tooth extraction
molar

Commonly referred to as a wisdom tooth, the last molar is a source of much discomfort. Around the world and across cultures there has always been interesting reference to it.

In English the connotation seems to be with its late appearance – much later than the other teeth and at an age where we would like to think of ourselves as a lot wiser. In Turkish it is known as ‘the 20th year tooth’, in Japanese as ‘unknown to the parents’ from the idea that it erupts after a child has moved away from the parental home, or even ‘love teeth’ in Korean, referring to the pain of first love. Whichever way you refer to them, these teeth are known for their hidden troubles. They are one of the last physical milestones before adulthood and often involve the discomfort of a rite of passage.

WHY ARE THEY A PROBLEM?

Wisdom teeth often become a problem because there is not enough space for them to erupt normally. A space shortage will cause them to get trapped behind the existing teeth, becoming impacted. This could lead to the tooth erupting either partially or not at all.

A partially erupted tooth is difficult to keep clean through normal brushing and flossing. Over time, the accumulation of bacteria, sugars and acids may cause a cavity to form, leading to decay of the impacted tooth and possibly its healthy neighbour. The trapped bacteria and food debris can also cause bad breath (halitosis) or gum infection around the wisdom tooth (pericoronitis).

If the tooth is completely impacted it can cause a deep bony ache as it pushes against the roots of its neighbour. This can cause destruction of the neighbour’s roots in some cases. It is also believed that this vertical force can contribute to the crowding of the front teeth, causing them to overlap or appear twisted.

SHOULD YOU HAVE THEM REMOVED?

There are a few things to consider when deciding whether or not to remove the wisdom teeth. It generally comes down to how effectively you are able to look after them if they are partially impacted and how much discomfort they are causing.

As mentioned, a partially exposed tooth is difficult to keep clean, and these areas can harbour a multitude of bacteria. It is this unpredictability that has prompted surgeons to encourage patients to have them removed as a preventive measure. Each case is unique though, and if you are able to maintain a clean environment it is sometimes worthwhile to leave them well alone.

However, if the tooth causes symptoms, for instance a recurrent gum infection, you are sometimes better off having the tooth removed rather than run the risk of developing more severe symptoms in the future. Three episodes of infection is normally considered a high-risk case.

Another indication for removal is possible damage to the otherwise sound neighbouring tooth. This can happen either because of decay or resorption of the neighbouring tooth’s root by the wisdom tooth. If there is a high likelihood of damage to the neighbouring tooth, it is acceptable to sacrifice a problematic tooth for the wellbeing of the whole mouth. An orthodontist may also request that the wisdom teeth be removed as they could interfere with treatment involving the second-last molars.

gums teeth

WHAT DOES EXTRACTION ENTAIL?

Although horror stories abound, the vast majority of wisdom tooth extractions are relatively simple and recovery is fast. This is however dependent on the size, shape and position of the tooth. With simple extractions there is usually little swelling, bruising and/ or bleeding and the procedure can normally be performed by your dentist in the dental chair. More complex extractions where the tooth is severely trapped are generally carried out by a specialist, sometimes in a surgical environment. Your dentist will be able to use X-rays to determine the complexity of your extraction and advise you on what to expect.

A FINAL THOUGHT

As indicated, the majority of problems occur when a tooth is partially erupted, thereby increasing the risk of developing gum infection and decay. By being extra vigilant in cleaning this area these teeth can hide away for many years without giving any problems. Even if gum infection develops, early treatment with antiseptic mouth rinses and tissue salts can often clear the symptoms within a few days. With fully impacted teeth there is less risk of developing infection and they are generally therefore less of a problem. However, in both cases if there is a risk of damage to the neighbouring tooth or surrounding structures, it is sometimes advisable to sacrifice a problematic tooth for the wellbeing of the whole mouth.

Like most aspects of dentistry, the goal of treatment is to maintain a comfortable and disease-free environment. When considering the treatment for your wisdom teeth it is important to ascertain how much their presence is impacting on your life and what risk there is of developing disease. Just because they are present does not always mean that they should be removed.

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