Do Wisdom Teeth Have to be Pulled?
The first molar usually erupts behind the baby molars when the patient is approximately 6 years old. The second molar usually erupts when the patient is nearing 12 years of age. And the third molar usually comes in when the patient is between 17 and 23 years old. This tooth is called the wisdom tooth, supposedly because at that age one should be wiser. Thousands of years ago, the wisdom tooth normally erupted into proper occlusion and function. Now only about 18% do and 82% need to be removed. The wisdom tooth is becoming vestigial and it is slowly being eliminated in the evolutionary process along with the appendix and the little toe. There are many people who never developed one or more or them, but there are those who actually have extra teeth which are called supernumeraries.
The greatest majority of wisdom teeth simply do not have enough room to erupt, and if they do, many times the roots are not normal in shape. The teeth with lack of room usually remain impacted, meaning that another tooth, bone, or gum tissue restricts their eruption. About 9 out of 10 people have at least one impacted tooth. The wisdom teeth may be side-ways (horizontal impaction), not fully erupted upwards and having bone over them (vertically impacted), tilted backwards (disto-angular impaction), and tilted forward (mesio-angular impaction). Some wisdom teeth are only partially erupted (partially impacted) and create inflammation or infection around the gums. All of these situations create problems and necessitate removal.
Impacted wisdom teeth are often the culprits in causing periodontal disease in the areas of the wisdom teeth, or may cause decay or external resorption on the second molar (12 year molar) just forward. They are the cause of swelling, soreness, bone loss, and infection and rarely are in the proper occlusion with the opposing wisdom teeth. And if they are, they are difficult to reach, difficult to keep clean, and difficult to restore. If they cause infection, there is a chance that the bacteria causing the infection can also affect your heart and kidneys, and perhaps other organs. It is also often said that they “push forward” and will affect the alignment of the front teeth. The actual truth is that all teeth push forward, not just the wisdom teeth. Since it is possible that the wisdom teeth may help create crowding in the front teeth, this is only one of the many factors to consider when making a decision to remove them.The upper teeth are “held backward” by the upper lip which is just like an elastic rubber band. As one ages, the “elastic” gets weaker. All that being said, sometimes the wisdom teeth cause no discomfort at all.
In many cases, the upper wisdom tooth will erupt fully and come into direct contact with the gum tissue on top of the lower wisdom tooth. This gum tissue is called an operculum. Sometimes, if and only if, the doctor believes there will be enough room for both wisdom teeth upon full eruption, and that there is proper root structure, the gum tissue alone is removed (operculectomy). If that is not the case, then both teeth are removed. Another similar situation is inflammation around the crown of the tooth (pericoronitis), usually found with a partially erupted wisdom tooth. It is often caused by food debris getting under the flap of gum tissue. Usually vigorous rinsing with warm saline will aid. Tilt your head down, effectively getting the lower wisdom tooth upside down, while you are rinsing. If this becomes a persistent problem, removal of the tooth is best.
If you look in your mouth and can count three molars, the first, second, and then the third (wisdom tooth), then your wisdom teeth have erupted. The only other way to know for sure is to have them x-rayed. You will then know how many you have, what angle they may be, and what treatment may or may not be required. If wisdom teeth are retained in your mouth due to good alignment, space, and root structure, and no periodontal disease, then they must be meticulously maintained and any dental decay restored with the proper restoration.
Since approximately 82% of patients require removal of their wisdom teeth, and since in some cases it it much easier for the patient and the surgeon to extract them at a young age, there is consideration for early removal. The bone of young people is less dense and the post-operative discomfort is usually considerably less. There are also those that say perhaps early removal should not done.
In the greatest majority of cases, the removal process is non-traumatic and there are very few post-op problems. Often, no medication is required, and if so, usually over-the-counter medications are all that are necessary. However, sometimes there can be more problems. Bleeding is stopped with pressure applied directly to the area by a moist gauze pad. Do not change this often as the clot may stick to the gauze. Physical activity of any kind is not recommended, as is smoking, suction through a straw, vigorously rinsing, or any carbonated beverage, as they all tend to dislodge the clot. Do everything you can to protect the clot. Early loss of the clot will leave a dry socket (alveolar osteitis) (inflammation of the alveolar bone) which is fairly uncomfortable and much slower to heal. Your dentist must then place a sedative salve over the bone which will give relief within about 45 minutes. Swelling is treated with cold the first 24 hours and heat after 24 hours. An ice pack should be placed over the area on the outside of your face for 10 minutes and then off for 20 minutes and repeat. After 24 hours the use of heat via a warm moist towel is used. This is held in place 20 minutes on and 20 minutes off. On a very rare occasion, parasthesia may be a problem. Sometimes the roots of the lower wisdom teeth are in close approximation to the nerve and pressure results in parasthesia, which is a tingling on the chin or tip of the tongue. This usually only lasts a few days, but sometimes even weeks or months, or in extremely rare cases, it may be permanent. The newer 3D CT scans (CAT Scans…Computed Tomography) give the surgeon a more advance view of the proximity of the root to the nerve.
Basketball players, and especially boxers should have any impacted wisdom teeth removed in the lower jaw since the presence of a wisdom tooth in the lower angle of the jaw means an absence of bone there. It is more subject to fracture from trauma to the chin than when it is solid bone.
A careful discussion of the pros and cons of extraction of the wisdom teeth is necessary between the general dentist or the oral surgeon.
Life Member of American Dental Association, Emeritus Fellow of Academy of General Dentistry, American Association of Implant Dentists