Wisdom teeth are your third set of molars; most people have one in each corner
of the mouth. Your third molars usually emerge or ‘erupt’
in your late teens or early twenties, and are your last
teeth to come in. Early humans needed large jaws and
more teeth because of a tougher diet, but modern humans
have smaller jaws and often don’t have enough room
for third molars to grow in.
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How do I
know if I should have my Wisdom Teeth Removed?
Your dentist or orthodontist may recommend you have your
third molars removed—either as a preventative measure,
or because you are already experiencing symptoms from the
erupting teeth. Your wisdom teeth can be removed by your
general dentist if they are simple extraction's, but if
there are any complications such as “impaction”,
you may be referred to an oral surgeon to remove them.
Early removal is often recommended, because
at a younger age, your wisdom teeth are less anchored in
the jaw and therefore easier to remove, but they can be
removed at any age if they become a problem.
Sometimes third molars don’t erupt
at all, remaining below the gum surface in the jaw bones
without causing any discomfort or crowding other teeth.
Often however, they do begin to erupt, and because there
is not enough room, they push against your other teeth,
causing them to crowd together. Your third molars can also
become ‘impacted’ or lodged in the jawbone and
gums, which can become very painful and lead to infections
in the bone and gums.
Potential problems with
leaving third molars in place include:
· Gum disease: when a wisdom
tooth erupts (breaks through the gum) only partially, bacteria
can get under the flap of skin, causing an infection in
the gum.
· Crowding: An impacted or
erupting wisdom tooth can push on adjacent teeth, causing
them to become crooked or even damaging them structurally.
· Decay: A wisdom tooth that
is hard to clean because of its partial eruption or position
far back in the mouth may become carious.
· Poor Position: A wisdom
tooth that grows toward the cheek or in an abnormal direction
can cause swelling, irritation to the inside of the mouth,
or may even make it difficult to bite down.
· Cysts: If the sac that
holds the crown of the tooth remains in the jawbone, it
can fill with fluid and cause a cyst that destroys surrounding
bone.
| Complications from Impacted and Partially Impacted
Wisdom Teeth |
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| (a) Infection |
 |
| (b) Crowding, damage |
 |
| (c) Cyst |
| Complications may
arise from partially impacted teeth (fig. a and
b) and totally impacted tooth (fig. c). |
“Impacted” wisdom teeth are teeth that have
grown in an abnormal direction, or at an angle to other
teeth. They can grow away (distoangularly), toward (mesioangularly),
or in a vertical or horizontal position to other teeth,
causing pain and/or swelling in the face and jaws.
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What
happens during surgery?
Generally, wisdom tooth removal is a relatively simple process.
Wisdom teeth can be removed using only a local anesthetic
if they are uncomplicated, but impacted teeth may mean that
general anesthesia (sleep) is necessary. You also may be
anxious enough that you prefer to be “asleep”
during the procedure. If you do decide to have general anesthesia,
it is very important to follow the surgeon’s instructions
carefully, particularly that you do not eat or drink for
at least six hours before the surgery.
Before Surgery you may be given a sedative
(by pill or IV), or nitrous oxide administered through a
mask placed on your nose. Once you are fully relaxed, or
asleep in the case of general anesthesia, you will be given
a local anesthetic to numb the wisdom tooth area. Most patients
feel little discomfort, reporting only pressure or tugging
sensations if they have chosen to remain awake during the
procedure.
Expect the procedure to take about an
hour. If your teeth are impacted, you will have stitches
in the back of your mouth to close the incision. You will
need a friend or family member to drive you home, especially
if you have been under a general anesthetic, and you may
want to take some days off work or school to give yourself
time to recover. You can expect some swelling and perhaps
bruising after the surgery, which will subside over a week
or two. You may be given a prescription for pain medication,
or instructions to take over-the-counter pain medication.
It’s important you follow your home-care instructions
carefully to promote fast healing.
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