Wisdom teeth are probably the most misunderstood teeth in dentistry. People associate any mention of wisdom teeth with pain, surgical procedures, swollen faces and all sorts of horror stories. I have had clients ‘warn’ me at their first visit that they “do not want to hear about their wisdom teeth”, which every dentist they’ve seen before me has advised they should have removed.
People either assume that pain-free is problem-free, therefore their wisdom teeth should be left alone, or that all wisdom teeth should come out. Both opinions are wrong, most of the time.
“Wisdom teeth” is a common term for third molar teeth. These third molars are the last of our adult teeth to erupt, usually between 16 and 18, which is probably why we call them “wisdom” teeth. Due to human evolution and the nature of our modern diet, it is becoming very common for people not to have all their wisdom teeth form or erupt. When they do erupt, they very rarely ‘fit’ in the jaw and often are positioned at an angle or become ‘stuck’ (impacted) under soft tissue or bone.
NOT ALL WISDOM TEETH HAVE TO GO!
If they erupt relatively quickly and painlessly and settle into a position similar to the surrounding teeth, wisdom teeth are treated just like any other tooth.
BUT…MOST PEOPLE ARE NOT SO LUCKY
In most people, one or more of the following complications of wisdom teeth eruption take place:
- Wisdom teeth erupt slowly and become completely or partially stuck below the soft tissue
This ‘flap of gum’ (operculum) traps food and bacteria and becomes inflamed and infected, leading to frequent painful episodes.
- Wisdom teeth erupt only halfway and settle lower than the surrounding teeth.
This allows more food to be trapped around them, making it difficult to floss the area and leading to tooth decay and gum disease around the wisdom tooth and the tooth next door.
- Wisdom teeth erupt at an angle before getting ‘stuck’ against the tooth next door.
This leads to bacteria being trapped on the surface of the wisdom teeth and between the wisdom teeth and the teeth next to them. Decay and gum disease can develop as the area is impossible to clean.
- Top wisdom teeth can ‘over-erupt’ into the space below them if the lower wisdom tooth is not there or hasn’t erupted properly.
This can be traumatic to the soft tissue in the lower jaw and create ulcers or can leave the top wisdom tooth vulnerable to plaque as it is difficult to clean.
SO, HOW DO WE KNOW WHEN THEY STAY AND WHEN THEY GO? This OPG radiograph allows us to assess wisdom teeth before the removal.
When deciding when to remove wisdom teeth, we look at a few factors:
- Do these teeth cause pain and trauma, which may prevent patients from carrying out their daily tasks?
- Are these teeth decayed and are they difficult to access for restoration (filling) to be done?
- Do these teeth pose a risk to the surrounding teeth?
- Do these teeth create weaknesses in the jaw, possibly putting patients at risk of jaw fractures in case of any trauma?
- Are these teeth safe to remove and is the benefit of having them out greater than the risk of removing them?
If the answers to these questions are yes, we then recommend that one or all of the wisdom teeth are removed.
There are various ways wisdom teeth can be removed:
- by routine extraction procedure, under local anaesthetic, by a general dentist
- by minor surgical intervention, under local anaesthetic, by a general dentist
- by minor surgical intervention, under local anaesthetic or sedation, by an oral and maxillofacial surgeon
- during a day-stay procedure in a hospital, under general anaesthetic, by an oral and maxillofacial surgeon.
HOW WILL I RECOVER?
Recovery time from wisdom teeth removal varies as much as the reasons behind their removal and the way they were removed. Everyone responds differently to the procedure. Most people handle it really well, suffer no complications and have no need for time off work.
Postoperative pain is common for up to 3 days and is best treated with antiinflammatories (eg. Ibuprofen).
You should expect longer recovery time for more complicated procedures and allow yourself between 24 and 72 hours for full recovery.
Remember: if they need to be removed, the longer you leave wisdom teeth untreated and avoid extraction, the more likely you are to suffer from complications before and after their removal.