Wisdom Tooth Extraction
The Wisdom teeth are the third molars at the end of both sides of an arch, each on the upper and lower jaw; therefore they are 4 in total. They normally erupt between the ages of 18-24 years, but sometimes they fail to erupt in the jaw.
There remains a great deal of controversy regarding extraction of wisdom teeth. 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, then their chances of harming are more.
Impacted Wisdom Teeth
In dental terminology an “impacted tooth” refers to a tooth that has failed to erupt completely into its expected position in the jaw.
Wisdom teeth often cause no harm if it erupts normally in the arch. But if there is not enough space for the wisdom tooth to erupt in the arch, it remains in the jaw bone and is referred as impacted tooth. Impacted wisdom teeth can cause pain, swelling, infection or cause damage to the adjacent teeth. If the gum around the wisdom tooth is inflamed it causes severe pain and even causes difficulty in opening and closing the mouth. If the infection starts in the gums covering the impacted tooth, also known as pericronal flab, then it causes pain in the area and causes bad breath and bad taste.
The exact cause of impacted is not known, it may be because of inadequate jawbone space in the arch. 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 Teeth
- Inability to open the mouth.
- Pain and swelling overlying the wisdom tooth, sometimes associated with a bad taste or purulent discharge.
- Bad taste or purulent discharge from the tooth.
- Severe pain that can radiate to head, neck and throat.
- Limited jaw movements
The process of eruption of the wisdom teeth can be painful, these teeth may take a long time to fully erupt and often the symptomatic treatment is possible like using analgesic or doing a hot water rinse can relieve the pain.
Wisdom Teeth Problems
A wisdom tooth which is abnormally placed in the arch is extracted to prevent further problems in future or if there is severe infection in the impacted tooth. The jaw may not be large enough to accommodate them, and they may become impacted and unable to erupt through the gums. The wisdom teeth may partially erupt through the 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 pericoronal infection.
More serious problems can develop from impacted teeth, such as infection, damage to other teeth and bone, or the development of a cyst within the jaw. Sometimes the wisdoms are aligned at different angulations causing damage or resorption of the adjacent tooth leading to mobility of the adjacent tooth.
Wisdom Teeth Removal (Extraction)
The surgical removal (tooth extraction) of one or more wisdom teeth depends on the problem caused by the impacted teeth. Examination of an X-ray is the best diagnostic tool to identify the position and location of the teeth within the jaw. Sometimes improper relation of small jaw and large teeth can also cause impacted teeth; in such a case multiple impactions can be seen.
People who have problems such as infection, cysts or tumors, tooth decay, or gum disease around a wisdom tooth are advised to get their teeth removed. If the infections are present, surgery is delayed until the infection reduces. Antibiotics are prescribed to reduce infection and proceed with further treatment.
In some cases, where a wisdom tooth eruption is delayed because of the presence of thick fibrous flap, removal of the flap surgically will help in eruption of the tooth. However, this alternative is not suitable for everyone.
If the tooth doesn’t fully erupted with an opposing tooth, if the oral hygiene is not good, if the periodontal condition around the wisdom tooth is not the same as around adjacent teeth, then extraction is recommended. Some people have a misconception that wisdom tooth eruption causes anterior crowding is absolutely wrong. The erupted dentition will as a whole move medially and will cause a lot of post orthodontically treated people to have anterior crowding when they reach their late 20’s or 30’s.
For an erupted wisdom tooth, the dentist will find it comfortable to extractions teeth within 3 to 4 minutes. If the tooth is impacted requiring elevation of a flap and either removal of bone and 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 such teeth will take an average 5 to 20 days for soft tissue depending on the number of incisions whether primary closure was needed, tissue management, and suture placement.
Wisdom teeth post operative pain varies from person to person, depending on the pain threshold. For extractions that don’t require an incision or remove of bone, then a couple of days of mild to moderate dull, achy sensations will be present. For those extractions that required any incisions or bone removal then, 3 to 7 days of moderate pain may be anticipated. Some doctors advise narcotic Vicodin and sometimes either a tapering steroid or an antibiotic depending on the difficulty and infection of the extractions.