When is wisdom painful? “If ignorance is bliss, tis folly to be wise.” In life, having wisdom is useful, but it can make everyday decisions difficult or painful. Wisdom teeth can cause difficulties or pain when they attempt to erupt into the mouth during our teens or early twenties. During these years we usually believe we know everything in the world and are full of wisdom. If you don’t believe this, just ask a teenager… To the best of my knowledge, this is why the term “wisdom teeth” become synonymous with third molars, although I have never found specific reference to when the term originated.

It is possible for any tooth not to enter the mouth and remain impacted within the upper or lower jaw bone. I am asked many times why wisdom teeth (third molars) remain impacted. It is not an easy question to answer because there are numerous reason. Normally, upper and lower adult teeth erupt vertically into their desired position. If an adult tooth is tilted off its normal eruption path, it will never reach its correct position in the dental arch owing to direct or indirect effects of cysts, malpositioning of adjacent teeth, thickened overlying bone and gum tissue, or heredity.

Finally, there is the issue of evolution and change. Most often impaction of third molars is caused by lack of space behind second molars to allow third molars to enter the mouth in a functional position in the dental arch. As man and woman have evolved, a teleologic argument can be made that our jaw bone structure has changed, encroaching on the space available for wisdom teeth.

Another issue in evolution is the evolution of our diet. Eating refined diets that do not cause as much wear on the top and in between our tooth surfaces results in maintaining dental arch length. Excessive dental arch length encroaches into the area of normal third molar eruption, adding another reason why wisdom teeth can remain impacted.

Patients are usually referred to an oral and maxillofacial surgeon for the removal of impacted wisdom teeth. The referral usually originates from a dentist, orthodontist, when symptoms arise or when the referring doctor has diagnosed insufficient space to accommodate their position in the dental arch.

A patient’s consultation with an oral and maxillofacial surgeon on wisdom teeth will include a clinical examination and a radiographic examination utilizing a panoramic radiograph.

After the consultation, the oral and maxillofacial surgeon can frequently predict if the wisdom teeth are going to cause trouble either in the near future or later in life. If so (or if the patient is currently in pain), the surgeon will recommend their removal. Removing wisdom teeth is usually easier in younger patients because roots have not yet fully developed and the bone is less dense.

What happens after surgery? Generally, after the removal of wisdom teeth the patient experiences some swelling and discomfort. Looking like Alvin the chipmunk with swollen cheeks usually subsides within one week. However, with rest and personalized postoperative instructions and medications, the oral and maxillofacial surgeon can reduce the possible discomfort following surgery.