About Wisdom Teeth
What is an Impacted Wisdom Tooth?
A tooth becomes impacted due to lack of space in the dental arch and its eruption is therefore prevented by gum, bone, another tooth or all three. Lack of space occurs because our jaws have become smaller (through evolution), we do not loose teeth through decay as frequently as in the past, and our diet is such that our teeth do not wear down as much.
What are the indications for removing wisdom teeth?
Wisdom teeth generally cause problems when they erupt partially through the gum. The most common reasons for removing them are:
decay – saliva, bacteria and food particles can collect around an impacted wisdom tooth causing it, or the tooth next to it, to decay. It is very difficult for the dentist to remove this decay and pain and infection will usually follow.
gum infection (pericoronitis) – 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). The infection can spread to involve the cheek and neck. Once the initial episode occurs, each subsequent attack may become more frequent and severe.
pressure pain – pain may also come from the pressure of erupting wisdom teeth against other teeth. In some cases, this pressure may cause the erosion of the teeth immediately in front of the wisdom teeth.
orthodontic reasons – 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.
prosthetic reasons – patients who have had dentures constructed should have wisdom teeth removed. If a wisdom tooth erupts beneath a denture it may cause severe irritation, and if removed the patient may have to have another denture constructed to accommodate the changed shape of the gum.
cyst formation – a cyst (a fluid-filled sack) can develop from the soft tissues which originally formed the wisdom tooth. Cysts cause bone destruction, jaw expansion and displacement and damage to the adjacent teeth. The removal of the cyst and tooth is necessary to prevent further bone loss. In rare circumstances, tumours may develop within these cysts or the jaw may even fracture if the cyst or tumour grows very large.
When is the best time to have my wisdom teeth removed?
It is now recommended by specialists that if impacted wisdom teeth need to be removed, this is best done between the ages of 14 and 22 years. At this time surgery is technically easier, patients recover more quickly and the risk of complications is much lower. This is a relatively easy procedure in a patient at the age of 20, however it may become very difficult in a patient over 40 years of age.
Do all wisdom teeth require removal (extraction)?
Not all wisdom teeth require removal. The following diagram summarises the management of wisdom teeth:
Travel to inaccessible place
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.
Should an impacted wisdom tooth be removed if it hasn't caused any trouble? There is always a risk that impacted wisdom teeth may cause problems at any age. Such problems may occur suddenly and at inconvenient times. If the wisdom teeth appear to have a high probability of causing problems, your oral surgeon may advise you to have them removed.
Should a wisdom tooth be removed when an acute infection is present?
Generally, no. Surgery in the presence of infection can cause it to spread and become more serious. Firstly, the infection must be controlled with antibiotics, local oral hygiene and sometimes the extraction of the opposing wisdom tooth.