Wisdom Teeth

What are Wisdom Teeth?

Wisdom teeth or Third Molars are the back corner teeth which usually erupt into your mouth round the age of  17 to 25.

The term probably dates back to the Latin term dens sapientiae which translates to wise teeth - however the wise is used in an ironic sense.

The term arrives from the fact that as they come through the person is probably at the age where they are considered (rightly or wrongly) to be wise.

People can have up to four wisdom teeth, one in each corner of the mouth. However, a few people are missing some if not all of them.

It is said that due to our evolution the human jaw bone is getting smaller and as a result there is not enough room for the teeth to fully come through.

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This x-ray shows a person with potentially troublesome wisdom teeth. The darker area around the lower teeth indicates a long term infection.

It is likely that this person’s lower wisdom teeth have partially come through. The right hand side is probably more painful as the top tooth will be biting down on the gum covering the lower tooth.

The wisdom tooth on the left side is high up, it may not have come through and by itself would be fine to leave. The lower left tooth has an area of infection round it and is on a horizontal angle. This would be a difficult extraction

 

Should all wisdom teeth be extracted?

No, a lot of people have no problems with their wisdom teeth.

Wisdom teeth, if present, are likely to do one of three things:

1. Come through fully and can be treated as normal teeth

2. Stay hidden in the jaw bones and never be a problem

3. Grow half way through and cause problems.

 

What happens if my teeth are only half through?

If the teeth only grow half way through (partially erupt) they are likely to cause problems. This is because they are extremely difficult to keep clean. If an area of a tooth is consistently not cleaned, plaque will grow and if left long enough a hole will form. Also if the tooth cannot be cleaned there is a higher chance that the soft tissue surrounding the teeth will get an infection, and this condition (called Periocorinitis) is painful and can lead to a swollen face and inability to open the mouth. This is a serious problem and urgent treatment is required.

If a lower tooth only comes half way through it may become painful if it gets infected and the upper tooth then starts to bite on the infected area. A simple solution to buy some time is to remove the upper tooth.

Some wisdom teeth especially the lower ones grow on an angle into the tooth in front of it (usually the Second Molar). This unfortunately leads to the situation that the wisdom tooth and the tooth in front develop a hole. Sometimes the hole on the tooth in front will be under the gum and mean that this tooth is severely compromised.

However, there are many situations that it is simply easier to extract them. Performing treatment on a wisdom tooth is the most difficult in any one’s mouth. This is because you are working at the very back of the mouth, the tongue and the cheeks limit access and vision, people are more likely to gag, and it is also hard to keep the area dry. In situations when it is difficult to place an adequate filling, or when there is no tooth for it to bite against your dentist will like you so much more if you agree to having the tooth extracted.

 

Are the extractions difficult?

Obviously everyone is different. The extraction of upper wisdom teeth can be extremely easy. However, some lower extractions can be extremely difficult and it is often necessary to refer you to a specialist.

The degree of difficulty is dependent on a number of factors

• How far the tooth has erupted

• Can the tooth be accessed

• The shape of the roots

• How close the nerves are

Often the teeth will be simply extracted with the use of forceps. However, for difficult extractions the teeth need their roots divided and surrounding bone removed to enable them to be extracted

 

Are there any risks to wisdom teeth extraction?

Yes.

For upper teeth the roots can be situated very close to the air sinus. In rare circumstances a hole can be formed with the extraction.

For lower teeth

• The inferior dental nerve can be damaged- this nerve supplies sensation to the lower teeth and lip

• The lingual nerve can be damaged- this nerve supplies sensation to one side of the tongue

• The back of the tooth in front of the wisdom tooth can be damaged due to the loss of supporting bone

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This x-ray shows a lower right wisdom tooth.

The root of the tooth runs down to the inferior dental nerve. Also notice how close the back of the tooth in front of it is

 

Can I get knocked out to get my teeth taken out?

Yes. For difficult extractions (ones which require a surgical approach) your dentist may refer you on to a specialist who can offer General Anaesthetic or alternatively if the extractions are straight forward but you do not want to be conscious during the procedure the dentist can offer intra venous (IV) sedation.

Sedation is when some relaxing drugs are administered. The work gets done, afterwards while feeling groggy you do not remember what has happened

 

Do wisdom teeth cause my front teeth to crowd?

There is no evidence to support this.

Please refer to the Colrane report which is found on NZDA home page

http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD003879/frame.html.

Our teeth are programmed to slowly move towards the front of our mouths. This is because our ancestors were more likely to get a few teeth knocked out while hunting woolly mammoths and the diet which they consumed was also more course. As a result of this their teeth would be worn down in height and width.

Studies are a bit inconclusive they show our teeth crowd any way, but does having the wisdom teeth increase the rate?