Wisdom teeth

WHAT ARE WISDOM TEETH?

Wisdom teeth (third molars) are the very back teeth on either side of the upper and lower jaws. They are the last teeth to erupt and are usually seen between the ages of 17 and 25 years.

WHY CAN THEY CAUSE TROUBLE?

Quite often the jaws are not large enough to allow wisdom teeth to take up their correct position and as a consequence they can be completely or partially crowded out (impacted). These impacted teeth can cause problems;

• Pain

Often the first sign of a problem is a dull ache in the back of the mouth. An x-ray may be required at this stage to help the diagnosis.

• Infection in the overlying gum

If only part of an impacted wisdom tooth comes through it can be difficult, if not impossible, to clean. As a result bacterial plaque and food debris can get under the flap of gum causing the gum to become infected and inflamed. This condition, known as pericoronitis, is especially common with lower wisdom teeth.

• Damage to the tooth in front

Pressure from an impacted wisdom tooth can also produce a type of erosion cavity in the tooth in front.

• Complications in orthodontic treatment

The pressure from wisdom teeth of the type shown above can also complicate orthodontic treatment. It may be decided that they be removed to help keep the teeth in front in their correct positions.

• Difficulties in cleaning the back teeth

It is not only partially erupted wisdom teeth but also those that have come through at an awkward angle that can make adequate brushing and flossing impossible. In these cases removal of wisdom teeth can prevent repetitive decay and gum problems in the area and make cleaning of the other back teeth far easier.

REMOVAL OF WISDOM TEETH

Often fully erupted wisdom teeth can be removed simply and easily. However for impacted wisdom teeth a surgical approach may be required. With a surgical approach it is necessary for the gum around the tooth to be incised and lifted to simplify removal of the tooth. The gum is then replaced and sutured back into position. The sutures that don't dissolve by themselves are removed several days later by the dentist.

Afterwards

Some swelling and discomfort can be experienced for a few days afterwards, especially when surgery has been involved. During this period it may be necessary to take analgesics as prescribed by the dentist, and it is important to follow the dentist's post-operative instructions. Any stitches are removed 5-7 days later by which time any soreness present will be diminishing. By the end of ten days healing should be well under way.

Complications

Occasionally the blood clot in the extraction area breaks down earlier than normal producing a "dry socket". This can produce more intense pain, and the dentist should be contacted as soon as possible. The dentist places a special medicated dressing in the socket to remove the symptoms and help promote healing.

Other much less common complications are the possibility of jaw fracture during tooth removal, which may require hospital attention, or damage to nerves surrounding the wisdom tooth, which may produce numbness either in the tongue or chin area which may last from days to months in the case of temporary damage, or it may become permanent numbness in the case of permanent damage. More complicated infections rarely occur, but if this occurs, may require antibiotic therapy.

Who should do the removal?

Your dentist will generally decide if he or she feels confident in doing the procedure. Sometimes, when the impacted wisdom teeth appear to be very difficult to remove, your dentist may recommend that a specialist do the job. Removal of impacted wisdom teeth is invariably a large part of the work done by oral and maxillofacial surgeons.

Where should the removal be done?

Simple removals can be done in the dental chair under local anaesthetic. If several impacted wisdom teeth have to be removed it may be suggested that this be done in a hospital or day-surgery under a general anaesthetic.

What is the best age to have them done?

It is common advice to have them done no later than the early twenties. At this time the task is invariably simpler because the bone around the teeth is softer and the roots are usually not fully developed.

Some impacted wisdom teeth cause no difficulties.

However removal of problem wisdom teeth eliminates the trouble and makes it easier to clean the other back teeth.