Home Dentistry Articles Wisdom teeth
Wisdom teeth are third molars that usually
appear between the ages of 18 and 20 (although they may appear
when older, or fail to appear at all). They are called "wisdom
teeth" because they appear so late-much later than the
other teeth, at an age where people are supposedly wiser than
as a child, when the other teeth erupt. Often they need to be
removed when they impact against other teeth-colloquially known
as "coming in sideways."
Impacted wisdom teeth fall into one of several
categories. Mesial impaction means the tooth is angled forward,
towards the front of the mouth. Distal impaction means the tooth
is angled backward, towards the rear of the mouth. Vertical
impaction occurs when the formed tooth does not erupt fully
through the gumline, and horizontal impaction occurs when the
tooth is angled fully ninety degrees forward, growing into the
roots of the second molar.
Impacted wisdom teeth may also be categorized
on whether they are still completely encased in the jawbone.
If it is completely encased in the jawbone, it is a bony impaction.
If the wisdom tooth has erupted out of the jawbone but not through
the gumline, it is called a soft tissue impaction.
Pericoronitis is a common problem in young
adults with partial impactions where the wisdom tooth has failed
to errupt completely through the gum bed, it allows bacteria
into an open space around the tooth, causing infection. Common
symptoms include a swolen lump near the eruption site, bad odour
or taste in the mouth and pain in the general area which may
also run down the entire mandible and / or neck.
Wisdom teeth are sometimes described as an
example of a "vestigial" trait that may be disappearing
from our species via evolution. Others argue that recent changes
to softer diets which cause less wear on the teeth may be causing
the third molars to be less useful, and problematic in many
humans. Alternately, it is possible that wisdom teeth were useful
when it was common for humans to lose several teeth to decay
by the age when they appear.
Although most people have 4 wisdom teeth, it
is possible to have more or fewer. Supernumerary teeth are any
Extraction of wisdom teeth
Wisdom teeth are extracted for two general
reasons: either the wisdom teeth have already become impacted,
or the wisdom teeth could potentially become problematic if
not extracted. The extraction of wisdom teeth can sometimes
be performed by a regular dentist, but more often the extraction
must be performed by someone who specializes in oral and maxillofacial
surgery. Despite the horror stories that you may hear about
having one's wisdom teeth extracted, a competent surgeon can
extract your wisdom teeth with little trouble. However, there
are always risks associated with surgery, and some of these
risks increase when extractions are performed on patients who
have kept their wisdom teeth for a significant number of years.
In many cases, anesthesia will be applied.
General post-extraction problems
There are several problems that can (and in
some cases will) manifest themselves after the extraction(s)
have been completed. Some of these problems are unavoidable
and natural, while others are under the control of the patient.
The suggestions contained in the sections below are general
guidelines that a patient will be expected to abide by, but
the patient should follow ANY and ALL directions that are given
by the surgeon in addition to the below guidelines. Above all,
the patient MUST NOT disregard the instructions given to them;
doing so is extremely dangerous and could result in any number
of problems ranging in severity from being merely inconvienient
(dry socket) to potentially life-threatening (serious infection
of the extraction sites).
Bleeding and oozing
Bleeding and oozing is inevitable and should
be expected to last up to a day in duration. Rinsing out your
mouth during this period is counter-productive, as the bleeding
stops when the blood forms clots at the extraction sites, and
rinsing out your mouth will most likely dislodge the clots.
The end result will be a delay in healing time and a prolonged
period of bleeding. Gauze pads should be placed at the extraction
sites, and then should be bitten down on with firm and even
pressure. This will help to stop the bleeding, but don't overdo
it as it is possible to irritate the extraction sites and prolong
the bleeding. The bleeding should decrease gradually and noticeably
upon changing the gauze. If the bleeding lasts for more than
a day without decreasing despite having followed the surgeon's
directions, contact the surgeon as soon as possible! This is
NOT supposed to happen under normal circumstances and signals
that a serious problem is present.
A dry socket is the event where the blood
clot at an extraction site is dislodged or falls out prematurely.
In some cases, this is beyond the control of the patient. However,
in other cases this happens because the patient has disregarded
the instructions given to them by the surgeon. Smoking, spitting
or drinking with a straw in disregard to the surgeon's instructions
can cause this. The extraction site will become irritated and
pain will mainifest at one level or another. The patient should
contact their surgeon if they suspect that they have a case
of dry socket; the surgeon can prescribe medication in topical
form to apply to the affected site. If this is done, dry socket
becomes only a mere annoyance, but without the medication dry
socket can progress to an infection of the extraction site.
Swelling should not be confused with dry socket;
although painful, swelling should be expected and is a sign
that the healing process is progressing normally. There is no
general duration for this problem; the severity and duration
of the swelling vary from case to case. The instructions the
surgeon gives the patient will tell the patient for how long
they should expect the swelling to last, including when to expect
the swelling to peak and when the swelling will start to subside.
If the swelling does not begin to subside when it is supposed
to, the patient should contact their surgeon immedietely. While
the swelling will generally not disappear completely for several
days after it peaks, swelling that does not begin to subside
or gets worse may be the sign of an infection.