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Why is there a wisdom tooth problem?
Why should I remove my wisdom teeth?
Should I have all my wisdom teeth removed at once?
Is general anaesthesia the best option to have my wisdom teeth taken out?
When is the best time to have them removed?
There was a time when our jaws could comfortably accommodate all 32 teeth, including the third molars (also known as wisdom teeth). A few million years ago, instead of walking upright, human ancestors used to get around on all four limbs, with a massive protruding jaw leading the way.
Early man’s jaws were larger and more prominent because teeth played a vital role in survival. With the front appendages occupied with balance and running, teeth were prehistoric man’s means of catching, dismembering and consuming prey. Our ancestors subsisted on a rough and coarse diet of leaves, roots and raw meat. Having 32 teeth’s worth of chewing ability was a huge advantage at this point, third molars might have played an important backup role when teeth were lost or worn down.
Eventually, teeth became not so important anymore! Through evolution, hominids began walking upright, and arms took on a greater role in obtaining food. After that, brains became larger and jaws became shorter. However this happened, the evolutionary change minimized the amount of space available to teeth in the mouth.
As our heads and jaws were changing, some cultural shifts were taking place as well. Around the same time, man was creating the first tools, including cooking utensils. With bigger brains, man got the ability to control fire and its ability to soften food. Overall, man’s diet became much more processed, when compared to the roots and raw meat our ancestors ate. As it is, though, we decreased our reliance upon the third molar.
Some anthropologists place greater weight on the dietary shift in lessening our reliance on wisdom teeth, discounting the role of our evolving jaws and brains. When teeth are in function, the thin ligament anchoring the tooth root in the jaw bone allows for small amounts of vertical movement. Therefore, a rubbing of contact areas between teeth occurs at the same time, causing some side wear that will eventually be compensated for by the forward drifting of teeth, produced by specialized gum cells and fibers. These fibers link every tooth in a jaw and behave as a single elastic structure pulling teeth together. In this process, tooth contact is maintained at all time, and crucial room is freed in the back of the jaw for an adequate positioning of the 3rd molar when they erupt later in life. This drift can be considerable with appropriate mastication. However, soft diet came with civilization and man no longer needed to chew for a long time. Conditions inhospitable to third molars were then created. There just isn’t enough room for them anymore to erupt normally, which is why they may come in various angulations, also known as being impacted.
There are many different forms of impaction, whether vertical or horizontal. The extraction of wisdom teeth is necessary when they are prevented from properly erupting within the mouth. They may grow sideways, partially emerge from the gum, and even remain trapped beneath the gum and bone. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to successfully erupt. In many instances today, wisdom teeth are accessory teeth and have inadequate root morphology to function as regular molars. Like the appendix, wisdom teeth tend to become vestigial organs.
The last four teeth to erupt are your third molars, also known as “wisdom teeth.” While most other teeth have fully erupted by age 12, this is the time when the wisdom teeth are starting to calcify and form. The average mouth usually has enough room to hold only 28 teeth.
Wisdom teeth may need to be pulled because of:
They can be impacted partially only; causing a deep opening right behind the adjacent tooth, down its back root. This opening is very narrow. You cannot see it, but it allows bacteria from your mouth to enter the lodging of the impacted tooth. When a wisdom tooth is impacted, it may be at the origin of a deep pocket, formed by gum and bone covering the partially submerged tooth, cannot be cleansed even with proper brushing. As debris and bacteria accumulate, you are very likely to experience pain and swelling due to infection. It is just a matter of time! When it remains partially covered by gum, bacterias accumulate in this “pouch”, created on top of the tooth. You can then experience cycles of pain and swelling due to inflammation and infection. Once the offending tooth is removed, the deep pocket will, most of the time, disappear along with the symptoms.
One interesting fact is that in most of those cases, impacted teeth exist quite asymptomatically: you wouldn’t even know they are there, let alone causing problems. Nevertheless, chronic infection lingers with continuous formation of pus oozing from the pocket all day long. There is now mounting evidence that pyophagia (swallowing of pus in minute amount) can deteriorate your general health.
Even when fully erupted, the teeth are difficult to properly maintain due to limited access. Therefore, they are much more prone to cavities. Once a cavity develops in a wisdom tooth, extraction is usually recommended because the access is very poor and restoration with fillings and crowns cannot be realized in an adequate manner most of the time.
If the tooth is totally impacted and no pocket is present, there is no need to extract it.
As the wisdom tooth forms, a group of cells that created the tooth buds, called the follicle, remains around the crown of the tooth. When impacted and untreated over long periods of time, the cells within the follicle can cause formation of a tumor or cyst. A cyst is a fluid filled sac lined with follicular cells. They are usually not cancerous and cannot spread to other parts of the body; however, when untreated, they can grow to very large sizes to cause local destruction of the jawbone and adjacent teeth. When we remove your wisdom teeth, we also remove the follicular sac to prevent formation of such cysts.
During growth, a tooth displaces and resorb bone as it forms. When impacted wisdom teeth are removed, a variable amount of bone will fill the room left by the tooth within the next 4 months. When wisdom teeth are removed at a young age (i.e. mid-teenage years), 95 – 100% of the bone will grow back. However, when they are removed at a later age, the bone may not fully regenerate. This results in a persistent pocket or bony defect behind the second molars that need to be addressed. It emphasizes the need to have wisdom teeth treated early to prevent this and many other potential complications. Another telltale sign is an adjacent root cavity at the contact area with the impacted tooth where bacteria can proliferate undisturbed.
About one in three wisdom teeth that initially show no signs of trouble will change position in time and end up causing problems later.
Some dentists and orthodontists believe that pressure and force from erupting wisdom teeth can cause movement and relapse of orthodontically aligned teeth. This movement happens very slowly over months and years. Removal of the offending wisdom teeth and use of your orthodontic retainers could prevent this potential problem.
Yes! The most important factor to base your decision on is that you will have the same discomfort level whether you have 1 or 2 removed at a time. Most postoperative discomfort is rated from mild to moderate and is easily controlled with appropriate medications. Most people are at a normal activity level within 24 to 48 hours of the procedure. Regardless of the number of teeth that are removed.
In addition, having it done at one time means less overall expense and less overall time missed from your activities. There is also decreased anxiety from not having to go through it twice.
No, unless you are extremely anxious.
It is always better if you remain responsive and cooperative during the procedure. General anesthesia is often unnecessarily promoted. It has its own inherent risks of nerve injury. Many studies have demonstrated that wisdom teeth extractions can be done easily and more safely with a local anesthetic injection.
Conscious sedation can be a good alternative if you wish to have a relaxing experience.
To learn more on that, please visit our page on Sedation Dentistry
The best time to remove a wisdom tooth is when it is not causing problems!
This is because by the time the tooth becomes painful, significant damage may already have occurred to the teeth nearby. In addition, the ability of the body to respond well to oral surgery decreases with age. Young, healthy patients, with no prior infections at the site provide the best opportunity for uncomplicated tooth removal.
As we age, the effects of retained and impacted wisdom teeth can be more consequential. Periodontal defects tend to get worse in the presence of retained third molars as you age. So too does the prevalence of cavities. The incidence of postoperative morbidity is notably higher in people over age 25. The ADA recommends having these teeth removed by age 20.
Dr Gaumet will provide you with the best method of extraction that fits your specific needs. Contact us today to have an assessment of your wisdom teeth status.
