Wisdom teeth

Wisdom teeth develop from ages 18 to 25 after the rest of the milk teeth have been replaced by permanent teeth. One wisdom tooth develops in the rear corners of either side of the upper and lower dental arch, with wisdom teeth consisting of either one or more of the four third molars. It is not uncommon to have no wisdom teeth or only one wisdom tooth develop.

Wisdom Teeth Development and Impact

Wisdom teeth have undergone an evolutionary change in their development due to modern civilisation. In earlier centuries before the use of cutlery to eat when humans needed to be able to chew raw or semi-raw meats, roots and other foods, wisdom teeth served a useful and powerful purpose.

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Over time modern living and diet have changed the way humans evolve physically, including smaller jaw development and impacted wisdom teeth. Some people still develop wisdom teeth and others do not. Wisdom teeth may erupt causing dental disorders and impacted teeth, requiring their extraction.

Wisdom Teeth Impaction

With smaller jaw development the dental structure may not always facilitate wisdom teeth development due to lack of space. When a wisdom tooth erupts under such conditions it may develop irregularly or cause impaction.

Irregularly developed wisdom teeth or impacted wisdom teeth often cause gum or operculum swelling, inflammation, infection and pain in the mouth and jaw. Impacted wisdom teeth may also cause halitosis or bad breath. These symptoms are caused by bacterial colonisation as a result of wisdom tooth impaction.

Leaving impacted wisdom teeth untreated may cause oral disease and illness. It is therefore vital for good health and well-being that impacted wisdom teeth are removed through tooth extraction.

Types of Wisdom Teeth Impaction

Wisdom teeth may erupt through the jaw bone and gum line developing irregularly in the following ways:

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Horizontal impaction

Horizontal impaction is when the wisdom tooth erupts and develops at a 180 degree angle to the tooth in front of it, thus pressuring it to move out of its correct position.

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Mesial impaction

Mesial impaction is when the wisdom tooth erupts and develops at a 45 degree angle to the tooth in front of it, leading to irregularity in tooth movement and position.

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Vertical impaction

Vertical impaction is when the wisdom tooth erupts and develops downwards locking with the tooth beside it, causing the neighbouring tooth to move out of position.

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Distal impaction

Distal impaction is when the wisdom tooth erupts and develops backwards into the rear jaw bone behind it, which can then cause jaw irregularities.

Wisdom Tooth Extraction

There are four main effects of wisdom teeth impaction requiring tooth extraction to preserve patient well-being. Wisdom teeth need to be extracted in cases of:

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Cavities

Wisdom tooth cavities result from tooth decay in the region of the wisdom tooth and affect neighbouring teeth. Food becomes trapped in the area of the irregular-developed wisdom tooth because it is difficult to clean. Excess oral bacteria colonises where plaque sticks to the trapped food, leading to the development of gum inflammation and infection. Extracting the wisdom tooth can prevent the spread of tooth decay to other dental structures.

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Cysts

Wisdom tooth cysts form from fluid and gas build-up in the infected bone around the impacted wisdom tooth. Cysts may grow and vary in size requiring enucleation and wisdom tooth extraction, so as to remove infection and prevent its spread in the body.

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Gum Disease

Wisdom tooth gum disease results from an inability to properly clean the impacted wisdom tooth. Plaque and excess bacteria colonises the food debris trapped in the region of the wisdom tooth. If left untreated gum disease can then develop. To preserve oral and overall health and prevent further bone loss the wisdom tooth is extracted.

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Pericoronitis

Wisdom tooth pericoronitis is caused when the gum tissue or operculum overlapping the wisdom tooth becomes infected by colonising bacteria and plaque. The infection often re-occurs and results in the need for wisdom tooth extraction.

Wisdom Teeth Treatments

While it is an option not to have dental treatment for an impacted wisdom tooth, the reality is that the pain and health complications may require treatment in the long term.

Leaving impacted wisdom teeth untreated may cause teeth and bone loss, which can drive up the cost of dental treatment, including emergency dental treatment for an impacted wisdom tooth. The need may also arise for medical treatment due to health complications as a consequence of untreated wisdom tooth impaction.

Recommended treatments for wisdom teeth impaction will differ based on the type and severity of the impaction. One or more dental treatments may be required. Dentists provide individuals with several treatment options for impacted wisdom teeth:

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Painkillers and anti-inflammatory medication

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Antibiotics

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Tooth extraction

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Cyst enucleation

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Root canal treatment

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Operculum gum contouring

NICE Guidelines about Wisdom Tooth Impaction and Extraction

According to the National Institute for Health and Clinical Excellence (NICE) Guidelines for impacted wisdom teeth, healthy impacted wisdom teeth that are not a threat to oral or overall well-being should be preserved and not be removed. The reason is because surgical risk is considered higher than the risk posed by the healthy impacted wisdom tooth.

