Wisdom teeth are the rearmost molars, that only fully develop in adulthood. In about 80% of people, these teeth don’t fit into the alignment and remain partially or fully impacted (retained) in the jaw.
How to decide over the necessity of wisdom tooth surgery?
- The following is evaluated upon making a decision:
- Have the impacted wisdom teeth caused changes in the jaw or are changes to be expected?
- Are the wisdom teeth developing and erupting normally?
- Are serious risks to be expected during surgery?
- Can wisdom teeth be used to replace already extracted or very damaged molars
A panoramic X-ray (orthopantomogram) with an overview of the teeth needs to be done to answer these questions.
What dangers can arise from impacted wisdom teeth?
In normal tooth development all teeth erupt and remain in the correct position in the tooth row. In abnormal development following issues occur:
- If the tooth is partially covered by mucosa, inflammations develop in about 50% of cases in these “hidden corners”, which in some cases develop into severe abscesses.
- Cysts that cause major jaw defects can form which can result in a jaw fracture.
- If a wisdom tooth lays on an adjacent tooth, it can damage that tooth’s root or surrounding bone.
- Since cleaning of the wisdom tooth is complicated, caries can often form in it, which is difficult or impossible to treat and can spread to an adjacent tooth.
What are the risks of wisdom tooth extraction?
In addition to general surgical complications like inflammation and bleeding specific surgical risks can occur:
- The mandibular wisdom tooth is located near two sensory nerves, which if damaged, can cause sensory disorders, especially numbness in mandibular teeth, gingiva, lip or tongue. Very rarely these changes can be permanent.
- An abscess or osteomyelitis can occur after the extraction of inflamed mandibular wisdom teeth.
- In very rare cases maxillary sinusitis can occur after the extraction of maxillary wisdom teeth.
- In very rare cases mandibular fracture can occur during or after wisdom tooth extraction.
When should wisdom teeth be removed and when should they be retained?
Every wisdom tooth extraction is decided upon separately, taking into account your specific circumstances.
Wisdom teeth should definitely be extracted in following cases:
- Inflammation of tissues surrounding the tooth in the case of so-called teething troubles or delayed tooth eruption (Dentitio difficilis).
- Wisdom tooth caries or root infection.
- Cysts and other bone changes. In this case a tissue sample should also be taken for analysis.
- Damage of adjacent teeth.
- Corrective surgery and orthodontic treatment of the jaw.
- Wisdom teeth hinder biting or cause pain and inflammation.
Wisdom teeth extraction should be considered in following cases:
A longer stay is planned in an area where medical aid is difficult to access.
- Other teeth are treated under narcosis and issues with wisdom teeth are foreseeable.
- Foreseeable risks of a prosthesis “grinding out” the wisdom tooth and causing inflammation.
- Wisdom teeth hinder orthodontic treatment.
Wisdom tooth surgery should not be undertaken in following cases:
- The wisdom tooth eruption in the correct position is foreseeable.
- Extraction of another tooth during orthodontic treatment is foreseeable.
- The wisdom tooth is deep in the bone without causing changes in the bone and its extraction is very traumatic and risky.
How is wisdom tooth extraction surgery carried out?
Wisdom tooth extraction is an outpatient operation made with local anesthesia. One tooth or two teeth from one side are extracted at a time.
Wisdom tooth extraction surgery is carried out by removing bone surrounding the tooth and chipping away the tooth with a drill. Small pieces of root can be left in the bone if their extraction can cause nerve damage.
After tooth extraction the wound is checked and cleaned and sutured. Sutures are removed after one week. Sometimes a swab is left on the wound, which must be changed after 3-5 days.
Antibiotic treatment is prescribed when there is an inflammatory tooth or the operation was highly traumatic, but also when the patient has major general diseases, such as diabetes.
Wisdom tooth surgery can be easy, but also a fairly complicated and traumatic procedure.