Wisdom Teeth

What should I do about my wisdom teeth?
There are many good reasons for removing wisdom teeth also known as third molars, there are also some risks and complications that are possible when extracting these teeth and sometimes there are some good reasons for leaving them alone. The decision on a specific course of action must be determined by a well informed doctor and patient working together.

REASONS FOR EXTRACTION OF WISDOM TOOTH One of the most common reason is that the mouth is just too small for these teeth to fully erupt into a good functional position. This leads to one of several situations.
The teeth remain completely buried in the bone of the upper and lower jaws in which they developed, a condition known as impaction.
In the case of the fully impacted tooth, it may continue to sit in the bone, surrounded by the normal cyst in which all teeth develop. It may also happen that the normal cyst, later in life, enlarges and may even develop changes in the cells that line the cyst. When such cysts get large enough, they should be removed and examined by a pathologist.
The teeth begin to erupt but are not able to assume their correct upright position. Most commonly the upper third molars will tend to face out towards the cheeks while the lower third molars will lean forward with just a small portion of the crown protruding through the gum. Teeth that are partially erupted lead to two problems.
First they make hygiene of the second molars difficult leading to increased possibility of decay and gum disease (periodontal disease) around these important teeth.
Second the pink flap of gum tissue which partially covers the erupting tooth creates a warm, moist and dark pocket where bacteria which normally live in the mouth can use the food you eat to flourish, multiply and cause an infection known as pericoronitis. In fortunate cases, the swelling and pain of this condition will be relieved when the infection drains back into the mouth. In those less fortunate, the swelling persists, does not drain back into the mouth but rather extends laterally and if not treated can become a very serious infection. The treatment of choice for pericornitis is extraction of the offending tooth. Antibiotics, operculectomies and other adjunctive treatments may be helpful from time to time but the problem can return as long as the conditions which allowed it to develop in the first place continue to exist.

That is the reason that many people have their wisdom teeth extracted while they are young and healthy and the teeth are surrounded only by a small normal developmental cyst rather than have to undergo a more extensive surgical procedure later in life when their recovery may not be as easy and their general state of health may not be as good.

Finally, some dentists subscribe to the theory that wisdom teeth may push the other teeth in the mouth forward and cause crowding and misalignment. You should be aware however, that not all oral surgeons believe this to be the case.

When a wisdom tooth is blocked from erupting into the mouth normally, it is termed as "impacted" A tooth may be partially impacted or totally impacted. Serious problems can develop from partially impacted teeth, such as pain, infection, and crowding of, or damage to, adjacent teeth. .Impactions according to positioning of the tooth have been classified

PANORAMIC RADIOGRAPH (ORTHOPENTOGRAM) (OPG) allows your dentist to see the entire structure of your mouth in a single image. Within one large film, panoramic X-rays reveal all of your upper and lower teeth and parts of your jaw. This particular radiograph shows impacted third molars. One placed at low-level, horizontal and distally directed.


Risks and potential complications
Now however, it is important to consider the possible risks and complications involved in the removal of third molars. There are some risks/potential complications which are common to all surgical procedures however major or minor they might be. These are:

Removal of third molars is a surgical procedure and some discomfort should be expected. It is also reasonable to expect that this discomfort will be taken care of by the pain medication prescribed.

In the absence of preexisting infection it is uncommon to see an infection resulting from the removal of third molars however, there are more bacteria per square inch in the oral cavity than anywhere else in the human body and so often patients are placed on antibiotics prophylactically during the initial healing period.

Post operative swelling and bruising are both within the spectrum of normal. The exact amount of each of these varies from patient to patient as does the time required for complete resolution of these symptoms. Surgical edema is a normal consequence of surgery and also normally resolves without extraordinary measures.

It is not possible to do surgery without some bleeding one should expect that the minimal oozing can be easily controlled by biting on clean gauze or a tea bag. In case Bleeding cannot be controlled than one should contact the dentist or emergency Deptt of the Hospital.
Patients whose medical condition contraindicates general anesthesia, third molars can safely and effectively be removed with local anesthetic only. Local anesthetics as used in the oral surgeon's office are among the safest of drugs around and true allergic reaction to a properly administered local anesthetic is very rare

Finally there are some risks/complications that are unique to the removal of third molars.

The upper third molars have roots which often are separated from the maxillary sinuses by only a very thin layer of bone. Occasionally, a small communication is established between the sinus and the oral cavity when one of the upper third molars is removed. If this is the case, the normal procedure is for the area to be sutured closed, the patient to be informed of the finding, appropriate antibiotics and decongestants to be prescribed, the patient to be instructed to avoid tasks which build up pressure in the sinus like nose blowing and bearing down forcefully and the patient advised to come for follow up. Most often this results in an uneventful healing period with no further treatment being required. Occassionally, the area will heal open rather than closed in which case an additional small surgical procedure will be required to close the communication.

The lower third molars often have roots that lie very near or even wrapped around the inferior alveolar nerve. This is the nerve that supplies feeling to the lip, teeth and tongue on each side of the mouth. Occasionaly, when a lower third molar is removed, that nerve will be bumped or bruised and if so a change in sensation may be noted on that side. It is important to understand that this is a sensory nerve and does not affect the ability to move the parts of the oral cavity to which it gives sensation (feeling). In most cases, the nerve heals itself but, because nerves heal slowly, it may take six months to one year before return of normal sensation. Very rarely, the damage to the nerve is permanent.

One should discuss all possible complications and also give a detailed medical history to the Dental Surgeon before he/she decides to go for a Third Molar Extraction.

It's wise to get an early opinion from your dentist on getting wisdom teeth pulled before they become impacted, causing pain, swelling, infection, cavities or gum disease.

Why don't wisdom teeth grow in right position?
The shape of the modern human mouth is often too small to accommodate wisdom teeth which make their first appearance in young adults between the ages of 15 to 25. Over the course of time in the evolutionary process, the need for strong jaws to chew food has been greatly reduced due to change in eating habits of human beings.

What does impacted mean?
When wisdom teeth don't have room to grow or they haven't reached their final position by age 25, they are considered impacted. Third molar impaction is the most prevalent medical developmental disorder.

What are the problems caused by impacted third molars?
Partially erupted wisdom teeth are breeding grounds for bacteria and germs that may cause infection, and cysts and tumors may grow on a trapped wisdom tooth. Jaw pain and gum disease may occur. Not all wisdom teeth cause problems, however.

Isn't antibiotic therapy enough to suppress the infection?
Antibiotics only soothe infected wisdom teeth for a short time. Since people frequently use a wide variety of antibiotics, the infection may be resistant to such medication and doesn't solve the real problem: The tooth can't fit in your mouth.

When is removal necessary?
It isn't wise to wait until wisdom teeth bother you. Early removal, as advised by your dentist, is generally recommended to avoid problems, such as an impacted tooth that destroys the second molar. People younger than 16 heal easier too. At an early age, people should be evaluated by their dentist who can track third molar development with the help of X-rays. Second molars should be visible to lessen the chance of damaging them during surgery. This occurs at age 11 or 12, so wisdom teeth should be removed when the decision has been made that they cannot erupt into an acceptable position.

What if there are no symptoms?
People with symptoms of impaction, such as pain, swelling and infection should have their wisdom teeth removed immediately. However, those with no symptoms can avoid the chance of ever suffering from the pain of impacted wisdom teeth or achieve better orthodontic treatment results by having them removed. Asymptomatic impacted wisdom teeth also should be removed to reduce the chance of unexplained pain, accommodate prosthetic appliances, or avoid cavities, periodontal disease, bone shrinkage and tumor development.