Wisdom teeth, or third molars, are the upper and lower molars that the furthest back in the jaws and are the last to develop and, if they grow in at all, it’s when you are “older and wiser”, usually between 16 and 20 years of age. Many times they are “impacted” or trapped in the jaw and will not fully erupt.
What is an impacted tooth?
This is a tooth that is growing in the jaw in such a way that it is trapped and can not grow in and be a functional tooth. The most commonly impacted tooth is the wisdom tooth, but any other tooth in the mouth can develop as an impacted one, including eye teeth (cuspids), bicuspids and lower 12 year molars are the next most common.
Why are so many wisdom teeth impacted?
While there is no perfect answer to this question, one explanation is that wisdom teeth are like spare tires. Some of the first permanent teeth to erupt in the mouth are the 6-year molars. Historically, they’re also some of the first teeth to develop decay and require removal. This often happened when a person was 12 -13 years old, leaving room for the 12-year molars to shift forward into the 6-year molar site and the wisdom tooth to take their place. Today, because of good dental care and fluoridation, the loss of teeth does not often occur, and this leaves no room for the wisdom teeth to erupt and function properly, creating the potential for problems.
Problems Caused by Wisdom Teeth
- Damage to Adjacent Teeth: Poorly aligned or partially erupted wisdom teeth can be hard to clean, leading to non-restorable decay of both the wisdom tooth and damage to the adjacent 12-year molars. Impacted wisdom teeth leaning into the roots of the 12 year molars can silently damage and destroy these roots. These situations require early removal of these important teeth.
- Periodontal Bone Loss and Pockets: Erupted or impacted wisdom teeth may displace or destroy the bone supporting the back roots of 12 year molars, or cause bone loss causing localized periodontal (pyorrhea) problems leading to early tooth loss.
- Infection: When the wisdom tooth partially erupts, it is particularly susceptible to infection (pericoronitis) and decay. Sudden infection can occur and severe infections can spread to the cheek, neck and throat, even requiring hospitalization.
- Cysts and Tumors: Wisdom teeth develop inside a sack of tissue called a follicle. If the tooth does not erupt fully this tissue can transform into a cyst or tumor, which can enlarge within the jaw.
- Jaw Joint (TMJ) Problems: The lower jaw joint hinges in from of the ears, allowing movement of the jaw for chewing, swallowing, and speaking. Poorly positioned wisdom teeth can shift the position of the jaw and the way the teeth meet or occlude. This can place excessive forces on the temporomandibular joint (TMJ), and can be one factor causing joint pain, earache, popping, clicking, locking of the jaws, muscle pain, and headaches. These persistent abnormal forces within the joints can lead to destruction of the joint requiring joint therapy, surgery or in some cases joint replacement.
- Trauma: The presence of impacted wisdom teeth results in an increased possibility of jaw fractures from facial trauma.
- Crowding or Shifting of Teeth: Crowding of teeth, especially the lower anterior teeth, occurs in many people, often in the teens and early twenties, and after orthodontic treatment. While crowding is not a well-understood phenomenon, and there is debate regarding the causes, many dentists, especially orthodontists, are concerned that wisdom teeth may accelerate the crowding process, and most recommend their removal soon after orthodontics. This may slow the crowding process, but removal of wisdom teeth is not a guarantee that no crowding will occur. For those who have previously had orthodontics (braces), continued use of well-adjusted retainers beyond the normal retention period is one of the best ways to minimize crowding.
With age, wisdom teeth continue to develop. Their roots continue to lengthen, and grow closer to the sinus cavities in the upper jaw and to nerves in the lower jaw that give feeling to the teeth, gums, lips, chin, cheek and tongue. They can shift within the jaws doing silent damage to the surrounding bone and adjacent teeth. The risk of complications, including nerve injuries and sinus openings, from surgery increases with age and greater root development. With increased age, surgery can be harder and healing slower.
Studies and our personal observation have confirmed that best time for removal of wisdom teeth is before the roots fully develop usually in the early to mid-teen years. Surgery is less difficult and healing usually faster with less complications.
Do all wisdom teeth have to be removed?
No. Wisdom teeth that have grown fully into the mouth and are surrounding by normal health gum tissues, and can be easily and predictably cleaned and maintained, may not require removal. But wisdom teeth including erupted ones that cant be maintained should be removed.
A consultation appointment including an oral examination and review of current panoramic x-rays (less than one year old) will allow us to determine if the wisdom teeth should be removed and the timing of their removal. In most cases, if wisdom teeth are ready for removal, all should be done at one surgical appointment. If it is determined that surgery is indicated, the procedure will be discussed with you by the surgeon, along with anesthesia choices that are available. After meeting with the surgeon, you will be able to discuss appointments and insurance benefits with a trained staff member.
Wisdom teeth can be removed PAINLESSLY using local anesthesia (Novacaine injections), Conscious Sedation/ Nitrous Oxide (Laughing Gas) or Outpatient Anesthesia (sleep). These options will be discussed with you. It is important to us that you understand your condition, your treatment options, and what to expect during and after your surgery. You will be part of the decision making process for your care.
What are the costs?
Fees for removal of wisdom teeth vary depending whether the tooth is erupted or impacted, the position of the tooth in the jaw and surgery required for removal, as well as they type of anesthesia that is used. These fees may be covered in part or whole by major medical health insurance or dental benefits or some combination of both, sometimes with a required co-pay. Details will be discussed with you at the consultation appointment.
Wisdom teeth that will not erupt normally and become functional have the potential to cause significant problems. These problems can occur silently until a crisis occurs. Since the risks of removal are lowest with early removal, it is beneficial to avoid a problem rather than wait for one.