In the past few months, I have been writing based on the experience of all my past patients and my point of view as a dentist. But I write this article from the point of view of being a patient.
Dental pain is very unique and once experienced, is never forgotten. It was when I was in my very early twenties. I was in dental school at that time and on the eve of a major final exam. The pain I experienced in my jaw was so excruciating that I almost fainted a couple of times even before I got to my professor's office. He confirmed my doubts. My wisdom tooth, which had never caused me any problem before, was infected and needed to be removed immediately. So, I was rushed to the oral surgeon's office and had to have an emergency surgery that day to remove the infected and impacted wisdom tooth. I got better and got wise. I went in a few months later and had the other three impacted wisdom teeth removed before they caused me distress.
Wisdom teeth are also known as third molars. They are usually the last teeth to form or erupt in one's mouth, estimated to occur between the ages of 16 and 25.
During the time of early humans, wisdom teeth did play a major role. But as evolution has progressed, due to changes in diet and dental practices, there usually has not been enough room for the wisdom teeth to grow and erupt in the jaw. Hence they become, fully or partially, impacted within the jaw bone.
What are the dangers of impacted wisdom teeth?
- They maybe painful.
- They may get infected.
- Sometimes a sac may form around the wisdom tooth. This fills with fluid, enlarges and forms a cyst. This cyst may hollow out the bone and may cause permanent damage to the adjacent teeth, surrounding bone and the nerves.
- The cyst, if not removed in a timely manner, may lead to tumor formation in it's walls, which requires a more serious and complicated surgical procedure.
Recent studies have shown that fully erupted wisdom teeth are just as prone to disease as impacted teeth. Wisdom teeth are just as prone to plaque formation and, due to their position, are hardest to keep clean hence leading to periodontal disease. Localized inflammation and bleeding around the wisdom teeth may often be an important indicator of generalized periodontal disease and systemic inflammation. This increases the risk for diabetes, cardiovascular disease and preterm birth.
Erupted wisdom teeth may also become decayed to the point that they cannot be restored. This is again because they maybe hard to reach with a toothbrush and floss and as a result, keep clean. Sometimes, because of periodontal disease and decay, they may start causing damage and problems to the teeth adjacent to them.
Like in my case, sometimes wisdom teeth don't show any initial signs of trouble, but the damage could be occurring without the person being aware of it. No one can predict when someone will experience problems and complication with their wisdom teeth. But it is not prudent to wait till such complications occur, to remove the wisdom teeth. Although the American Association of Oral and Maxillofacial Surgeons (AAOMS) is very clear that it does not advocate unnecessary surgical procedures including the prophylactic or unwarranted removal of wisdom teeth, they do support the surgical treatment of erupted or impacted wisdom teeth that are diseased or have the potential of getting diseased and causing complications.
It is easier to remove the wisdom teeth in younger patients. This is because the roots of the wisdom teeth are not completely formed, the surrounding bone is softer and there maybe less chances of nerve damage. As wisdom teeth grow, their roots become longer, the jaw bone become more dense and the nerves may get more involved, making them more complicated to remove.
Not all wisdom teeth need to be removed. Wisdom teeth that have fully erupted and are functional, painless, decay-free, periodontal disease-free, complications-free and not causing any problems to the adjacent teeth maybe retained. However, if the choice has been made to retain the wisdom teeth, it is necessary to manage them. A regular and periodic hygiene maintenance along with x-ray and dental check up is advised. Excellent oral hygiene should be followed.
It is important to have a chat with your general dentist, orthodontist or family physician about your and your children's wisdom teeth. A consultation with an oral and maxillofacial surgeon maybe recommended. An oral and maxillofacial surgeon is a graduate of an accredited dental school who has completed an additional four or more years of training in an accredited, hospital-based oral and maxillofacial surgery residency program. Oral and maxillofacial surgery is the specialty of dentistry that includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and aesthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
Before surgery, discuss the expectations and all your questions with your surgeon. It is extremely important to let your surgeon know about your medical history and medications in detail. Some people have a history of recreational drug use and it is very important to discuss this with the surgeon to prevent anesthetic complications and interactions. Discuss your anesthetic option with your surgeon and if you are a candidate for sedation. It is important to understand that the removal of wisdom teeth is a surgical procedure, and like with any other surgery, pain, swelling and discomfort may occur. Your surgeon and his or her team should give you postoperative instructions and it is advisable to follow these instructions to prevent post surgical complications.
Every individual is unique. It is wisdom not to base our fears on someone else's experience. Put your dental anxieties aside, discuss finding a good oral and maxillofacial surgeon with your general dentist and think about tackling those wisdom teeth before they might cause complications.
And, as always, brush, floss and take excellent care of your gums and pearly whites so that they can keep your smile beautiful for life!