Wisdom Teeth

Wisdom teeth refer to any of the four third molars that grow after puberty.

A wisdom tooth is another name for any one of four third molars found in the permanent dentition (adult teeth). These teeth are the last or most posterior teeth in the dental arch.

Although most people have wisdom teeth, it is possible for some or all of the third molars to never develop. It is also possible for a person to have more than four wisdom teeth. In many individuals, the wisdom teeth aren't visible because they have become impacted (not normally erupted through the gums) under the gingival tissue.

You know if you have wisdom teeth by examining your mouth and finding three permanent molars in each dental quadrant. However, if the tooth is impacted under the tissue, the presence of the tooth needs to be verified by a radiograph.

• A panoramic radiograph is usually the preferred X-ray to help assess the angle of eruption and state of development of the tooth.
• Most wisdom teeth can be visualized erupting through the gingiva in early adulthood, between the ages of 16 to 23. Sometimes, a person will feel the effects of the wisdom teeth before they can visualize them in their mouth.
• Erupting wisdom teeth will usually produce a feeling of pressure or dull throbbing in the back of the jaws.

Your general dentist will often be able to inform you of the condition of these erupting teeth.

Not all wisdom teeth need to be extracted. When a wisdom tooth erupts cleanly through the tissue without compromising the adjacent tooth, the wisdom tooth can be retained in the mouth with little concern as long as the person can brush, floss, and clean it thoroughly.

The condition of wisdom teeth changes a lot between the ages of 16 and 23; they must be examined regularly by a dental professional to determine the proper diagnosis and course of action in this age group.

Sometimes wisdom teeth cause pain, but a person can avoid extracting them with a few modifications of the surrounding tissues or oral hygiene habits.

• If there is a small flap of swollen gum tissue barely covering the back of the tooth, a person may have pain from biting down on that gum tissue.
• If there is otherwise enough room for the wisdom tooth, the gum tissue can be removed from the back of the tooth to remedy this problem.
• Changing the angle of tooth brushing and increasing the frequency of flossing both in front and behind the wisdom teeth can help keep the gum tissues healthy and avoid the potential of painful gingivitis or infection around the wisdom teeth.

There are certain situations, however, where the extraction of wisdom teeth is necessary.

• The wisdom tooth may erupt at an angle such that the adjacent molar can become difficult to keep clean and free of dental caries.
• Sometimes the position of the wisdom tooth will cause deep periodontal pockets, gum disease, or recession around the adjacent tooth, and should be removed before too much damage is caused to the much more critical second molars.
• If there isn’t sufficient room in the mouth for the wisdom teeth and they are trying to erupt, they may cause significant pressure on the surrounding teeth and tissues. This pressure can result in a bad headache, jaw pain/stiffness, or tooth pain that is only resolved by removing the wisdom teeth. The pressure can give the impression that the wisdom teeth are causing crowded teeth.
• If the third molar has erupted through the tissue but is without opposing occlusion (contact with other teeth), extraction should still be considered. Considering the posterior position of an erupted wisdom tooth, these teeth are often difficult to keep clean.
• If wisdom teeth get tooth decay, it is usually best to extract them instead of removing the decay and fixing wisdom teeth with fillings, root canals, or crowns. These treatments that are indicated for the rest of the teeth are often less successful in treating wisdom teeth due to their position in the back of the mouth.

Removal of a wisdom tooth is indicated if the tooth has partially erupted through the gingival tissue, causing inflammation and/or infection. This condition is called a partially erupted, or partially impacted wisdom tooth. A soft-tissue growth over a partially erupted wisdom tooth is referred to as an operculum. If bacteria become trapped under the operculum, an infection called pericoronitis can develop.

Pericoronitis is one of the most common indications for emergency extraction of a wisdom tooth and typically happens when there isn't enough room for all of the teeth in the lower jaw. Infection symptoms are red, swollen gum tissue behind the last visible molar, bad taste/smell, pain with biting in the back teeth, and sometimes pus oozing and draining from the area.

Occasionally, the infection will lead to swelling of the gum tissue, cheek, or another area around the affected side of the jaw. Swelling can cause pressure on adjacent structures and can radiate to the ear causing an intense earache.

Sometimes an ear infection or a sinus infection can cause pain that radiates to the teeth as well, so it is very important to get examined whenever there is suspicion of infection.

If there is swelling, infection, difficulty swallowing or breathing, fever, or intense pain, priority needs to be given to getting the wisdom teeth out as soon as possible. Antibiotics may be prescribed to help keep an infection from getting worse or spreading for a very short while. Warm saltwater rinse or antibacterial mouth rinse and OTC painkillers can be used as short-term remedies for tooth pain until more definitive treatment can be obtained. Some large dental schools may offer emergency evaluation and/or tooth extraction.

A variety of home remedies have been suggested to help with symptomatic wisdom teeth. While home remedies can be helpful if used to provide temporary relief, they are not alternatives to seeking a diagnosis and proper treatment from a licensed dentist or oral surgeon. With prolonged use, they can worsen the condition by making the symptom less noticeable while allowing the source of infection, tooth decay, or pain to increase until it spreads or causes more severe consequences.

