The Wisdom on Wisdom Teeth

Teeth by Numbers

Wisdom teeth are no different than other teeth, except that they are the last ones to grow into the mouth.   Some people do not grow any wisdom teeth.

Healthy and properly positioned wisdom teeth can be as useful as other teeth. However, they can cause problems if the teeth do not erupt into the mouth properly.

What is an impacted wisdom tooth?

The term that is used to describe wisdom teeth that don’t come through normally is impacted wisdom teeth. Two reasons for this are a lack of space, or other teeth being in the way. Impaction means that the tooth may  be partially trapped by the jawbone, back teeth or gums. These teeth can grow sideways, emerge only part way from the gum or remain trapped beneath the gum and bone. Just because a tooth has not erupted doesn’t mean it is impacted. The persons teeth may be developing slowly and it may  be too early to tell. Only a dentist,  with use of x-rays, can determine if the jaw size can accommodate up to four wisdom teeth and whether the teeth  are growing properly.

Problems with wisdom teeth

For most people, wisdom teeth cause no problems at all, but some people can suffer problems such as inflammation of the surrounding gum, a higher risk of tooth decay, gum disease in other teeth, and possibly problems with teeth in later life.

Removal of wisdom teeth is a fairly common procedure to be carried out in our health service in Ireland. In common with other countries, impacted wisdom teeth have  sometimes been removed whether or not they were causing problems, this is often referred to as prophylactic removal of wisdom teeth.

This practice is being questioned by leading researchers including highly respected academics and oral surgeons. The National Institute of Clinical Excellence in the UK reports no reliable evidence to suggest that operating on impacted wisdom teeth that are not causing problems has any benefit for the patient as every operation has some associated risk.

Based on an assessment of the evidence NICE recommends that impacted wisdom teeth that are free from disease and otherwise healthy teeth should not be operated on as there is no reliable research to suggest that this practice benefits patients.

On the contrary, patients who have healthy wisdom teeth removed are being exposed to the risks of surgery which can include:

  • nerve damage
  • damage to other teeth
  • infection
  • bleeding
  • very rarely death

When should wisdom teeth be removed?

NICE recommends that only patients, who have diseased wisdom teeth, or other problems with their mouth, should have their wisdom teeth removed. Your dentist or oral surgeon will be aware of the sort of disease or condition which would require you to have surgery. These conditions include:

  • untreatable tooth decay
  • damage to adjacent teeth
  • abscesses
  • recurrent infection of overlying gum
  • cysts
  • tumours
  • if the tooth is in the way of other surgery
  • Removing the tooth

The actual extraction can be done by a dentist or it may be referred to an oral surgeon who is a specialist dentist. The decision is based on the dentist’s and the patient’s preference and any case specifics such as how deep the roots are and whether the teeth are erupted or impacted. Some wisdom teeth can be removed with ease in a few minutes, especially upper wisdom teeth. Lower wisdom teeth are usually more difficult and can take anything from 30 minutes to an hour. The procedure can be done in the dentist’s surgery or in the oral surgeon’s surgery, a special surgical day care centre or in a hospital or dental hospital.

It can be performed under local anaesthetic, intravenous sedation or general anaesthesia.

Before the operation

Pre-operative instructions are comprehensive and may include fasting instructions for a general anaesthetic. No food or drink for six hours before the operation and no smoking to reduce chance of infection and improve healing.

The operation

There are several methods that can be used to remove wisdom teeth. An extraction involves getting access to the tooth through the soft and sometimes hard tissue (bone), gently detaching the connective tissue between the tooth and bone, and removing the tooth.

After the operation

After a general anaesthetic or sedation expect to be out of action for least  two days, avoiding driving and other complex tasks requiring full attention span. The first six to eight hours are usually uncomfortable and will  require medication prescribed by the surgeon or strong over the counter pain medication. Swelling should be controlled by ice packs and bleeding with a pressure pack of folded gauze pads placed over the extraction site. A soft diet is generally best for the first few days following the extraction.

Teeth can be brushed the next day, but be careful to avoid the surgical area for the first few days. If you notice any unusual bleeding, swelling or pain in the days following the surgery call your dentist or oral surgeon immediately.

How to prevent a dry socket

Dry socket is the most common complication following a wisdom tooth extraction. This is a very painful condition which is often accompanied by a foul odour and bad taste.  It occurs when the normal healing process is interrupted by an improperly formed blood clot or if a newly formed blood clot is dislodged too early. This results in the underlying bone being exposed. A blood clot is a necessary foundation for new tissue and bone to grow and heal over a two month time-frame. When the clot is lost, the cavity becomes dry and is unable to heal, resulting in a painful post operative complication.   The condition is preventable. A few simple steps can help prevent the condition:

Follow instructions of your dentist or oral surgeon carefully

  • Avoid disturbing the wound for the first 24 hours
  • Avoid drinking with a straw because the suction will interfere with blood clotting
  • Avoid smoking because it can contaminate the extraction site and delay healing
  • Avoid excessive mouth rinsing which may interfere with blood clotting

Sources:  1. American Dental Associastion: http://www.ada.org    2. Academy of General Dentistry: http://www.agd.org          3.American Association of Oral and Maxillofacial Surgeons http://www.aaoms.org                    4. National Institute of Clinical Excellence http://www.nice.org.uk

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