by Gabriella Choi
Wisdom teeth are the third and final set of molars that most people get in their late teens or early twenties. Sometimes these teeth can be a valuable asset to the mouth when healthy and properly aligned, but more often, they are misaligned and require removal.
When wisdom teeth are misaligned, they may position themselves horizontally, be angled toward or away from the second molars, or be angled inward or outward. Poor alignment of wisdom teeth can crowd or damage adjacent teeth, the jawbone, or nerves. Wisdom teeth also can be impacted -- they are enclosed within the soft tissue and/or the jawbone or only partially break through or erupt through the gum. Partial eruption of the wisdom teeth allows an opening for bacteria to enter around the tooth and cause an infection, which results in pain, swelling, jaw stiffness, and general illness. Partially erupted teeth are also more prone to tooth decay and gum disease, because their hard-to-reach location and awkward positioning makes brushing and flossing difficult. That’s why many healthcare providers recommend removing them.
If wisdom teeth erupt into their proper positions, they can provide support in the back of your mouth and preserve bone in your jaw. But in general, we don’t really need our wisdom teeth. In fact, most healthcare providers consider them vestigial, meaning they served a purpose at one point, but don’t anymore. Our ancestors’ primitive diet consisted of a lot of raw plants, hard nuts and tough meats — and wisdom teeth were necessary to grind these foods for proper digestion. Today, modern food preparation and eating utensils have eliminated our need for wisdom teeth. As we got used to these dietary changes, our bodies went through some small evolutionary changes. For example, our jaws became smaller, which is why many people don’t have enough room in their mouths for their wisdom teeth to grow in.
Contrary to their name, wisdom teeth won’t make you smarter. They’re called that because they usually come in around ages 17 to 25 (when you're older and "wiser", ergo "wisdom teeth"). Wisdom teeth erupt in the very back of your mouth, just behind your second molars. People who have all four wisdom teeth have one in each quadrant — upper left, lower left, upper right and lower right. One research study found that about 53% of the general population has at least one wisdom tooth, but some people never develop wisdom teeth at all.
A wisdom tooth looks similar to any other molar. Most have two to three roots (the part of the tooth that is below the gums), but some can have four. The shape of the roots can vary from person to person. Often, the roots fuse together, giving the appearance of one big, cone-shaped root. Other times, the roots can curl or splay out in different directions.
Your wisdom teeth usually erupt (grow in) between the ages of 17 and 25. However, you might not see fully impacted wisdom teeth when you look in your mouth. If you have a wisdom tooth coming in, there are a few signs and symptoms. You may notice:
Redness or swelling in your gums, behind your last molars.
Jaw pain or tenderness.
Facial pain, due to wisdom teeth putting pressure on nerves.
White flecks behind your last molars. These spots are likely the tops of your new teeth erupting through your gums.
Ask your dentist about the positioning of your wisdom teeth. They may take an X-ray periodically to evaluate for the presence and alignment of your wisdom teeth. They may also decide to send you to an oral surgeon for further evaluation. Your dentist or oral surgeon may recommend that your wisdom teeth be extracted even before problems develop. This is done to avoid a more painful or more complicated extraction that might have to be done a few years later. Removal is easier in young people, when the wisdom teeth roots are not yet fully developed and the bone is less dense. In older people, recovery and healing time tend to be longer.
Most wisdom teeth with signs of disease or clear problems should come out. Reasons include:
Infection or cavities
Lesions (abnormal looking tissue)
Damage to nearby teeth
Bone loss around roots
Not enough room to brush and floss around the tooth
Some dentists recommend taking them out as a precaution, even if they aren't causing problems in the present, because they could cause problems in the future, like:
Before the tooth comes in, the sack of tissue around it can grow into a cyst, which can lead to bone loss in your jaw.
If the tooth is on its side under your gum, it can destroy nearby teeth by eating away the roots.
Bacteria and plaque can build up around a tooth that’s only partly out.
However, many researchers and public-health experts don’t think taking out otherwise healthy teeth is a good idea. If your dentist suggests it and you’re not sure if you should, you can always get a second opinion.
Before your wisdom teeth are pulled, the teeth and the surrounding tissue will be numbed with a local anesthetic. In addition to the local anesthetic to numb the pain, you and your dentist or oral surgeon may decide that a sedative is desired to control any anxiety. Sedating medications that could be selected include: nitrous oxide (also known as "laughing gas"), an oral sedative (for example, Valium), or an intravenous sedative (administered via an injection into your veins). If nitrous oxide is given, you will be able to drive yourself home. If any of the other medications is selected, you will need someone to drive you both to and from the appointment.
The relative ease at which your dentist or oral surgeon can extract your wisdom teeth depends on their position and stage of development. Your oral health care provider will be able to give you an idea of what to expect during your pre-extraction exam. A wisdom tooth that is fully erupted through the gum can be extracted as easily as any other tooth. However, a wisdom tooth that is underneath the gums and embedded in the jawbone will require an incision into the gums and then removal of the portion of bone that lies over the tooth. Often, for a tooth in this situation, the tooth will be extracted in small sections rather than removed in one piece to minimize the amount of bone that needs to be removed to get the tooth out.
After having your wisdom teeth removed, the speed of your recovery depends on the degree of difficulty of the extraction (a simple extraction of a fully erupted tooth versus a tooth impacted into the jawbone).
