Wisdom teeth or third molars are routinely removed as an adolescent. They are the last tooth in our mouth to develop and erupt. Wisdom teeth may first appear radiographically as early as age 14. Since wisdom teeth are the last teeth to develop, they frequently become impacted. Impacted simply means something is obstructing the normal eruption of a tooth. This can be soft tissue, bone, another tooth, or even a tumor. In the case of routine third molars, they are classified according to the degree of impaction. Soft tissue impaction, partial bony impaction, or complete bony impaction. This degree of impaction will determine the difficulty of extraction and may dictate the degree of pain a patient experiences with an extraction. A wisdom tooth that is impacted may create an adult “teething” experience where a patient complains of pain and swelling behind the second molar. This is termed pericoronitis. Complete bony impacted teeth may still cause the same symptoms but are less likely too. Do not be fooled, lack of symptoms is not a reason to ignore wisdom teeth.
Why Should I Have My Wisdom Teeth Removed?
Wisdom teeth are the last teeth to erupt within the mouth. When they align properly and gum tissue is healthy, wisdom teeth do not have to be removed. Unfortunately, this does not generally happen. 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.
These poorly positioned impacted teeth can cause many problems. When they partially erupt, the opening around the teeth allows bacteria to grow and will eventually cause an infection. The result: swelling, pain, illness, and possible damage to the second molar. The pressure from the erupting wisdom teeth may move other teeth and disrupt the orthodontic or natural alignment of teeth. The most serious problem occurs when tumors or cysts form around the impacted wisdom teeth, resulting in the destruction of the jawbone and healthy teeth. Removal of the offending impacted teeth usually resolves these problems. Early removal is recommended to avoid such future problems and to decrease any risk involved with the procedure.
I explain to my patients that wisdom teeth removal is best accomplished at a young age, with or without symptoms. The reason is the age of the ones. The younger a patient at the time of surgery the better they respond to the surgery or in other words the shorter the recovery time. This is assuming that the patient is emotionally mature enough to understand and participate in the surgery. An unwilling participant will make the surgery and recovery period longer. The bone structure or density is less in a younger patient. The outer covering of bone, the cortical bone, is thinner and less “calcified” in teenagers. The bone gives way when removing an impacted third molar or wisdom tooth. This means that the wisdom teeth are easier to be removed and less bone manipulation and a smaller flap are required. A younger patient heals faster and has fewer complications associated with any surgery. The complications associated with wisdom teeth removal will be discussed later.