Managing Your Wisdom Teeth

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Managing Your Wisdom Teeth
Dr. Rajiv Butany
UBC Faculty of Dentistry

As a general practitioner, I frequently perform consultations with patients regarding the status of their dreaded Îwisdom teethÌ. Most patients will have already started to experience the aches and pains associated with these unique teeth by the time they visit, while others are shocked and amazed at how these teeth can end up in the creative positions we see on x-rays. It is for these reasons that I thought it would be useful to elaborate on the history of these popular teeth, and the options available to treat them in the dental office.

What are Wisdom Teeth?
ÎWisdom teethÌ or Îthird molarsÌ are the last teeth to erupt in the mouth. An individualÌs first molars will erupt at 6 years of age, his second molars at age 12 and his third molars between the ages of 17 and 21 years, the so called Îage of wisdom.Ì These teeth can be functional and useful if they grow into the mouth in a proper orientation and relationship to opposing teeth, and if they allow the surrounding gums to be kept clean. Interestingly, studies by anthropologists have shown that the primitive diet of early humans resulted in significant wear of their teeth. As a result, teeth used to drift forward to compensate for the spacing created by excessive wear, and in-turn space was created in the jaw for the third molars to erupt. As humans have evolved, our diet has become more refined. This fact, coupled with the popularity of procedures used to straighten and improve tooth position, has now limited the amount of space available for the wisdom teeth to come into the jaw.

What is an Impacted Tooth?
The dental term ÎimpactionÌ refers to a tooth that has failed to emerge fully into its expected position. This may result from limited space in the dental arch, causing the tooth to be held back by overlying gum and bone or another tooth. These teeth can be either partially impacted (only a portion of the tooth has broken through the gum tissue), or completely impacted (no part of the tooth is able to break through the gums).

Do I need to have my wisdom teeth out if they arenÌt bothering me?
Unfortunately, many problems caused by wisdom teeth are not always visible or painful. As these teeth grow, their roots elongate and complications become more likely when they are removed. Even erupted wisdom teeth may need to be removed if they are non-functional, interfering with a personÌs bite, severely decayed, at risk for periodontal disease, or interfering with surrounding teeth restorations.

Symptoms of Impacted Wisdom Teeth
The following symptoms are often seen during the course of eruption of impacted wisdom teeth:

pain
bad taste in mouth
swelling of the gumline at the back of the mouth
infection in the mouth
facial swelling
Why Should I have my Wisdom teeth removed?


Impacted wisdom teeth (total or partial) can be associated with a number of problems if not treated early on.
Due to their position in the mouth they, they may frequently serve as traps for bacteria and plaque.
If they are covered by a flap of gum tissue, food and debris can be caught under the flap, causing the gums to be red, swollen, and tender.
If positioned awkwardly against neighbouring teeth they may lead to tooth decay and possibly bone loss.
A cyst may develop if the sac surrounding the tooth becomes filled with fluid. A growing cyst may hollow out the jaw if not treated promptly and cause permanent damage to surrounding teeth, bone and nerves.
On rare occasions, a tumor may develop from the cyst walls and a much more involved surgery would be required to remove the structure.
One or more of your wisdom teeth may try to enter the jaw at a difficult angle, with the top of the tooth facing forward, backward or to either side.
What can I expect during the surgery?
Wisdom teeth removal can be carried out at your General DentistsÌ office or with an Oral and Maxillofacial Surgeon, often using intravenous sedation and local anesthesia. This means that you may be given medicine to help you relax, in addition to ÎfreezingÌ all of the areas around the tooth. Your surgeon will open the gum tissue around the tooth, remove any bone overlying the tooth and separate the tissue connecting the tooth and bone. The tooth may sometimes be removed in multiple pieces depending on its position in the jaw. The tissue may then be closed with dissolving stitches. The ease with which a tooth will be removed will depend upon a number of factors, including root development (it is recommended that the teeth be removed when roots are almost formed or three-fourths developed), tooth position and proximity to vital structures (i.e. nerves, major blood vessels).

Alternatives
Removal of Wisdom teeth is often the only way to alleviate painful symptoms and persistent infection. Although antibiotics can provide temporary relief, symptoms are likely to flare up again in the future.

What are the risks of wisdom teeth surgery?
As with any surgery, there are possible complications associated with wisdom teeth removal, these include:

Pain and swelling around the gums and tooth socket
Prolonged bleeding post-operatively
Difficulty opening your jaw (trismus)
Damage to existing dental work or to the roots of nearby teeth
Post-operative infections
Temporary numbness due to bruising or stretching of nerves in the jaw
An opening in the sinus cavity, when a wisdom tooth is removed from the upper jaw
Wisdom teeth serve as a constant reminder of our evolutionary past. It is important to carefully consider all information provided and understand all of the risks before proceeding with surgery. It is rarely harmful to your health to have your wisdom teeth removed. The likelihood of complications is reduced in younger patients (late teens and early 20Ìs) since the tooth roots are not fully formed, and the jaw bone is not as dense which makes removal easier. It is best to discuss your case with your dental practitioner so that you can come to a decision comfortably, and correctly.

Should you have any questions or require further information, please visit the Old Masset Dental Clinic, or I can be reached via e-mail at sajiv.butany@utoronto.ca.