Why Should Wisdom Teeth Be Removed?
The wisdom teeth, or third molars, begin forming in late childhood and early adolescence, and complete their formation throughout the teenage years. As the wisdom teeth are the last to develop, the remaining teeth have often taken up all the available space in the jaws, which may not allow enough room for proper eruption through the gums and into the mouth. If this occurs, the wisdom teeth remain impacted or embedded under the gum tissue and/or the bone.
Patients are often referred to an Oral and Maxillofacial Surgeon for the evaluation and possible removal of these impacted teeth. Although these teeth may often partially erupt, and may be causing pain, it is quite common for patients to report that they have no pain at all associated with these teeth. In these circumstances, patients will often ask why we need to consider taking out these teeth if they are not causing pain, and why we can't just wait until they start hurting before considering their removal. This would certainly seem like a logical question, after all, too many people unfortunately don't seek any dental care at all unless they are experiencing pain. While pain is certainly an obvious sign that something is happening in this location, it is important to remember that pain is not the most reliable indicator of developing problems with the wisdom teeth. In other words, these impacted teeth can cause significant damage, without ever producing any painful symptoms!
There are several types of problems that the wisdom teeth can cause. These include:
One of the most significant concerns is that of an impacted wisdom tooth causing the formation of cavities on the adjacent tooth. This is a result of the presence of bacteria from the mouth, which can travel down the gum pocket behind the 2nd molar tooth, in an area where it is not possible to brush or floss. These bacteria can then cause decay on the 2nd molar (usually at the point of contact with the 3rd molar), in an area where the Dentist is unable to restore the damaged tooth. This can result in premature loss of the otherwise perfectly good 2nd molar tooth, as well as the 3rd molar (wisdom tooth).
The problem that most frequently causes pain in the area of the third molars is that of infection of the soft tissue surrounding the impacted or partially impacted teeth. This is due to the collection of bacteria under the flaps of skin that cover the impacted tooth. This often makes the tissue covering the impacted tooth swell, which then causes the upper teeth to traumatize this area when biting, further irritating the site. These infections can progress to more serious infections, which may require surgery and/or hospitalization.
This is still an area of controversy, with some clinicians believing that the developing wisdom teeth can cause continuous pressure on the remaining teeth, resulting in crowding or shifting, while others believe that the wisdom teeth have little or no effect on the shifting of the lower front teeth. This is difficult to determine because the effect of the developing wisdom teeth can't be isolated from other factors that can also make teeth shift. While a wisdom that has fully formed it's roots is not likely to be putting any active pressure on the adjacent teeth, it is possible that a developing wisdom tooth (whose roots are still actively forming), may put some pressure on the adjacent tooth, and that this may help produce a shifting of the lower front teeth.
This progressive shifting of the lower front teeth has been observed in cases where the wisdom teeth have either been removed, or congenitally missing, so this tells us that the gradual shifting of the teeth may be multifactorial, and that while the wisdom teeth may be a contributing factor, there may be other forces that may affect this as well.
On some occasions, the cells that are left over from the formation of the teeth, which usually remain dormant as the follicle or "sac" surrounding an impacted tooth can degenerate, and form a cyst or tumor. The cysts are more common, and these usually consist of empty spaces in the bone, lined by a larger sac, and often filled with fluid. These cysts are nearly always benign, but may grow to a very large size, and are normally painless, so that the patient may be completely unaware that a cyst is present. This can damage adjacent structures, and can substantially weaken the jaw, in some cases enough to cause a spontaneous jaw fracture.
If the wisdom teeth are left in place, it is possible that the normally shallow gum pocket behind the back of the 2nd molar tooth can enlarge (or deepen), which then allows the influx of bacteria. When this pocket gets deep enough, it is not possible to adequately clean down into this deep pocket with brushing and flossing etc., and may eventually result in loss of the supporting bone along the back of the 2nd molar, and eventual contact of these bacteria with the impacted 3rd molar tooth. Once the bacteria have contaminated the impacted tooth, there is considerable risk of continuation of the bone loss, as well as the other concerns such as active soft tissue infection, or damage to the adjacent 2nd molar tooth. This deepening of the gum pocket along the back of the 2nd molar can result in premature loss of this tooth.
What Is The Best Time to Have Wisdom Teeth Removed?
The decision to remove impacted teeth is dependent upon a number of factors, including the patient's age, jaw size, position and stage of development of the teeth, the likelihood of successful eruption, and the anticipated potential for any future problems. When extraction is indicated, it is strongly preferred that this be done when the patient is in his/her teenage or young adult years, as the younger patients will have faster healing, less risk of complications, and a smoother postoperative experience than their older adult counterparts.
Do I Have To Be Awake For The Surgery?
Although in some circumstances the surgery can be accomplished with the patient fully awake under local anesthesia alone, it is highly recommended that the patient have this surgical procedure under Intravenous Sedation. Please refer to the Anesthesia presentation below for a more detailed presentation of the indications, risks, procedures, anesthetic options, and postoperative information.