Wisdom Teeth

Wisdom teeth, also know as third molars, are part of the normal complement of the adult dentition. A complete dentition includes 2 incisors, one canine, two premolars and three molars on each quadrant of a patient’s mouth, hence the wisdom teeth are the innermost teeth in a full dentition. In a percentage of cases, which is perfectly normal, wisdom teeth are absent from birth, whereas in other cases, they may remain unerupted (buried) for life. In a minority of cases however, wisdom teeth will try to erupt even though there may not be enough room for them in the mouth, and it is in such cases that problems may develop.

Why do wisdom teeth cause pain and discomfort?

In cases where the mouth is too small for the full set of teeth, when wisdom teeth start to erupt, they will in most cases impinge on the gums and the teeth in front of them. Such teeth are know as impacted wisdom teeth, and may be impacted to the tooth in front, to the bone of the jaw, or both. This may lead to an unpleasant sensation, similar to teething in children when the teeth unsuccessfully try to push through the gums.

In most cases however, it is the gum around the wisdom tooth that gets infected that causes pain and discomfort. With the wisdom teeth being impacted, it will be very difficult to properly cleanse the teeth and the gum margins around them. The gum will hence become inflamed and subsequently may get infected. Proper careful brushing therefore, sometimes requiring the aid of a special brush such as a single-tufted or an inter-dental brush will in most cases ward off symptoms. The use of a disinfectant mouthwash may also be recommended in particular cases.


Why do wisdom teeth need to be removed?

Where wisdom teeth manage to erupt successfully in the mouth, they do not normally need to be extracted. In some cases however, your dentist might recommend the removal of one or more wisdom teeth


Where the wisdom tooth is decayed beyond repair: As with other teeth, a decayed wisdom tooth may cause pain or infection. It is more difficult to fill a badly decayed wisdom tooth as opposed to any other tooth, and extraction might be the only option,

Where the impacted wisdom tooth is preventing proper cleansing of the molar next to it, thus causing it to decay: The decay may be stopped or treated after the wisdom tooth is removed

When multiple episodes of gum infection around the wisdom tooth have been noted: Sometimes, even though the patient tries hard to brush their gum around the wisdom tooth, this may get infected every so often, and may require a short course of anti-biotics. If that is the case more than once, the dentist might suggest having the wisdom tooth extracted. Note that multiple episodes of infection do not refer simply to a dull ache experienced as the tooth is erupting, but rather to an episode of pain, swelling, a reduced ability to open one’s mouth and malaise that is experienced as infection sets in.

How is a surgical removal of a wisdom tooth carried out?

A wisdom tooth that needs to be surgically removed may be impacted to tooth, to bone, or both, and hence may need splitting of the tooth or bone removal for successful extraction. Under local or general anaesthetic or sedation, the dentist will usually make some cuts along the gum to expose the tooth and the surrounding bone, drill the bone and/or the tooth until a sufficient leverage can be applied, and have the tooth removed in different pieces. This should not take more than 20 minutes to do in the easier cases, and the only discomfort arises from the vibrations of the drill, just like having a filling feels.

What risks are involved in having a wisdom tooth extracted?

In most cases, especially with wisdom teeth that have completely erupted, extraction of the tooth is uncomplicated, and healing is uneventful, just as any other extraction would proceed.

In a minority of cases, especially those where a buried or partially impacted wisdom tooth needs to be removed surgically, some risks are associated with the procedure. In a proportion of cases, the roots of the wisdom tooth may be very close to or touching a nerve that runs through the bone of the jaw, which nerve supplies sensation to the lower lip and side of face on the same side. Sometimes, albeit rarely, the said nerve may be damaged during the removal of the tooth, and this may result in temporary or permanent loss of sensation to the lip and chin. This only happens in the most difficult or complex cases, and your dentist will always inform you of the risk after assessing each tooth individually, possibly taking XRays to help assess it further. Some people may not want to run this risk, and may opt to not have the tooth removed. This is an entirely personal decision. To avoid getting complications and delayed healing or infection following the extraction of a wisdom tooth, your dentist might feel the need to place some sutures (stitches) around the socket. These may resorb within a week or so, or may need removing manually. It is recommended to avoid smoking for as long as possible following extraction of a wisdom tooth, as this is a known risk factor for the development of complications.