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At a glance:
- Wisdom teeth are the third molars. They are referred to as wisdom teeth due to the fact that they erupt later in life - typically in the late teens or early 20s.
- Wisdom teeth typically come in pairs - two upper and lower third molars - but some people develop more while others develop fewer or none at all.
- Not everybody with wisdom teeth has issues with them. 9 out of 10 people have at least one impacted wisdom tooth but may not have any problems.
- Unless a wisdom tooth erupts straight and with enough room, it may become impacted, meaning it is partially covered by gum tissue and may push against another tooth.
- Impacted wisdom teeth may cause pain, infection, tooth damage or the development of cysts or tumours in the jaw.
- Problem wisdom teeth are typically removed.
Wisdom teeth are the final set of molars (back teeth) that come through. These third molars typically come in pairs - two upper third molars and two lower third molars - but some people may have more than four wisdom teeth while others may have less or even none.
Why are they called wisdom teeth? These teeth come through last, usually in the late teens or early 20s, long after the other adult teeth have erupted.
Why do we have wisdom teeth? The purpose of wisdom teeth appears to be for aiding in the grinding of tough plant tissue for sustenance, a vestigial trait left over from our human ancestors.
It is believed that the jaws of human ancestors were more pronounced than modern humans, and housed more teeth to help better grind cellulose heavy vegetation. Human jaws have shrunk since that stage thanks to a better, not to mention softer diet, but we still have those extra teeth trying to vie for limited space.
Wisdom teeth aren’t necessarily problematic - many people have them come through just fine, without pain or complications, but for others wisdom teeth can become a source of pain, infection and a host of other potentially debilitating problems.
Problems With Wisdom Teeth
When a wisdom tooth erupts (comes through the gum), unless it emerges straight and with enough room it can cause what is referred to as impaction. An impacted wisdom tooth comes out at an angle and may push up against another tooth, against the gum, or angle outwards to rub against the cheek.
This may lead to pain as well as possible tooth decay or infection as the impacted tooth may be difficult to clean properly. Especially in the upper jaw, a wisdom tooth may angle outwards irritating the cheek, potentially causing ulcers or inflammation as well as difficulty or pain when chewing.
When a wisdom tooth is impacted, it may completely erupt from the gum, partially erupt from the gum (partially impacted) or even remain trapped in the gum (fully impacted). Depending on the degree of impaction and the angle that the tooth has grown may lead to a number of problems and complications, including:
- Gum Disease - A wisdom tooth that has only partially erupted from the gum may lead to pericoronitis, an inflammation or infection in the surrounding tissue. This is due to a partially erupted, impacted tooth being difficult to properly clean, making it far more susceptible to infection than a healthy tooth.
- Tooth Decay - Due to how far back in the mouth wisdom teeth are located, it may be difficult to properly clean them, even if they have erupted normally. Partially erupted wisdom teeth appear to be more prone to decay as food particles and bacteria can become trapped between the partially erupted tooth and the gum.
- Tooth Damage - An erupted wisdom tooth that pushes up against the second molar may cause damage to both teeth increasing the chance of decay and infection.. A wisdom tooth that has failed to erupt because it is lying flat in the jaw may also cause damage to the roots of nearby teeth.
- Cysts and Bone Loss - Teeth develop in sacs in the jawbone. The sac containing a partially or fully impacted wisdom tooth may fill with fluid, forming a cyst. A cyst may damage surrounding tissue, bone and nerves, and may even develop into a benign (not cancerous) tumour. Cysts and tumours may require the removal of bone and gum tissue to treat.
Symptoms of Wisdom Tooth Problems
Depending on the degree of impaction and the amount of damage or infection, the symptoms of wisdom tooth problems vary, but may include:
- Difficulty or pain when chewing
- Difficulty opening the mouth due to inflammation or pain
- Difficulty swallowing
- Fever
- General mouth/jaw pain
- Halitosis (bad breath)
- Inflamed, reddened gums around the wisdom tooth
- Lymph node pain and inflammation (under the jaw)
- Pus coming from the gums around the infected tooth
- Ulcers in the cheek
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Treatment For Wisdom Tooth Problems
Again depending on the degree of impaction, treatment for wisdom teeth issues may involve anything from over the counter pain relievers and better oral hygiene to antibiotics, wisdom teeth removal or even removal of damaged bone and tissue.
Before any course of treatment is undertaken, the dentist will first evaluate your teeth and jaw to investigate the degree of impaction and any other issues that may have arisen, such as decay, damage or infection. This testing may involve visual inspection, dental x-rays and having the patient explain their symptoms and experience.
Once a diagnosis has been made, the dentist will then decide on an appropriate treatment, such as pain relievers or antibiotics. In many cases, however, problems with wisdom teeth are treated in the same manner - the removal of wisdom teeth.
Wisdom Teeth Surgery
Wisdom tooth extraction is typically required when a wisdom tooth is damaging nearby teeth, is infected (or leading to periodontal disease), decayed or has led to the development of a cyst or tumour.
In people who have impacted wisdom teeth but no symptoms (referred to as asymptomatic wisdom teeth, some dentists may recommend the prophylactic removal of the teeth before they have a chance to become problematic.
Wisdom teeth removal is almost always performed as an outpatient procedure, meaning that you go home after the procedure is completed. Depending on the difficulty or the wisdom tooth extraction, the patient may either be given a local anaesthetic to numb the area around the tooth, or a general anaesthetic to put them to sleep throughout the procedure.
Once the patient has been anaesthetised, the dental surgeon will then make an incision in the gum to give access to the impacted tooth and remove any bone that may be restricting access to the impacted root. When it is freed up, the tooth is then removed.
After the wisdom tooth has been removed, the wound is typically packed with gauze and closed. There may be some pain and bleeding from the operation, as well as some difficulty opening the mouth or chewing for a time after the surgery, but patients will be sent home with instructions for after care, such as the use of an ice pack to reduce inflammation and eating only soft foods. Any remaining discomfort or bleeding should pass within a few days.
Other Treatments
In some cases, a partially impacted wisdom tooth that is not crowding other teeth may be freed up by the removal of the gum tissue that is partially covering the tooth. This operation is referred to as an operculectomy.
One of the most effective ways to help keep your wisdom teeth from becoming an issue, or to have them taken care of before they cause a real problem is to visit a dentist every six months for a checkup .