The third set of molars, wisdom teeth, typically emerge in the late teens or early twenties, marking the final stage of permanent tooth development. The decision to keep or remove them is highly individual, depending on the specific position and health of the tooth and surrounding oral structures. A professional dental evaluation, often involving X-rays, is necessary to determine the proper course of action.
Determining Factors for Retention
Wisdom teeth can remain only if they meet strict criteria ensuring they will not cause future problems. A dentist or oral surgeon assesses three main factors: full eruption, proper alignment, and accessibility for cleaning. The tooth must have fully broken through the gum line and reached a functional position, not partially covered by gum tissue.
Proper alignment is required, ensuring the tooth grows straight up and down and meshes correctly with the opposing tooth. If the tooth is angled sideways or toward the adjacent second molar, it creates pressure and potential damage, making retention ill-advised.
The final condition is the ability to maintain excellent hygiene. Since these molars are situated far back, they must be easily accessible for routine brushing and flossing to prevent decay and gum disease. These assessments are made using a panoramic X-ray, which provides a comprehensive view of the jawbone, roots, and relationship to nearby nerves.
If the X-ray confirms sufficient space, a vertical growth pattern, and healthy surrounding tissue, the teeth can be retained under active surveillance. However, failure to maintain access for cleaning means they will likely develop problems over time.
Common Issues Arising from Impaction
When a wisdom tooth attempts to erupt but lacks space or grows at an angle, it becomes impacted, leading to painful pathologies. A common consequence is pericoronitis, a painful inflammation of the gum tissue surrounding the molar’s crown. This occurs because the gum flap creates a protected space where food debris and bacteria accumulate, leading to recurrent infection, swelling, and sometimes pus discharge.
Impaction can also cause direct harm to the adjacent second molar. Pressure from a sideways-growing wisdom tooth can lead to root resorption, where the wisdom tooth slowly dissolves the root structure of the second molar. Difficulty cleaning the area between the two teeth significantly increases the risk of decay or gum disease developing on the back of the second molar.
In severe cases, a fluid-filled sac called a dental cyst can form around the crown of the impacted tooth within the jawbone. If this cyst grows, it can weaken and damage the surrounding bone structure and nerves, necessitating surgical removal of both the cyst and the tooth.
What to Expect During Surgical Removal
Surgical removal is recommended for teeth that do not meet retention criteria. The consultation involves reviewing the panoramic X-ray to understand the tooth’s position, root shape, and proximity to the mandibular nerve. Depending on complexity and comfort level, the procedure uses local anesthesia to numb the area or intravenous sedation, allowing the patient to sleep.
During surgery, the surgeon makes an incision to expose the tooth, especially if it is embedded in the jawbone. An impacted tooth may need to be sectioned into smaller pieces to facilitate removal without damaging surrounding structures. After extraction, the surgeon cleans the socket and may place dissolvable stitches to aid healing.
Post-operative care focuses on managing swelling with ice packs for the first 36 hours and controlling bleeding by biting firmly on gauze pads. Patients must maintain a soft diet and avoid using straws for about a week, as the sucking motion can dislodge the blood clot and lead to dry socket.
Long-Term Monitoring If Wisdom Teeth Are Kept
If wisdom teeth safely remain, they require ongoing surveillance to ensure they do not develop issues years later. Routine dental X-rays, typically panoramic images taken every three to five years, are the most important monitoring tool. This imaging allows the dentist to track subtle changes in the tooth’s alignment, root structure, or the health of the surrounding bone.
Patients with retained wisdom teeth must be diligent about oral hygiene, focusing on thoroughly cleaning the farthest back surface of the mouth. Even fully erupted teeth are prone to decay because their location makes brushing and flossing difficult. The dentist will periodically reconsider extraction if late-onset problems occur, such as new decay, gum disease, or a shift in position that threatens the adjacent molar.