Wisdom teeth, also known as third molars, are the final set of molars to emerge. They typically appear between the ages of 17 and 25. While removal is a common procedure, it is not always necessary. The decision to keep or remove wisdom teeth depends on their position, health, and potential impact on overall oral health.
When Keeping Wisdom Teeth is Possible
Wisdom teeth can be safely retained if they emerge properly and pose no risk to oral health. This occurs when they are fully erupted and correctly aligned within the dental arch, positioned upright like other molars.
Adequate jaw space is important to accommodate them without crowding adjacent teeth. The surrounding gum tissue and the wisdom tooth itself must be healthy, showing no signs of decay, gum disease, or cysts.
The wisdom teeth must also be accessible for regular cleaning. If they can be effectively brushed and flossed, it helps prevent future issues like cavities and gum inflammation. Finally, the wisdom teeth should contribute to a functional bite, aiding chewing without disrupting the alignment or health of other teeth.
Potential Complications of Retaining Wisdom Teeth
When wisdom teeth do not emerge correctly or are not maintained properly, they can lead to several oral health problems. Impaction is a common issue, where the tooth is trapped partially or entirely beneath the gum line or jawbone. This can cause pain, infection, or damage to neighboring teeth. An impacted tooth might also grow at an angle, pushing against other teeth.
Pericoronitis is another frequent complication, characterized by inflammation and infection of the gum tissue surrounding a partially erupted wisdom tooth. Food particles and bacteria can get trapped under the gum flap, leading to pain, swelling, bad breath, and difficulty opening the mouth. Untreated pericoronitis can become severe, potentially involving pus discharge or facial swelling.
Wisdom teeth are also prone to tooth decay due to their location at the very back of the mouth, making them difficult to clean effectively. Partially erupted or impacted wisdom teeth are particularly susceptible to cavities because food and bacteria accumulate in hard-to-reach areas. This decay can sometimes spread to adjacent teeth.
Difficulty in cleaning can also lead to gum disease, specifically periodontitis, around the wisdom teeth. This condition involves inflammation and potential destruction of the bone and tissues supporting the teeth. Cysts can develop around an impacted wisdom tooth within the jawbone, potentially damaging the jawbone, nerves, or other teeth.
The Dental Evaluation Process
Determining whether wisdom teeth can remain requires a thorough dental evaluation. This process begins with a comprehensive oral examination, where the dentist visually inspects the wisdom tooth area and surrounding gum tissue. This assessment helps identify immediate signs of inflammation, decay, or improper eruption.
Dental X-rays are an important diagnostic tool. Panoramic X-rays provide a broad, two-dimensional view of the entire mouth, including teeth, jawbones, and associated structures like sinuses and nerves. This X-ray is useful for visualizing wisdom teeth position, root development, and their relationship to adjacent teeth and vital anatomical structures.
In more complex cases, or when a panoramic X-ray doesn’t provide enough detail, a cone beam computed tomography (CBCT) scan may be recommended. CBCT provides a three-dimensional view of teeth, bone, and surrounding tissues, offering precise details about impaction, root morphology, and proximity to nerves or sinuses. This advanced imaging helps assess potential risks and plan any necessary intervention.
The dentist assesses criteria including jaw space, impaction degree, and signs of decay or gum disease. They also evaluate the overall health of the bone and tissue supporting the wisdom teeth. Based on these assessments, the dentist provides a personalized recommendation tailored to the individual’s oral health situation and potential future risks.