Wisdom teeth

Wisdom teeth are the third and last set of teeth to appear in the mouth and usually erupt in the late teens or early twenties, supposedly the age when you are thought to have gained some 'wisdom', although many would be inclined to disagree. Research has shown that the vast majority of people don't have enough room for their wisdom teeth to erupt into a position which is conducive to good oral hygiene. It's thought that wisdom teeth are a left over trait from when people had a much more abrasive diets which caused attrition of the teeth and a reduction in molar size. The processed foods we currently eat cause a lot less wear than our ancestors' diet and when coupled with the increases in oral health this means that cavities and loss of teeth are much less likely to occur. This leaves us with the problem of partially erupted or 'impacted' wisdom teeth.

Improperly aligned wisdom teeth can present a number of potential hazards. They may be horizontally positioned, angled in the wrong direction or just poorly aligned. This can cause problems with crowding and may even damage other teeth, nerves and even the jawbone itself. If your wisdom teeth are leaning improperly towards your second molars this leaves them open to attack from decay as food debris and plaque is trapped. Your wisdom teeth may be completely or partially trapped within your jawbone of the soft tissue at the rear of your mouth. These are known as 'impacted' teeth. If your wisdom teeth hasn't fully erupted then this leaves room for bacteria to enter your tooth, causing an infection. Infections produce a number of unpleasant symptoms such as swelling, pain, stiffness in the jaw and other illnesses. Due to the fact that wisdom teeth which have only partially erupted aren't easily accessible, they are much more vulnerable to tooth decay and gum disease.

Potential Problems

Although a lot of impacted wisdom teeth aren't a problem and don't require treatment, they are vulnerable to several problems and in some cases can require extraction. Some of the most common problems include;

Pericoronitis - A dental condition where the gum tissues which surrounds your molar teeth develops an infection and swells. Impacted teeth provide an opening for infection as they allows bacteria to enter your tooth. In some cases the condition can cause plaque or food debris to get caught under a gum flap where it can irritate the gum tissue and cause Pericoronitis. In the most severe cases the infection and swelling can spread beyond the mouth into the cheeks, neck and jaw.

Gum Disease - Also called 'Periodontal disease', this condition occurs when plaque which has built up over time causes an infection in the gums and leads to swelling. This has the potential to spread and can affect nearby teeth and even the surround bone.

Tumors and Cysts - Although extremely rare, in some cases the tissue which surrounds the impacted tooth may become infected and this can increase the risk of a tumor or cyst developing.

Treatment

An impacted tooth only needs treating when it has the potential to cause serious oral health problems and great pain to the patient. Also, research suggests that there's little benefit to removing impacted teeth that aren't causing problems. If impacted teeth are causing problems there are a number of treatments available. Antibiotics are often prescribed but in many cases they will provide only temporary relief. Another potential option for dealing with pain caused by impacted teeth pressing into the nearby gum tissue is a surgical operation to cut back the gum. By far the most common treatment for impacted teeth is having them surgically extracted, especially in cases where severe dental problems like gum disease or cysts are involved.

The Extraction Procedure

Both local and general anaesthesia can be used during the extraction process. Where local anaesthetics will be used the target area will first have a special gel applied which will numb the area. The local anaesthetic will then be injected which will numb the teeth and a sedative may be given to the patient to help them relax. If general anesthetic is used then it's usually advised that you don't eat or drink anything for a few hours before undergoing the operation.

During the operation a small cut will firstly be made in the gum directly over the wisdom tooth to provide access. This isn't required if the tooth has emerged fully or partially of its own accord. The next step is usually to remove the small piece of bone which covers the teeth before breaking the tooth itself into smaller parts for easier extraction. Any incisions that have been made will then be sutured using dissolvable stitches.

Aftercare

Immediately following surgery it's usually advised that you rest a while before returning home. If you've undergone the procedure under a general anaesthetic then it's commonly advised that you don't drink alcohol, drive or sign any legal documents for a couple of days afterwards. It's common to experience some soreness or stiffness in your jaw so it's likely that you'll be prescribed some medications to help with any pain. You'll also be prescribed mouthwashes and antibiotics to help promote healing and protect against infections. If you experience any swelling following treatment it's commonly recommended that you apply a cold compress at the site of the swelling. You may experience a slight bleeding in your gums but your dentist will provide detailed instructions of how to handle all your aftercare. It's also advised that you stick to soft foods for a few days and avoid spicy food and hot drinks like tea or coffee. Similarly, if you're a smoker then it's advised you abstain from smoking until the gum has fully healed.

The Risks

Although the vast majority of wisdom teeth extractions are performed safely, as with any surgical procedure, there are some risks involved. One complication which may occur is a blood clot forming over the wound is dislodged, exposing nerves and bones to food, fluids and air. This may last upwards of a week so it's usual for your dentist to cover the socket with a special dressing which will be replaced until the socket is fully healed. Smokers are at a much greater risk of this complication. Accidental damage to other teeth or nerves in the jaw which are close to the roots of the tooth may be damaged during surgery which may result in temporary numbness.