Wisdom teeth, formally known as third molars, are the final set of adult teeth to emerge in the human mouth. They typically appear during late adolescence or early adulthood, generally between the ages of 17 and 25. Their common name reflects this later emergence, often associated with increased maturity. Though once functional for chewing and grinding tough, raw foods in ancestral diets, the human jaw has evolved to be smaller, often leaving insufficient space for them to erupt without issues.
Common Reasons for Extraction
A frequent justification for removing wisdom teeth is impaction, which occurs when a tooth is partially or fully trapped beneath the gums or jawbone. This lack of space can lead to various types of impaction, such as mesial (angled towards the front), distal (angled towards the back), vertical (correct position but still trapped), or horizontal (lying completely on its side). Mesial impaction is the most common, where the tooth is partially erupted and angled forward.
Impacted wisdom teeth often cause pain and discomfort, which are common symptoms prompting extraction. They can also trap food particles and bacteria under a gum flap, leading to infection and inflammation known as pericoronitis. Pericoronitis symptoms include bad breath, pus, facial swelling, and difficulty opening the mouth, and it can spread if left untreated.
Wisdom teeth can also pose a threat to adjacent teeth. They may push against neighboring second molars, causing damage such as enamel erosion, cavities, or root resorption (the gradual loss of root structure). This pressure can also lead to dental crowding and misalignment of other teeth, potentially undoing previous orthodontic work. Cysts, fluid-filled sacs, can form around an impacted wisdom tooth, which can damage the jawbone, nerves, and nearby teeth. In rare cases, tumors can also develop.
Risks of Keeping Problematic Wisdom Teeth
Failing to remove problematic wisdom teeth can lead to a progression of oral health issues. Untreated infections, such as pericoronitis, can worsen and spread beyond the mouth into the neck or bloodstream, posing systemic health risks. Chronic inflammation and infection can cause persistent pain and discomfort, significantly affecting an individual’s quality of life.
Impacted wisdom teeth continue to exert pressure on adjacent teeth, increasing decay risk due to food and bacteria accumulation in hard-to-clean areas. This pressure can also contribute to bone loss around the second molars. Cysts around impacted teeth can expand, causing more extensive damage to the jawbone and surrounding structures. Additionally, wisdom teeth become more difficult to remove with age as roots fully form and bone density increases, potentially leading to a more complex procedure and recovery.
Understanding the Extraction Process
Wisdom tooth extraction typically begins with an initial consultation, where a dentist or oral surgeon examines the mouth and takes X-rays to assess the wisdom teeth’s position and condition. This evaluation helps develop a personalized treatment plan. The procedure itself usually takes about an hour, though the total time including preparation and recovery can be longer.
Anesthesia is administered for comfort during the procedure, with options including local anesthesia to numb the specific area, sedation anesthesia (intravenous or oral) for relaxation, or general anesthesia for sleep. Once the area is numbed, the surgeon may make incisions in the gums to expose the tooth, and sometimes remove bone blocking access to the tooth root. The wisdom tooth is then carefully loosened and removed from its socket, sometimes divided into sections for easier extraction, particularly if it is horizontally impacted.
After removal, the surgical site is cleaned to eliminate any debris or infection. Stitches may be placed to close the wound, though not always necessary. Gauze is typically applied to help control bleeding and promote blood clot formation. Immediate post-operative care involves managing mild discomfort, slight bleeding, and swelling, with specific instructions from the oral surgeon.
When Extraction Isn’t Needed
Not all wisdom teeth require removal; some individuals can retain them without experiencing any problems. Extraction is generally unnecessary if the wisdom teeth are healthy, have fully erupted into the mouth, are properly aligned, and function correctly with opposing teeth. They must also be easily accessible for daily cleaning to prevent plaque buildup and decay.
In such cases, when wisdom teeth are integrated into the dental arch without causing pain or posing risks to oral health, they can remain in place. Regular dental check-ups and X-rays are important for monitoring these teeth over time, even if they are not currently causing issues. This allows dental professionals to track their development and detect any potential problems early, ensuring they continue to be healthy and functional.