with the healing. Pain-killers prescribed by your surgeon will usually deal with any pain. It is best to stay fairly quiet and relaxed for 24 hours afterwards to make sure there are no bleeding problems. Most patients generally have a soft diet for 3-5 days. There may be some stitches to help the gum heal over and you will be reviewed in a week’s time.
A dry socket occurs when either an adequate blood clot has failed to form in the extracted tooth's socket. Since the formation of a blood clot is an important part of the healing process, healing is delayed. The typical dry socket produces a dull pain that doesn't appear until three or four days after the tooth has been extracted. The pain can be moderate to severe. There is often a foul odor associated with this condition. Usually a medicated dressing will be placed in the dry socket that can soothe and moderate the pain. Dry sockets are found to occur more often in women (even more so in those taking oral contraceptives), persons over the age of 30, and smokers.
Wisdom teeth can be positioned in the jaw in a manner in which they lie in close proximity to nerves. Sometimes during the process of extracting a wisdom tooth these nerves can be bruised or damaged. As a result, temporary numbness of the tongue, lip, or chin may occur. Having this condition is termed "paresthesia." A hope of avoiding the complication of paresthesia is one reason why dentists suggest that wisdom teeth be removed when a patient is "young." As humans age on through their twenties the roots of their wisdom teeth continue to form and develop, making the teeth more difficult to extract without disturbing surrounding tissues (like nerves). The incidence of nerve damage for wisdom teeth removal runs as high as 10% after the age of 35, whereas it is rare for teenagers (less than 1%).