The Wisdom teeth are the large molars at the end of each line of teeth – there is one Wisdom tooth at the end of each row – therefore there are 4 in total. Wisdom teeth also known as third molars.
They appear in the mouth between the ages of 18-24 years and may develop in the jaw but never erupt or appear in the mouth. There remains a great deal of controversy regarding whether or not these teeth need to be removed. It is generally suggested that teeth that remain completely buried or un-erupted in a normal position are unlikely to cause harm. However, if these impacted teeth are in an abnormal position (a dentist can show you this on an X-Ray), their potential for harm should be assessed.
Impacted Wisdom Tooth
In dental terminology an “impacted tooth” refers to a tooth that has failed to emerge fully into its expected position.
Wisdom teeth often cause no problems. They are described as impacted when there is not enough space for them at the back of the mouth. Impacted wisdom teeth can cause pain, swelling, infection or damage to the teeth next to them. If the gum around the wisdom tooth is swollen the jaw may become stiff and sore. Infection at the back of the mouth can cause bad breath and a bad taste.
People who have impacted wisdom teeth that are not causing problems do not need to have them removed, teeth extraction.
The reason why some wisdom teeth are impacted is not an easy question to answer. A primary cause of wisdom tooth impaction is simply that there is inadequate jawbone space behind the person’s second molar. Why this lack of space exists is not fully understood, however there does seem to be a correlation between large tooth size, tooth crowding, and the presence of impacted wisdom teeth.
Symptoms and Signs of Impacted Wisdom Tooth
- Tooth in communication with the mouth, it is often possible to see all or part of the wisdom tooth.
- Pain and swelling overlying the wisdom tooth, sometimes associated with a bad taste or purulent discharge.
Eruption of the wisdom teeth can be painful (teething). These teeth may take a long time to fully erupt and often the symptoms are settled by simple analgesics and hot salt-water
Wisdom Tooth Problems
A wisdom tooth is extracted to correct an actual problem or to prevent problems that may come up in the future. When wisdom teeth come in, a number of problems can occur:
- Your jaw may not be large enough to accommodate them, and they may become impacted and unable to break through your gums.
- Your wisdom teeth may break partway through your gums, causing a flap of gum tissue to grow over them. Food and germs can become trapped under the flap and cause your gums to become red, swollen, and painful. These are signs of infection.
- More serious problems can develop from impacted teeth, such as infection, damage to other teeth and bone, or the development of a cyst.
- One or more of your wisdom teeth may come in at an awkward angle, with the top of the tooth facing forward, backward, or to either side.
Wisdom Tooth Removal (Extraction)
The precise reasons why an individual’s wisdom teeth need to be extracted should be explained to them by their dentist, after an examination which almost certainly will need to include X-Rays.
The surgical removal (tooth extraction) of one or more wisdom teeth can relieve pain problems. However, removing the wisdom teeth does not usually improve crookedness or crowding in other teeth.
The procedure often can be done in the dentist’s or surgeon’s office. You may have the surgery in the hospital, especially if you are having all your wisdom teeth pulled at once or if you are at high risk for complications.
People who have problems such as infection, cysts or tumors, tooth decay, or gum disease around a wisdom tooth should think about having it removed. If you have any infections, surgery will usually be delayed until the infection has cleared up. Your doctor or dentist may have you take antibiotics to help heal the infection.
What are the Alternatives to Wisdom Tooth Extraction?
Having wisdom teeth removed is often the only way to permanently relieve painful symptoms. Although antibiotics can provide temporary relief, the symptoms tend to flare up again in the future.
In some cases, where a wisdom tooth is causing pain because it is pressing into the surrounding gum, removal may not be necessary – an operation to cut back the gum may be all that is needed. However, this alternative is not suitable for everyone.
Doctor about Wisdom Teeth
Dr. Jeffrey, Board Certified Oral and Maxillofacial Surgeon
Here’s some further info about wisdom tooth that I provide my patients with everyday.
1. For removal (extraction) wisdom tooth
I break it down as simply as this, is the tooth fully erupted and in function with an opposing tooth, can the patient keep the tooth clean, is the periodontal condition around the wisdom tooth the same as around adjacent teeth. If any of these questions are answered “no” then I recommend extraction.
As for the comment that erupting wisdom teeth promote anterior crowding, that’s one of the biggest misconceptions in dentistry. The medial force that the wisdom tooth places on the erupted 2nd molars isn’t anywhere near enough force to move and tip the roots of the 7 teeth that are in front of it. Ask an orthodontist sometime about it.
True though that over time, without retention, the erupted dentition will as a whole move medially for most folks, and that’s what will cause a lot of post orthodontically treated folks to have anterior crowding when they reach their late 20’s/30’s.
2. Surgery times
For an erupted wisdom tooth, any practitioner who is comfortable with extractions should take no more than 3 to 4 minutes a tooth. If the tooth is impacted requiring elevation of a flap and either removal of bone and/or sectioning of the tooth, it can take up to 30 minutes per tooth depending on the tooth’s angulations, bone density, sinus and inferior alveolar nerve proximity. Healing time for most folks will take on average 5 to 20 days for soft tissue depending on the number of incisions (if any), whether primary closure was needed/achieved, tissue management, and suture placement(if any).
Post operative pain varies tremendously. First off, if you’re someone who gets a paper cut and needs a Vicodin, then, it’s going to hurt a bit. If you’re the type that could get hit by a bus, take 2 Motrin, and feel fine, then you’ll have no problems. For extractions without have to lay an incision or remove any bone, and then figure a couple of days of mild/moderate dull, achy sensations. For any incisions/bone removal then 3 to 7 days of moderate pain may be anticipated. MOST docs will get you a script for a narcotic (Vicodin or the like) and sometimes either a tapering steroid (solumedrol dose pack) and/or an antibiotic depending on the difficulty of the extractions.
Ask for who should do the wisdom tooth extractions, ask, ask, and ask. True, most 3rd molar cases are done by oral surgeons, its their bread and butter money winners (1500-2500 billing for in most cases less than 30 minutes of work), but a lot of that also has to do with the ability to administer IV conscious sedation.
Due to extremely large increases in mal-practice insurance fees and a relatively small (read as non cost effective need) to use this on a regular basis, most GP’s aren’t IV certified. A lot of GP just aren’t comfortable at taking out teeth, and don’t have a lot of experience at it.
I feel very comfortable at extraction almost any tooth. My partners never had such extensive training at extractions, and hence rarely take any teeth out. I still though send a lot of my 3rd molar cases to the oral surgeon, simply because I want to keep my patients as comfortable as possible, and having the IV in the AC fosse with some Versed and Fentanyl flowing helps a ton!
Hope that helps a bit.
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