Wisdom teeth, also referred to as the 3rd molars, are the last teeth to develop in the mouth. Many people do not have any wisdom teeth or are missing several of them genetically.
Wisdom Tooth Problems
The main problem with wisdom teeth is that in many individuals the teeth cannot migrate properly into position in the jaw. They may tip sideways, forward or backwards, or not be able to erupt at all. They can cause crowding of other teeth, with the resulting problems expanding into other areas of the mouth.
The term “impaction” is used to describe the inability of the tooth to properly erupt into the oral cavity. The impaction can be partial or total. A partial impaction is one where only a portion of the tooth has erupted above the gum. We sometimes refer to this type of impaction as a soft tissue impaction, where most of the body of the tooth lays just under the gum. Most times a person is unable to adequately keep this semi-erupted tooth clean. This can lead to food being trapped, decay, or periodontal disease. A frequent problem with this type of impaction is that the gum tissue covering the partially erupted portion of the wisdom tooth becomes inflamed and swollen. We call this a pericoronitis, which can be painful and unpleasant. Treatment can be cleaning the site along with antibiotic coverage – or extraction of the problem wisdom tooth.
Wisdom teeth that are stuck within the bony part of the jaw are called bony impactions. In this case, the wisdom tooth can lean against the roots of adjacent healthy teeth and cause problems. In some cases they can cause no problems at all.
Thorough assessment of wisdom teeth removal needed in some cases
In some instances, a third molar may be impacted so deeply that it lays against a vital structure such as the mandibular nerve. An attempt at removal of this tooth may cause injury to the nerve, resulting in temporary or permanent numbness to the lip, chin, and tongue. If such a wisdom tooth needs removal, a thorough assessment of the risk is necessary to determine if removal is best or if leaving the tooth alone would be the best solution.
Sometimes, a wisdom tooth causes so much discomfort that a patient must consider removing it even when it in close proximity to the mandibular nerve. One solution in this situation is a partial removal- a coronectomy- where just the “head” or crown of the tooth is removed and the remaining roots are left so that less complications are likely.
When should we consider removal of wisdom teeth?
- If they are causing constant pain
- If they are causing crowding in the arch they are attempting to erupt into.
- If they have a severe cavity that cannot easily be treated.
- If they are tipped over against the adjacent teeth, and those teeth begin to decay by this associated pressure.
- If cleaning them becomes a near impossibility.
- If pericoronitis (painfully inflamed gum tissue) persists.
When should we leave wisdom teeth alone?
- If they are not posing a problem.
- If the patient has a medical condition that precludes surgery.
- If the removal would lead to possible complications due to surrounding structures.
When are wisdom teeth best removed?
Wisdom teeth are best removed as early in life as possible. Removal of early developing wisdom teeth are easier due to incomplete development of the roots. They often do not present the same complications as later on in life. If an evaluation of wisdom teeth in mid-teen years indicates there is insufficient room for these teeth and there is no alternative, removal before age 20 is recommended.
Do all wisdom teeth have to be extracted?
No – many people have wisdom teeth that are fully erupted healthy third molars. Many times they are fully functional and have proper occlusion against the opposing tooth. In this case, there is no need for extraction.
For more information, a video on wisdom teeth is available here…