Wisdom
teeth, or third molars, are the last teeth to develop and
appear in the mouth. They are called "wisdom teeth"
because they usually appear during a person's late teens
or early twenties, which has been called the "age of
wisdom". The normal position of wisdom teeth is behind
the upper and lower second, or 12-year, molars. Many times
the jaws of modern humans are not normally large enough
to accommodate the four wisdom teeth. This is why wisdom
teeth cause more problems than any other teeth in the mouth.
In fact, for nine out of ten people, at least one wisdom
tooth remains under the gum tissue due to lack of space
in the mouth.
WHAT
IS AN IMPACTED WISDOM TOOTH?
When
a wisdom tooth is blocked from erupting or coming into the
mouth normally, it is termed "impacted". A tooth
may be only partially impacted; meaning it grows in crooked
and breaks through the gum only partially, or it may fail
to break through at all and thus remains totally impacted.
Serious problems can develop from partially impacted teeth,
such as pain, infection, and crowding of, or damage to,
adjacent teeth. For totally impacted teeth, more serious
problems can occur if the sac that surrounds the impacted
tooth fills with fluid and enlarges to form a cyst.
This
enlargement can hollow out the jaw and result in permanent
damage to the adjacent teeth, jawbone and nerves. If the
cyst is not treated, a tumor may develop from the walls
of the cyst and a more involved surgical procedure may be
required for removal.
Many
problems with wisdom teeth can occur with few or no symptoms,
so there can be damage without your knowing it. It is important
to know that as wisdom teeth develop, their roots become
longer and the jawbone becomes denser. Thus, as a person
grows older, it becomes more difficult to remove wisdom
teeth and complications can become more severe. In addition,
as people age there is an increased chance of the symptoms
mentioned above. For these reasons, the oral and maxillofacial
surgeon may recommend the removal of wisdom teeth even if
they are not yet causing obvious problems, particularly
for young adults.
WHAT
IS THE BEST WAY TO IDENTIFY AN IMPACTED TOOTH?
The
best way to identify an impacted third molar is by a panoramic
x-ray and an examination by an oral and maxillofacial surgeon.
HOW
SERIOUS IS AN IMPACTED TOOTH?
Serious
problems can develop from partially blocked teeth such as
infection, and possible crowding of and damage to adjacent
teeth. More serious complications can develop when the sac
that surrounds the impacted tooth fills with fluid and enlarges
to form a cyst, causing an enlargement that hollows out
the jaw and results in permanent damage to the adjacent
teeth, jawbone and nerves. Left untreated, a tumor may develop
from the walls of these cysts and a more complicated surgical
procedure would be required for removal.
MUST
THE TOOTH COME OUT IF IT HASN'T CAUSED ANY PROBLEMS YET?
No
one can tell you when your impacted molar will cause trouble,
but trouble will probably arise. When it does, the circumstances
can be much more painful and the teeth can be more complicated
to treat.
WHEN
SHOULD I HAVE MY IMPACTED TEETH REMOVED?
The
key to timely attention to third molars is regular x-rays
of the mouth. With the help of these pictures the oral and
maxillofacial surgeon can frequently predict if the wisdom
teeth are going to cause trouble, either in the near future
or later in life. If so, chances are the oral and maxillofacial
surgeon will recommend their removal rather than wait for
trouble to occur.
Removal
is easier in younger patients. Roots are not yet fully developed
and the bone is less dense. In older patients, removal before
complications develop is key to shorter recovery and healing
time and minimizing discomfort after surgery.
HOW
ARE WISDOM TEETH TREATED?
Treatment
of impacted wisdom teeth involves their removal using special
surgical techniques appropriate for each individual case.
Wisdom teeth are best treated by an oral and maxillofacial
surgeon. If the wisdom teeth have fully erupted into normal
position, they may be observed by your dentist during your
regular visits to ensure that you are properly cleaning
them and no problems are developing, such as decay. Minor
abnormalities in the position of an erupted wisdom tooth
may be taken care of by your dentist, or removal might still
be best.
The
removal of wisdom teeth can be performed on an outpatient
basis, either in the dental office, or in certain cases,
in a hospital setting. If the tooth is impacted, an incision
is made in the gum tissue and the tissue is turned back
so that the tooth can be seen. If bone is covering the tooth,
it may be necessary to remove some of the bone in order
to expose and extract the tooth. The tooth may be removed
whole, or in some cases it may be cut into sections, and
each section is then individually removed. Usually the surgical
procedure will take less than an hour, although this varies
according to each case. After surgery you will spend some
time "in recovery" before going home. In most
cases normal activities can be resumed within a few days
depending on the degree of impaction and the number of teeth
removed.
WHAT
HAPPENS BEFORE SURGERY?
Before
the surgeon can determine if your wisdom teeth should be
removed, the surgeon must first conduct an oral-facial examination
and discuss the results with you. The examination will include
x-rays, which show the presence of the impacted teeth and
reveal such important things as curved roots, nerve location,
and other vital surgical information that requires the use
of an x-ray.
A
complete health/medical history will be taken including
your blood pressure and other vital signs, medications you
currently take, any allergies you may have, and any medical
conditions that may alter treatment.
You
will also be given pre-operative instructions to prepare
you for the day of surgery.
WHAT
HAPPENS AFTER SURGERY?
Generally
after surgery the patient experiences some swelling and
discomfort. However, with personalized postoperative instructions
and medications, the oral and maxillofacial surgeon can
reduce the possible discomfort following surgery.
Portions
of the above information provided as a courtesy by:
American
Association of Oral and Maxillofacial Surgeons
9700 W. Bryn Mawr Avenue
Rosemont, Illinois 60018-5701
847/678-6200 Fax: 847/678-6286
Website: www.aaoms.org
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