Wisdom teeth
What are wisdom teeth?
Wisdom
teeth are the third molars that erupt into the mouth from age 16 to 21 years.
There are the last 4 teeth in the permanent set of 32 teeth to erupt into the
mouth.
What are the problems with wisdom teeth?
The possible problems with wisdom teeth are:
1.
Pain
This can arise when the teeth are erupting through the gums from age 16-21. If there is sufficient space for the teeth to erupt through, this is only a transient phase. On the other hand, if there is insufficient space for the teeth to erupt through, they may become impacted (angulated) and pain may be recurrent.
2.
Impaction
Insufficient space in the arch causes the wisdom tooth to be angulated, with no possibility of erupting fully. The impaction causes food debris to accumulate behind the anterior second molar tooth.
3.
Gum infection
The main cause of gum infection around the wisdom teeth is food trapping in the “crevice” of the impaction and normal brushing is ineffective in removing all the food debris. Also the cheek tissue may extend to “cover” the wisdom teeth. Persistent gum infection may flare up and extend to the face and neck.
4.
Decay
Wisdom teeth that are difficult to maintain may decay. Additionally, the anterior second molar may decay at the point of contact of the impacted wisdom teeth. This can be very difficult to restore with a filling as it may extend below the gums.
5.
Cysts / Tumours
In rare
instances, cysts or jaw tumour may develop around the impacted wisdom teeth. As
a result of the growth of cyst or tumour, bony swelling may be observed
externally causing facial asymmetry. At the same time, jaw bone may be resorbed
(“eaten away”) internally.
6.
Others
a.
Wisdom teeth may impede teeth movement
during orthodontic treatment (braces).
Some may feel “pressure” on the lower anterior teeth as the wisdom teeth
erupt.
b.
Wisdom teeth have been implicated in lower
jaw fractures as they are positioned in the angle that constitutes a weak
point.
c.
Patient undergoing radiotherapy,
chemotherapy or transplant surgery may encounter increased problems with their
wisdom teeth as a result of adverse effects of treatment. Additionally, any
extraction or surgical treatment can pose greater risks than the usual and requires
advanced management.
Do I have to remove my wisdom teeth?
There is no necessity to remove the wisdom teeth
if they have erupted into the mouth and not giving any problems. However, if you have any of the problems
listed above, then it is advisable to have them removed. There is a school of
thought that recommends that wisdom teeth that are completely buried in the jaw
bone need not be removed. However, should any problems arise later in life, it
becomes extremely difficult to manage especially in the event of poor or
compromised medical status.
When can I remove my wisdom teeth?
If there is a need to remove your wisdom teeth,
it is advisable to have them removed early (late teens or early twenties). This
is because your jaw bone is still “elastic” and post-operative healing is
usually rapid and uneventful. Additionally, scientific literature has shown
that there is complete regeneration of the jaw bone following wisdom teeth
removal when is done before age 25.
What is the post-operative care after wisdom teeth surgery?
Following wisdom teeth surgery, the usual effects
of oral surgery will be seen ie bleeding, swelling, discomfort, difficulty
opening your mouth and eating. If there is excessive bleeding, biting on
sterile gauze at the site of operation for half an hour usually stops the
bleeding. You may rinse your mouth but do avoid vigorous rinsing that dislodges
the blood clot from the socket. Maximal
effects of swelling and discomfort are usually seen on the second to third day.
A cold pack on the face to prevent swelling is very useful for the first day.
You should rest and avoid vigorous exercises for 5-7 days. A soft diet is
helpful. You should take any prescribed
medications and mouthwash to aid the healing. Your Surgeon 24 hour hotline
number is useful should there be any unexpected complications.
What are the complications of wisdom teeth surgery?
Most wisdom teeth surgery can be carried out
routinely without any major complications. Slight discomfort, pain and swelling
are inevitable. However, possible complications immediately after surgery are
bleeding and nerve injury. Bleeding is
manageable with haemostatic agent and bite pressure. Nerve injury to the lower
lip is due to the fact that both the teeth and lower lip share the same nerve.
This nerve can pass fairly close to the root tips of the wisdom teeth. The
reported risk may range from 1-30%, depending on the severity of impaction and
experience of the surgeon. The best management is anticipation and prevention.
Fortunately, this complication is usually temporary.
As healing of the operation site takes up to 3
weeks, the other possible complications are:
a.
Infection
Infection can occur and the operated site must be reviewed post-operatively. Antibiotics may be required and good oral hygiene is very important.
b.
Pain due to “dry socket”.
Severe pain may occur when there is “dry socket”. This requires cleansing and dressing of the socket. Strong painkillers are usually prescribed.
c.
Gum infection
Gum infection of the second molar tooth may occur
if wound healing is less than ideal. This usually occur when the wisdom teeth
are removed 
later
in life (30 or more).
d.
Rare complications :
Jaw fracture
Jaw joint pain.
Who can I see for wisdom teeth surgery?
See your Family Dentist or an Oral &
Maxillofacial Surgeon (Oral Surgeon, for short). An x-ray is mandatory before
removal of impacted wisdom teeth. Where the impaction is very deep, an x-ray
called orthopantomogram (OPG) or Cone-Beam Computerised Tomography is very
useful to assess the overall condition, especially vital structures such as
maxillary sinuses and nerves.
Disclaimer:
The above FAQs are strictly for information only. It is NOT
intended as treatment advice over the Internet. See your Oral Surgeon or
Dentist to assess your individual need.