Wisdom teeth are one of the least understood and mistreated areas of the human mouth. Some 33% of people never experience any. Another common term for them is an 18-year molar, or a third molar. Some don’t actually have them emerge or come through the gum. There is a genetic anomaly that suppresses them altogether for some patients. In the event they are below the surface, this is troublesome if they become impacted within the jaw and suffer an infection or a cyst.
They often can be viewed on X Rays growing in sideways, and causing pressure with other existing teeth. Many patients cannot remember accurately which teeth they have had extracted. Some patients feel wisdom teeth are a curse and don’t belong in their mouth. That decision should be made by a dentist using current technology. Back when wild animals roamed the Earth, and the Beatles began singing on the Ed Sullivan Show, young adults were marched to the dentist for wisdom tooth removal. They may be difficult to extract if impacted.
In rare cases, a wisdom tooth may require splitting in pieces and removed in sections. They usually arrive anytime between 16 and 22 years of age, and as teeth growing into a mature jaw – hence the nickname ‘wisdom’ teeth. In Spanish, they are referred to as ‘Teeth of Judgement’. Centuries ago when humans had broader jawbones and dined on extinct species, food required more ‘gnawing’ than chewing. Today’s more refined foods have resulted in reduced jaw areas, and patients may have anywhere from 0 to 4 wisdom teeth, which do not grow back.
Some racial and ethnic origins have a marked absence of wisdom teeth. NASA no longer requires it (but still recommends it) where astronauts were required to remove wisdom teeth and appendix prior to heading into space! The same applies to scientists working in Antarctica. Ditto for virtually any military deployment worldwide. Dental house calls in outer space or battle zones are non-existent.
The most effective method of diagnosis is using a Panoramic X Ray. We see everything, including roots and any teeth which have not emerged. If a patient has impacted wisdom teeth, they may not cause any difficulty until past age 60. At that time of life, many people are on various medications for blood pressure, and heart problems. Infected wisdom teeth can cause damage to other areas of the body including lungs, hearts, plus major headaches if it spreads to the brain.
If dental surgery to remove an impacted wisdom tooth arises, the patient may be more fragile medically which makes it more risky considering potential nerve damage. A trigeminal nerve injury can affect any small area of the gum, to the entire side of the face. We prefer being aware of all existing teeth – above and below the gum line – and developing the most accurate treatment plan in conjunction with our patient. The preferred time to have this discussion is not when anyone is in pain. Using the Panoramic X-Ray unit is we can determine the level of deeply impacted teeth and make educated decisions on the method of sedation required.
I recommend everyone ask their dentist about their potential for wisdom teeth problems. If they don’t use a Panoramic X Ray, they are guessing! The phrase ‘If they don’t bother you, we’ll just leave them’ is in my personal opinion simply reckless.
Today dentists have options for pain control. Lasers are available and perform much dental surgery without needles for freezing. They reduce the trauma of wisdom tooth extraction, and reduce collateral damage from vibration. We perform major dental implant surgery with oral medications and in-office I.V. sedation, and in extreme situations patients may be treated in a general anesthesia suite.
Another somewhat common situation is the development of a dry tooth socket. Some wisdom tooth sockets are large, and the dental team may pack the socket with medicated gel or dressings. It may result in some discomfort for several days after surgery. The problem is disturbing the clotting action in the tooth socket, and we encounter more issues with patients who are fastidious with their oral care. Excessive rinsing can disturb the clot which is trying to fill the hole and reform the bone.
Some patients have joked that they might lose their ‘wisdom’ with the loss of those specific teeth, but dentists believe greater wisdom using accurate technology ensures a happy and healthy mouth!
Dr. Michael Dolynchuk is a General Dentist practicing in Caroline and Red Deer.
