Wisdom Teeth


Wisdom Teeth

Wisdom teeth are the third molars (arrowed in right diagram) 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 oral cavity. As such, they may be obstructed from erupting normally or be angulated (impacted) against the anterior second molar tooth.

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 teeth to be angulated with no possibility of them erupting fully into the oral cavity.

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.

Necessity to remove 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.

Timing to remove 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.

Post-operative effects and care after wisdom teeth surgery

Following wisdom teeth surgery, the usual effects of oral surgery will be seen ie bleeding, swelling, pain, difficulty opening your mouth and discomfort at eating. If there is excessive bleeding, biting on sterile gauze at the site of operation for half an hour usually stops the bleeding. It is the stabilised blood clot in the socket that stops the bleeding. As such, vigorous rinsing is to be avoided. Do expect blood stained saliva which can be left alone or very gentle rinsing. Maximal effects of swelling and discomfort are usually seen on the second to third day. A cold pack on the face is very useful for the first day to prevent swelling. You should rest and avoid vigorous exercises for 5-7 days. A soft diet such as porridge, noodles or soup 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.

Possible complications from 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 TMJ / Jaw joint pain

Clinical preparation for wisdom teeth surgery

Consult your Dentist or an Oral & Maxillofacial Surgeon for a clinical examination. A dental x-ray called orthopantomogram (OPG) is used to assess the severity of the impaction. Along with this, additional information such as the adjacent teeth, bone condition, nerve or other pathologies are elicited. Where the impaction is very deep and closely related to the nerve (inferior alveolar nerve), a cone-beam computed tomography will greatly assist the surgeon to identify 3-dimensionally all vital structures. Actions can then be taken to minimise complications.

OPG (Orthopantogram)
Cone-beam Computed Tomography (3-D scan)