In certain situations, however, the following home remedies can be helpful:

1. Clove oil: Clove oil contains eugenol, which is a natural numbing agent. Place a few drops on a cotton ball and place it adjacent to the area causing pain. If used for very long, it can cause irritation or burns to the tongue or other tissues, and the pain will return soon after removing the clove.
2. Saltwater: Saltwater has a cleansing effect that battles bacterial infections. If a wisdom tooth has pericoronitis or another type of abscess, a saltwater rinse can help clean the infected area until the source is treated. Dissolve a small amount of salt in warm water and swish for 30 seconds one to two times per day. This can also help after wisdom teeth are removed to help keep the sockets free from debris and infection. Saltwater won't permanently cure an infection if the source is a poorly positioned or decayed wisdom tooth.
3. Garlic: Garlic also works to stop the growth of bacteria that cause infections. Make a paste with minced garlic and salt and apply it to the problem area to help control an infection until a dentist can diagnose the condition. The strong odor of garlic is difficult to withstand for too long though.
4. Tea bag: Various types of tea have natural properties that can help problems associated with wisdom tooth pain and extraction. Peppermint tea has numbing properties and can provide temporary relief of pain by applying a cooled tea bag to the painful site. Black tea contains tannic acid, which helps stop bleeding by inducing clot formation. If a wisdom tooth has been extracted and the bleeding won't stop with pressure after an hour, place a moistened tea bag on the bleeding area and bite down gently to provide pressure.

Again, people should contact a dentist as soon as possible as the above home remedies will not cure the underlying problem and may mask a more serious condition.

Once it has been determined that a wisdom tooth is problematic, extraction by an oral surgeon or qualified general dentist is usually indicated. Local anesthesia is administered to ensure the tooth can be pulled out without any major discomfort. Many people will choose conscious sedation (being put into a sleepy state where pain signals are blocked) so they have little or no memory of having their wisdom teeth extracted.

Minor surgery is then performed where the tissue and bone around the wisdom tooth are removed so that the tooth can be cleanly extracted from the socket. Several stitches may be needed to close the surgical site and promote the healing of the overlying tissue. These stitches may either be dissolvable stitches that come out on their own after three to five days or stitches that need to be removed by the surgeon after a certain period.

The initial recovery and healing from a wisdom tooth extraction usually occur over about three to five days. It is normal to have slight bleeding (oozing) from the site considering the surgical procedure performed. The minor bleeding (oozing) after extraction should start to ease after the first 24 hours. When the anesthesia wears off, there may be jaw stiffness, difficulty opening the mouth all the way, and some pain.

• Pain medication is often prescribed to help with any postoperative symptoms and discomfort. Usually, Tylenol, an ice pack, and a mild narcotic are enough to provide pain relief. Some patients may be prescribed antibiotics.
• The patient will be asked to eat soft foods for a few days and avoid spicy foods, tobacco and alcohol use, and excessive exercise for three to four days following surgery.

One of the most important things to remember is to avoid smoking after wisdom teeth removal. Smoking will delay the healing process and increase the chance of postoperative pain and complications.

The best remedies for pain following extraction are rest and giving the area time to heal. Adhering to the postoperative instructions of the surgeon is important to minimize any complications. Complete healing of the gums may take three to four weeks.

While it is hard to eat for the first few days following a tooth extraction, it is important not to skip meals and to stay well-nourished to help maintain strength and heal faster.

• For the first day or two, it is best to eat mostly soft foods or liquids like smoothies, yogurt, shakes, pureed foods, soups, pudding, etc.
• It is best to avoid drinking through a straw and eating extremely hot or spicy foods.
• Also, foods that can get caught in the extraction socket like nuts, rice, seeds, and popcorn should be avoided.

As the extraction areas start to heal, regular foods that require chewing can be slowly introduced back into the diet depending on the comfort of the person.

Although the postoperative recovery is usually uneventful, problems can occur. The most common adverse occurrence of a wisdom tooth extraction is a dry socket or alveolar osteitis. This condition is created when the blood clot in the surgical site accidentally dislodges, leaving exposed bone Once this occurs, the bone along the extraction socket can become inflamed and painful. If it happens, a dry socket will typically develop between two and five days after the extraction and will produce a bad smell/taste in the mouth along with constant throbbing pain. If a dry socket occurs, the surgeon should be contacted.

This complication is easily treated and often resolves quickly with a packing medication or stimulation of a new blood clot. More serious complications are rare but can include injury to the adjacent inferior alveolar nerve for wisdom teeth on the bottom of the mouth (mandible), sinus perforation for wisdom teeth on the top of the mouth (maxilla), damage to adjacent teeth, prolonged numbness or altered sensation of the tongue, lip, or gum tissue (paresthesia), or problems with the temporomandibular joint as a result of trauma to the area.

The potential risks of wisdom tooth extraction should be reviewed with a dentist. If a wisdom tooth is deemed compromised, removal of the tooth in adolescence is advantageous to extracting the tooth in late adulthood. The extraction procedure and healing both become more difficult as the person gets older.

Discussion with a dentist about the condition of the wisdom teeth and the timeline for the extractions is important and will help minimize complications.

The cost of the procedure is often dependent on whether the tooth is impacted or not and can range from about $100 to $600 per tooth. The cost can increase if sedation is needed or requested.