Q: My dentist says my wisdom teeth need to be removed and I have been referred to a specialist surgeon. What is this all about?
A: Wisdom Teeth
Wisdom teeth, also known as third molars, are the last teeth to erupt in your mouth. This generally occurs between the ages of 17 and 25, a time of life that has been called the "Age of Wisdom."
Anthropologists note that the rough diet of early humans resulted in the excessive wear of their teeth. Normal drifting of the teeth to compensate for this wear ensured that space was available for most wisdom teeth to erupt by adolescence. The modern diet, which is much softer, and the popularity of orthodontic tooth straightening procedures produce a fuller dental arch, which quite commonly doesn't leave room for the wisdom teeth to erupt, thereby setting the stage for problems when the final four molars enter the mouth.
What is an Impacted Tooth?
A tooth becomes impacted when there is a lack of space in the dental arch and its growth and eruption are prevented by overlying gum, bone or another tooth. A tooth may be partially impacted, which means a portion of it has broken through the gum, or totally impacted and unable to break through the gum at all.
How serious is an Impacted Tooth?
Impacted and partially impacted teeth can be painful and lead to infection. They may also crowd or damage adjacent teeth or roots.
More serious problems may occur if the sac surrounding the impacted tooth becomes filled with fluid and enlarges to form a cyst. As the cyst grows it may hollow out the jaw and permanently damage adjacent teeth, the surrounding bone and nerves. Rarely, if a cyst is not treated, a tumor may develop from its walls and a more serious surgical procedure may be required to remove it.
Despite the considerable concern regarding impacted third molars, a recent study sponsored by the American Association of Oral and Maxillofacial Surgeons and the Oral and Maxillofacial Surgery Foundation finds that third molars which have broken through the tissue and erupted into the mouth in a normal, upright position may be as prone to disease as those third molars that remain impacted.
Must the Tooth Come Out if it Hasn't Caused Any Problems Yet?
Not all problems related to third molars are painful or visible. Damage can occur without your being aware of it.
As wisdom teeth grow, their roots become longer, the teeth become more difficult to remove and complications become more likely. In addition, partially or totally impacted wisdom teeth are more likely to cause problems as patients’ age.
No one can predict when third molar complications will occur, but when they do, the circumstances can be much more painful and the teeth more difficult to treat. It is estimated that about 85% of third molars will eventually need to be removed.
When Should I Have My Wisdom Teeth Removed?
It isn't wise to wait until your wisdom teeth start to bother you. In general, earlier removal of wisdom teeth results in a less complicated healing process. The AAOMS/OMSF study strongly recommends that wisdom teeth be removed by the time the patient is a young adult in order to prevent future problems and to ensure optimal healing. The researchers found that older patients may be at greater risk for disease, including periodontitis, in the tissues surrounding the third molars and adjacent teeth. Periodontal infections, such as those observed in this study, may affect your general health.
What Happens During Surgery?
Before surgery, your oral and maxillofacial surgeon will discuss with you what to expect. This is a good time to ask questions or express your concerns. It is especially important to let the doctor know about any illness you have and medications you are taking.
The relative ease with which a wisdom tooth may be removed depends on several conditions, including the position of the tooth and root development. Partially or totally impacted wisdom teeth may require a more involved surgical procedure.
Most wisdom tooth extractions are performed in the oral and maxillofacial surgery office under local anesthesia, intravenous sedation or general anesthesia. Your oral and maxillofacial surgeon will discuss the anesthetic option that is right for you.
What Happens after Surgery?
Following surgery, you may experience some swelling and mild discomfort, which are part of the normal healing process. Cold compresses may help decrease the swelling, and medication prescribed by your Oral and Maxillofacial Surgeon can help manage the discomfort. You may be instructed to modify your diet following surgery and later progress to more normal foods.
ORAL AND MAXILLOFACIAL SURGEONS: AN IMPORTANT LINK
Oral and maxillofacial surgery is the surgical specialty concerned with the diagnosis and treatment of diseases affecting the mouth, jaws, face and neck. An oral and maxillofacial surgeon is a graduate of an accredited dental school who has completed additional four or more years of training in an accredited, hospital-
Consultant specialists working in this area are variously termed oral surgeons, maxillofacial surgeons or oral and maxillofacial surgeons (OMS). Oral and maxillofacial surgeons frequently work alongside other specialists including orthodontists, oncologists, neurosurgeons, plastic surgeons, and ENT surgeons.
The scope of the specialty is extensive and includes the diagnosis and management of facial injuries, head and neck cancers, salivary gland diseases, facial disproportion, facial pain, temporomandibular joint (TMJ) disorders, impacted teeth, cysts and tumors of the jaws as well as numerous problems affecting the oral mucosa such as mouth ulcers and infections.
SASMFOS has produced specialty specific criteria, standards and evidence for the practice of oral and maxillofacial surgery in Southern Africa.
Visit the OMS website: http://www.sasmfos.org/ This website contains information and links to numerous oral and maxillofacial resources and extensive information about SASMFOS which we hope will be of interest and benefit to clinicians, patients and careers.
Complications from Impacted and Partially Impacted Wisdom Teeth
(b) Crown Damage
Complications may arise from partially impacted teeth (fig. a and b) and totally impacted tooth (fig. c)
Wisdom Teeth Growth by Age
12 Years 14 Years
17 Years 25 Years
Wisdom teeth are easier to remove when the patient is younger, since their roots are not completely formed, the surrounding bone is softer, and there is less chance of damaging nearby nerves or other structures. Removal of wisdom teeth at a later age becomes more complicated as the roots have fully developed (may involve the nerve), and the jawbone is denser.