Wisdom Teeth

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Mother Nature is generous when it comes to our teeth. First, we get baby teeth; next we grow permanent teeth; and finally, around age 16 or 17, we start getting a set of molars called wisdom teeth.

There are usually four wisdom teeth, one on the top and bottom levels and on each side of the mouth. They are the farthest back in the mouth, which means they are also the most difficult to clean even if they erupt into the proper position. Wisdom teeth are a valuable asset to the mouth when they are healthy and properly positioned; however, oftentimes problems develop that require their removal.

Wisdom teeth are generally extracted as a result of the following circumstances:

  • When the jaw isn’t large enough to accommodate wisdom teeth, causing the teeth to become impacted (unable to grow in) or misaligned. Wisdom teeth may be forced to grow sideways, emerge only partway from the gum, or remain trapped beneath the gum and bone.
  • When wisdom teeth only partially erupt, leaving an opening for bacteria to enter around the tooth and cause an infection. Pain, swelling, jaw stiffness, and general illness can result.
    When a cyst (fluid-filled sac) forms and destroys surrounding structures, such as bone or tooth roots.

Impacted teeth
If there is not enough room for the wisdom teeth to come in, they will remain trapped in the jawbone. When this happens, the wisdom teeth are typically impacted. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to erupt successfully. Sometimes, part of the wisdom tooth shows in the mouth.

Even though impacted wisdom teeth are not usually visible in the mouth, they can cause a number of problems. Commonly, patients will go to their dentist because of pain in the back of the jaws, and having the wisdom teeth removed usually resolves the problem.

Sometimes the impacted wisdom tooth may be the source of the pain, while other times there may be an infection associated with it. Bacteria that are always present in the mouth can work their way under the gum tissue and cause a painful infection around the crown of the wisdom tooth, even though you can’t see the tooth. People often mistake soreness of gum tissue overlying their wisdom teeth as an effort by the teeth to erupt. Unfortunately, this is often a warning sign that trouble is brewing. The constant pressure from an impacted wisdom tooth can lead to destruction of a tooth or teeth adjacent to it.

Wisdom teeth removal
As soon as it is determined that the wisdom teeth are or will become impacted, they should be removed. This can often be determined by age 16 or 17, as the jaw at this age has attained the majority of its adult size. Removing impacted wisdom teeth at this time has several advantages. First, at this age, seldom are the roots fully formed, even though the tooth has become impacted. If left in place, the tooth will not erupt into the mouth but the roots will continue to grow.

Removing an impacted wisdom tooth before the roots are fully formed is easier and less traumatic for the patient. Also, at this stage of a patient’s development, the bone surrounding the impacted tooth is more pliable. Typically, patients having impacted wisdom teeth removed in their mid-teens heal more rapidly and have a shorter and less complicated postoperative recovery.

Historically, patients removing impacted wisdom teeth were admitted to their local hospital, taken to the operating room, and given general anesthesia. Today, the vast majority of patients have their wisdom teeth removed in an oral and maxillofacial surgeon’s office. Improvements in surgical techniques and sedative medications allow patients to have their teeth removed comfortably and efficiently in a pleasant environment that is far less costly and intimidating than a hospital.

Ask your dentist about the health and positioning of your wisdom teeth. Your dentist may make a recommendation for removal or refer you to an oral surgeon for further evaluation.