It’s a good idea to have a ride home because you may be groggy from the medicine. You may be able to manage your pain with over-the-counter drugs, or your surgeon may recommend prescription painkillers, especially if they took out any bone. You’ll probably have a little bleeding the first day and also feel sore and swollen for a few days. Any bruises could take a bit longer to go away. You should not brush or rinse your teeth for 24 hours. After that, gently gargle with warm saltwater every 2 hours for a week.
Bleeding may occur for several hours after tooth extraction. To control it, position a piece of clean moist gauze over the empty tooth socket and bite down firmly. Apply constant pressure for about 45 minutes. A moistened tea bag is an effective alternative. The tannic acid in tea helps healing blood clots to form (blood clots function similarly to scab over an open wound). Repeat this process if a small degree of bleeding continues; if heavy bleeding continues to occur, contact your dentist or oral surgeon. Avoid rinsing or spitting for 24 hours after tooth extraction, avoid "sucking" actions (for example, don't drink beverages through straws or smoke) and avoid hot liquids (such as coffee or soup). These activities can dislodge the clot, causing a dry socket to develop.
Facial swelling in the area where the tooth was extracted typically occurs. To minimize swelling, place a piece of ice, wrapped in a cloth, on that area of your face on a schedule of 10 minutes on, followed by 20 minutes off. Repeat as necessary during this first 24-hour period. Facial swelling in the area of the tooth extraction should be treated with heat after the first 24 hours of ice. Apply a moist warm towel to the area on a 20-minute on, 20-minute off schedule. Repeat as necessary. Keep in mind that swelling usually peaks 2 to 3 days after the procedure.
Pain medications, such as acetaminophen (Tylenol) or ibuprofen (Motrin or Advil), can be taken for minor pain. Your dentist or oral surgeon may prescribe more potent pain relievers, if necessary. Antibiotics that may have been prescribed prior to tooth extraction (to treat any active infection around the wisdom tooth to be extracted) should continue to be taken until the full prescription is gone.
Foods should be restricted to a liquid diet until all the numbness from anesthesia has worn off. Eat soft foods for a few days. Also avoid alcohol if you're also taking narcotic pain medication. Continue to brush your teeth, but avoid the teeth directly neighboring the extracted tooth during the first 24 hours. On day two, resume the gentle brushing of your teeth. Do not use commercial mouth rinses, as these can irritate the extraction site.
After 24 hours, rinse your mouth with warm salt water (1/2 teaspoon of salt in a cup of warm water) after meals and before bed. Do not use commercial mouth rinses unless your dentist directs you to. Stitches, if used and if not of the self-dissolving type, need to be removed by your oral health care provider in about 1 week. If you do require stitches, ask what type you have been given.
Complete healing doesn't occur for a few weeks to a few months following the extraction. However, usually within the first week or two, enough healing has taken place for use of your mouth to be reasonably comfortable in the area of the extraction. Your dentist will explain what to expect in your specific case.
You should be able to get back to your normal activities soon after the procedure. To speed the healing and ease any pain, you can:
Hold a cold pack against your jaw intermittently to help with soreness and swelling.
Try not to spit too much so you won’t move the blood clot that’s keeping the area from bleeding.
Drink lots of water, but stay away from alcohol, hot beverages, or sodas for 24 hours.
You probably won’t be able to fully open your mouth for about a week. Stick to soft foods that won’t bother the area.
It’s rare, but the surgeon can damage some nerves while taking out the lower teeth. That might leave your lips, tongue, or chin permanently numb. With upper teeth, the surgery can damage your sinuses, your air-breathing cavities under your eyes. If your blood clot goes away too soon and leaves your nerves and bone exposed, that can lead to a painful condition called dry socket. That can happen with both simple and surgical extractions.
Talk to your dentist or surgeon right away if:
You have a hard time breathing or swallowing.
Blood won’t stop oozing after a day or two, or pain lasts more than a week.
Your face or jaw stays swollen for more than a few days.
You have a fever.
You feel numbness or notice pus or foul smells.
Two of the more important complications after having your wisdom teeth removed include:
Dry socket. Dry socket is a common complication that occurs when either a blood clot has failed to form in the extracted tooth socket or else the blood clot that did form has been dislodged. Without clot formation, healing will be delayed. When it happens, dry socket typically occurs 3 or 4 days following the extraction and is accompanied by pain (ranging from "dull" to moderate to severe) and a foul mouth odor. Your dentist or oral surgeon will treat the dry socket by placing medication in the socket.
Paresthesia. Paresthesia is a rarer complication of wisdom teeth extraction. Wisdom teeth entrapped in the jawbone are often close to nerves. Sometimes these nerves can be bruised or damaged during the tooth removal process. The result is a numbness (called a paresthesia) of the tongue, lip, or chin that can last a few days, weeks, months, or may even be permanent.
Simple extraction of a wisdom tooth can cost as little as $99 per tooth. The cost of wisdom teeth that are impacted can cost between $230 and $340 and even more. Because costs vary in different areas of the country, contact your dentist or oral surgeon for their charges. Also, check with both your dental insurance carrier and medical insurance provider. One or the other type of insurance may cover a portion of the cost of wisdom teeth removal.
Removing wisdom teeth has become a rite of passage for many teens and young adults around the globe. But if your wisdom teeth erupt in alignment with your other teeth and don’t cause any issues, you may not need to remove them. To learn more about your wisdom teeth and whether you should remove them, talk to your healthcare provider.
Sources:
https://my.clevelandclinic.org/health/body/23223-wisdom-teeth Assessed and Endorsed by the MedReport Medical Review Board