NICE Guidelines state that only unhealthy impacted wisdom teeth should be extracted, such as those with cavities from tooth decay, repeated gum inflammation and development of cysts. A wisdom tooth that causes oral disease and infected wisdom teeth often requires tooth extraction.

Wisdom Tooth Surgery and Procedures

Dentists initially examine a patient’s wisdom tooth or teeth to check for signs of dental damage, decay, gum inflammation, infection and disease. Diagnostic screening, such as X-rays and CT scans, are used to evaluate jaw structure and wisdom tooth proximity to the inferior dental nerve or ID nerve.

The reason the wisdom tooth to ID nerve proximity is assessed is because of its function in lip, chin and facial sensation. If the ID nerve is damaged facial expression may alter causing a level of facial disfiguration, and the individual may experience pain and discomfort.

Prior to wisdom tooth surgery the patient is administered local anaesthetic and intravenous (IV) sedation where necessary. Patients suffering from dental phobia sometimes benefit from IV sedation for greater relaxation and safety during wisdom tooth removal.

The oral surgeon assesses patient response to the anaesthetic and begins the surgical procedure when the wisdom tooth region is numb for pain-free treatment. The surgeon lifts the gum tissue and lifts out the wisdom tooth.

Depending on the type and severity of wisdom tooth impaction, the surgical procedures may be somewhat different. For example, it may be necessary for the surgeon to remove wisdom tooth bone piece-by-piece to preserve surrounding dental structure.

Once the wisdom tooth is removed the surgeon uses self-dissolving stitches to re-seal gum tissue for healthy recovery. The entire surgery occurs within the mouth and does not affect the outer facial skin or structures.

Once the anaesthetic and sedation has worn off the patient may start to experience some discomfort. The dentist may prescribe painkillers to alleviate any distress. A disinfectant mouth rinse such as Corsodyl may also be used.

It is normal for individuals to experience some bleeding, swelling, pain and tenderness after wisdom tooth extraction. The facial muscles and jaw may feel sore, though these side-effects are short-term and will pass with healing. An antibiotic is prescribed to prevent infection and allow for healthy recovery.

The dentist will provide the patient with details on how to care for the site of the wisdom tooth extraction. Guidance may include:

  • Place a dirt-free gauze or cloth in the wisdom tooth socket and press down on it to stop bleeding
  • Raise the head with a pillow during sleep to prevent excessive blood flow to the extraction site
  • Notify the dentist immediately if excessive bleeding or lip and tongue tingling continues
  • Wait 24 hours before rinsing the mouth with dentist-recommended mouth wash or salt water
  • Do not consume hot beverages for 24 hours
  • Refrain from exercise for a couple of days after surgery
  • Follow a soft diet for a couple of days after surgery
  • Use painkillers as prescribed or pain-relief
  • Avoid smoking or tobacco use for at least a week after surgery

The guidelines allow patients to heal at their natural pace without complications, such as painful dry socket that may result from smoking. Usually the stitches self-dissolve over a 2 to 3 week period, but in some cases, they may require removal by the oral surgeon. Appointments are made to monitor patient recovery from wisdom tooth surgery and treatment as needed. Any concerns should be reported immediately to the dentist.

Typical risks or complications after any surgery include allergy, infection and bleeding. However, oral surgeons and dentists are qualified in how to minimise the occurrence of such risks and complications. Potential risks of wisdom tooth surgery include:

  • Dry Socket
  • Paresthesia

Dry socket occurs when the blood clot formed in the socket at the location of wisdom tooth extraction bursts or is lost, thus exposing the underlying jaw bone and nerves. Air, saliva or fluids touching this exposed extraction site can cause excruciating pain. A patient may experience dry socket after the third day post-surgery and the pain may endure for about a week.

Blood clotting of the wisdom tooth socket is necessary for healthy recovery. Healing is delayed when dry socket occurs. Dentists discuss how to prevent dry socket, and an emergency dentist should be contacted for treatment if dry socket occurs.

Paresthesia may be temporary or permanent and occurs when the inferior dental or ID nerve is harmed during wisdom tooth surgery due to close proximity of the wisdom tooth to the ID nerve. The dentist will talk about the risk of paresthesia with the patient as part of their care plan.

Tongue or lip tingling or numbness is a sign that the ID nerve may have been damaged during surgery. Patients should notify the dentist for assessment and appropriate treatment. The risk of accident during surgery may not entirely be eliminated, but the patient will be notified about this in such cases.

An oral surgeon specialises in treatments such as wisdom tooth extraction, lip and gum lifts and facial reconstruction. They have the expertise to reduce risks and complications so that patients may gain the benefits of oral surgery.

Unhealthy wisdom teeth are removed to eliminate spread of infection in the mouth to the rest of the body, where it would otherwise have the potential to trigger other health conditions, such as heart disease and diabetes.

Untreated wisdom teeth lead to bone loss, requiring missing tooth replacement so that dental function and facial volume is restored. More expensive dentistry treatments and cosmetic dentistry care may be required if an unhealthy wisdom tooth is left untreated.

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