Wisdom teeth woes

Wisdom teeth, also known as the third molars, are the last teeth to erupt in the mouth. They usually appear in the mouth from the end of puberty, usually between 16 and 18 years. If the jaw is too small to accommodate them, they may cause pain or crowd other teeth out of position.

Not everyone gets wisdom teeth. Approximately 10-15% of the population never develop wisdom teeth.

South African dentist, Dr Leslie Lang explains, "In some cases there is simply not enough room for wisdom teeth to erupt and they remain inside the jaw bone and are then termed impacted. Sometimes they develop facing the wrong way and then they will also not erupt."

Why do we have wisdom teeth?

"In our journey through the development of modern man, the jaws have become progressively smaller and smaller. While in the less-developed species there is plenty of room for three molar teeth, modern man has lost the available space for the third molar and as the diet changed didn’t actually need it", says Dr Lang.

When wisdom teeth cause pain

Impacted wisdom teeth cause two main problems, Dr Lang explains.

If wisdom teeth start to erupt and perhaps just a little of the tooth appears in the mouth before it gets jammed, there is a flap of gum which lies over the tooth. Food and debris get caught under the gum and serious and painful infections can develop.

Secondly, the teeth develop in a sack which provides nourishment. If the tooth remains in the bone and unerupted, fluid will start accumulating in the sack and a cyst can form. A cyst provides no symptoms at all and often the first indication of the presence of a cyst is when it bursts, puts pressure on a nerve or other structure or it weakens the jaw. A fracture can then occur.

Impacted wisdom teeth don't always cause signs and symptoms. Common signs and symptoms include:

• Pain or tenderness around the gums
• Swelling around the jaw
• Red or swollen gums around the impacted tooth
• Jaw pain
• Bad breath
• Foul taste when biting down or near the impacted area
• Prolonged jaw or headache

Removing wisdom teeth
Not all wisdom teeth have to be removed if they erupt normally and there is space.

However, if erupting wisdom teeth don't grow properly and cause problems dentists will recommend that they be removed. Dentists believe that it's better to remove the teeth while someone is still young and more likely to recover faster from surgery.

Pain killers to relieve mild pain, antibiotics and rinsing with hot, salty water can help if the area around the wisdom tooth is infected. However, these measures provide temporary relief and don't treat the cause.

Surgery can prevent symptoms from returning and allow nearby teeth to be treated.

Dr Lang explains that there are two procedures for the removal of wisdom teeth.

If the teeth are erupting fairly normally it can be extracted in the normal manner.

If the tooth is partly erupted or impacted, a surgical procedure in which the surrounding bone is removed and the tooth is removed or the tooth is sectioned into two or more pieces then removed. This procedure is usually done under general anaesthesia or conscious sedation.

Complications can arise from having your wisdom teeth removed

Infection in the socket is the problem which most often presents itself. It is difficult to prevent and can be painful until the infection is brought under control.

The biggest potential problem is damage to the nerve which runs in the jaw and the wisdom tooth develops fairly close to this nerve. The nerve is usually carefully identified on the x-ray prior to removal but sometimes it has an unusual path or pressure during removal that can cause the damage.

Damage to adjacent teeth is also a problem as often the wisdom tooth has pushed into the tooth in front and it may not be possible to remove the wisdom tooth without damaging the other tooth.

Very rarely fracture of the jaw can occur.

What to expect after wisdom teeth removal

How quickly you recover depends on the degree of difficulty of the extraction. Your dentist will give you a list of instructions that you should try to follow as religiously as possible.

In general here's what can be expected:

• Bleeding can occur for several hours after extraction. To control it, place a piece of clean moist gauze over the empty tooth socket and bite down firmly. Constant pressure should be applied for 45 minutes. Don't rinse or spit for 24 hours after extraction. Also avoid 'sucking' actions and drinking hot liquids.
• Facial swelling will occur in the area where the tooth was extracted. To relieve swelling, place a piece of ice wrapped in a cloth on the affected area on the face on a schedule of 10 minute on followed by 20 minutes off. Repeat as necessary during the first 24 hour period. 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.
• Food should be chewed on the side of the mouth opposite the extraction. Hot liquids and alcohol beverages should be avoided for at least 24 hours. In the case of a difficult extraction, a soft liquid diet for the first 24 hours is advised.
• Brush your teeth but avoid the teeth directly neighbouring the extracted tooth during the first 24 hours. After 24 hours rinse your mouth with warm salt water after meals and before going to bed.
• If you needed stitches, ask the dentist which type they are. If they are not self-dissolving they need to be removed by the dentist in about a week.

Check your wisdom teeth

Ask your dentist about the position of your wisdom teeth. An x-ray will be taken to determine the presence and alignment of your wisdom teeth. Your dentist might also send you to an oral surgeon for further evaluation.