Common wisdom tooth problem and how to deal with them

Molars are rounded or flattened surfaced adapted for grinding. They are eight in number four on the upper jaw and four on the lower. However, when we are between 18-24 years four more erupt, that is two in the upper jaw and two in the lower jaw. Since these erupt later in life they are called ‘wisdom teeth’.

How common do problems occur with wisdom teeth?

Early man ate rough and raw food, resulted in increased jaw growth as young adult and this allowed the smooth space for the third molar or the wisdom tooth to come into the dental arch. But as we evolved and started eating refined food, the jaw growth has stopped. Nature has allowed for the jaw space to accommodate the third molar however this jaw space is reducing with successive generations.  However even in the people who do find jaw space for the 3^rd molar there could be pain and discomfort associated with the eruption process.

People who have chronic ear, or throat infections are more susceptible to wisdom tooth related problems.

What are impacted wisdom teeth and what are the problems it can create?

Impacted wisdom teeth are complications of the wisdom teeth when it does not erupt into the dental arch or erupts improperly.  An easy way to understand the problems caused by the wisdom teeth is

• During eruption, the gums over the erupting teeth can be stressed.  The person feels a constant need to bite on the gum. This could lead to redness or inflammation of the gum tissue above the erupting teeth. This is generally referred to as pericornitis.
• If the wisdom tooth of the opposite arch has erupted it can cause irritation the opposing tissue as the vertical space is also reduced.
• A partially erupted tooth, can have impacted food, and associated infection. This can cause swelling or even trismus, which is the inability to open the jaw.
• Decay of the partially erupted or improperly erupting teeth is another common complication. This often happens due to the difficulty in accessibility to adequate oral hygiene. Quite often there is food impaction over the partially erupted tooth. The complication of this could be swelling of the corner of the jaw, bad breath, or inability to open the jaw.
• Impacted wisdom teeth are those teeth that are unable to erupt. This could either be partial that is part of the crown is visible, or might not emerge from the bone, or it could be stuck between the gum and the bone but not tearing the gum. This could be because
  • The tooth has grown at an angle towards the second molar.
  • The tooth has grown inwards at an angle facing the jaw
  • The tooth could be inverted and trapped within the jaw bone.
  • The tooth could be ‘lying down’ which would mean that it is at right angles to the neighbouring tooth.

How are these wisdom teeth complications handled?

Decay

If the wisdom tooth is partially erupted or at an angle to the adjacent teeth there could be food impaction that causes decay of both the 3^rd molar and the neighbouring 2^nd molar. The extent of decay is accessed and restored while the 3^rd molar might require extraction.

Gum Problems

The redness and irritation of the gums caused by impacted wisdom tooth is accessed and treated with:

• Oral hygiene protocol called irrigation. Mouthwashes and rinses are used to reduce the inflammation and dislodge food.
• Pain killers are prescribed to manage the pain. Usually Aspirin is prescribed.
• If the inflammation is aggressive or if there is presence of infection then antibiotics are used.
• Sometimes a minor surgical procedure is performed on the gum that is over the wisdom teeth. This prevents food impaction, and collection of debris and plaque. This means reduced inflammation. This procedure is called operculectomy.

Cyst

A cyst is the formation of a sac around the tooth, or associated with the tooth it could be filled with fluid or gas. This requires surgical intervention where the cyst is excised along with any tissue or bone that is impacted by the cyst.

Is extraction of wisdom necessary, what are the criteria for extraction?

It is not mandatory to extract wisdom teeth. If the tooth is healthy and erupts in a healthy manner then extraction is not required. However, extraction is considered if the impacted teeth are causing complications.  

Extraction and post extraction care

The extraction of the 3^rd molar is routine procedure done under local anaesthesia. However, there might be times when general anaesthesia is considered.  The recovery period is 1-2 weeks. If stitches have been placed after the extraction of the wisdom teeth, then it is taken off after a week. During the week, warm water rinses and exercise to keep the jaw functional has to be practised.

During recovery it is normal to have swollen mouth and cheeks.  It gradually reduces over the week. Cold compression helps to keep the swelling down. The stiffness of the jaw will take about 7-10 days to wear off, while if there is skin bruising it takes about 2 weeks.  There could be an unpleasant taste in the mouth, and sometimes tingling or numbness of face lips or tongue.

A little self-care helps to reduce pain and aids recovery. Here are some tips:

• It is okay to use OTC painkillers like paracetamol or ibuprofen. Ibuprofen seems to work the best though.  If anything stronger is required your dentist will prescribe it.
• It’s better to avoid strenuous activity and exercise for a few days.
• Using an extra pillow to support the head at night helps, as it reduces possibility of a bleed.
• To promote wound healing, it is necessary to have the clot is place. To ensure that the clot is in place, for 24hrs its best to avoid rinsing, spitting, hot drinks or anything that might cause dislodging of the clot.
• Avoid alcohol or smoking for 24hrs.
• For a week or so eat soft food chewing on other teeth.

Since procedure is usually done under local anaesthesia, it might you may not require a ride a back. However, it is advisable not drive if you have been given a sedative. It is also advised that you take a day or two off from work after having the extraction done. If you have been prescribed antibiotics, make sure that your course is complete. Brushing should be possible after few days until then use warm saline water or antiseptic mouthwashes. Ensure that you have a post-surgical check up after a week or ten days.