Do they always cause trouble?
You go to the dentist for your regular 6-month checkup. After the X-rays are taken, he comes and tells you that you might want to consider having your wisdom teeth removed because they’re partially impacted. What does this mean? Why do wisdom teeth need to be removed more frequently than other teeth?
Wisdom teeth are the third, and final set of, molars that grow at the back of the mouth. They’re the last adult teeth to emerge, usually appearing between 17 – 25. This is how they got their name. The term “teeth of wisdom” was used during the 17th century since the third molars arrive when a person is an adult and presumably much wiser than a child, which is when the first and second molars appear. In the 19th century, the name was shortened to what we use today.
For some people, wisdom teeth don’t cause any issues. They come in and line up perfectly behind the second molars. Unfortunately, most people’s mouths are too small to accommodate them, forcing them not to develop normally. The third molars can become trapped (impacted). Some of the tooth is visible if they’re partially impacted, whereas fully impacted means it doesn’t break through the gum. Regardless of how it’s impacted, third molars can grow in a variety of ways, including at an angle toward the next tooth (second molar), at an angle toward the back of the mouth, at a right angle to the other teeth (it appears as if the wisdom tooth is “lying down” within the jawbone), or straight up or down like other teeth but stay trapped within the jawbone.
Impacted third molars don’t always cause symptoms. However, if the tooth becomes infected, damages other teeth, or causes other dental problems, you might have red/swollen gums, tender gums, bleeding gums, jaw pain, swelling around the jaw, bad breath, an unpleasant taste in your mouth, and difficulty opening your mouth. If you notice any of these symptoms, you should see your dentist as soon as possible.
If not treated, impacted wisdom teeth can result in several complications. One significant concern is damage to other teeth because it increases the risk of infection in that area. The pressure can cause problems with crowding of the other teeth, which might require orthodontic treatment to straighten the other teeth. Another big issue with partially impacted third molars is that they’re at higher risk of tooth decay (caries) than other teeth because food and bacteria get easily trapped between the gum and a partially erupted tooth. Also, they’re harder to clean for the same reason. The difficulty cleaning increases the chances of developing a painful, inflammatory gum condition called pericoronitis in that area. Sometimes, the third molar develops in a sac within the jawbone. This sac can fill with fluid, forming a cyst that can damage the jawbone, teeth, and nerves.
If your third molars are causing problems, your dentist will recommend that they be removed. Conditions that would indicate your third molars should come out include infection/gum disease (periodontal disease) involving them, tooth decay if they’re partially erupted, if they have any cysts/tumors, or if they’re causing damage to neighboring teeth. The surgery is an outpatient procedure, so you’ll go home the same day. The process includes local anesthesia, which numbs your mouth; sedation anesthesia that depresses your consciousness; or general anesthesia, making you lose consciousness. In some cases, a combination of these is used to help keep you comfortable. During the actual procedure, your dentist makes an incision in your gums and removes any bone that blocks access to the impacted tooth root. After removing the tooth, the wound is closed with stitches, and the empty space (socket) is packed with gauze. It’s common to have some pain, bleeding, and swelling of the site or jaw. Some people also have trouble opening their mouths wide due to swelling of the jaw muscles. You’ll receive instructions for caring for wounds and managing pain and swelling. Some complications of the surgery include painful dry socket, or exposure of bone if the post-surgical blood clot is lost from the socket, infection in the socket from bacteria or trapped food particles, or damage to nearby teeth, nerves, jawbone, or sinuses. While the thought of having a tooth removed may be overwhelming, there are many ways to ease your anxiety, such as listening to music or watching videos. You may be able to bring along a supportive family member or friend.
There are two schools of thought when dealing with impacted third molars that aren’t causing any problems. Some dentists recommend removing asymptomatic third molars to prevent future potential problems. They state that symptom-free doesn’t mean disease-free. Also, if there isn’t enough space for the teeth to emerge, it’s hard to get to them and clean them properly. In addition, severe complications with third molars happen less often in younger adults. Removing the teeth is more difficult and more likely to cause complications later in life.
On the other hand, other dentists recommend a more conservative approach. They feel that there isn’t enough evidence to suggest that impacted third molars not causing problems in young adulthood will later cause problems. They further state that the expense and risks of the procedure don’t justify the expected benefit. Your dentist will monitor your teeth for decay, gum disease, or other complications with this approach. If a problem arises, then they will recommend removing a tooth.
While you can’t prevent your third molars from being impacted or partially impacted, there are steps you can take to reduce the chances of having complications. The most important thing is to have regular six-month dental appointments. During these visits, the dentist will not only clean your teeth but examine them to monitor for any potential issues. Part of the monitoring includes keeping an eye on the growth and emergence of your wisdom teeth.
Wisdom teeth aren’t all bad. However, if yours are causing you difficulties, your dentist can easily manage it. If you have any questions or concerns about wisdom teeth, please speak with your dentist. If you would like more information, please visit Mouth Healthy’s wisdom teeth page at https://www.mouthhealthy.org/en/az-topics/w/wisdom-teeth