Surgical removal of wisdom teeth, or “third molars”, is one of the most common procedures undertaken in dentistry.
Now, if you haven’t had yours removed yet, you must be wondering whether it’s necessary for everyone to have them removed. And if not, under what circumstances would you need to have your wisdom teeth removed and when is the best time?
The answer to this varies because each case and each patient is different. It is true that wisdom tooth extraction can prevent a lot of dental problems, both now and later. But only after assessing the growth, position and impact on the surrounding teeth can we decide whether removal is the best option in your case. The decision to extract a wisdom tooth depends on a balance between symptoms (or pathology) and relative risks of removal. In order to make an informed decision we need to look at the teeth clinically and radiographically.
In many people the wisdom teeth are blocked from coming down by bone or other teeth. This causes the wisdom teeth to be trapped underneath the gum – what we call “impacted”. Impacted wisdom teeth don’t always produce symptoms, but they can cause other problems, such as pericoronitis, dental caries and infection.
This is a mild to moderate inflammatory response of the gum surrounding a partially erupted wisdom tooth. If this happens, part of the tooth may be covered by a flap of gum. Bits of food and bacteria can become trapped under the flap and this can cause swelling and low-grade infection. Pericoronitis is most common with lower wisdom teeth. If a wisdom tooth has had acute or recurrent pericoronitis then it is normally indicated for wisdom tooth removal.
Dental caries (tooth decay) is often present on wisdom teeth due to the difficulty in reaching the region to clean it adequately. If a wisdom tooth has extensive caries and is difficult to restore, we normally advise the patient to have the wisdom tooth extracted.
Pericoronitis or caries that has caused the living pulp in the centre of the tooth to die can result in infection, either localised or spreading into the fascial spaces. In this case, an extraction would also be indicated because if the infection spreads rapidly it can be life threatening in the form of a malignant cyst or tumour.
Other possible reasons for wisdom tooth extraction:
- Fractured tooth
- As part of your orthodontic/orthognathic treatment plan
- Prophylactic removal in the “at-risk” patient (for example, bacterial endocarditis)
- As an aid to denture provision.
Wisdom tooth removal is NOT indicated if:
- there is a high risk of injury to the inferior alveolar nerve during extraction of the wisdom tooth
- the patient has an uncontrollable clotting disorder
or if the tooth is:
- healthy – no signs of decay or cavities
- fully erupted
- fully functioning – has an opposing tooth in the arch and is being used for chewing
- positioned correctly in the arch – not impacting neighbouring teeth and not impacting on crowding in the arch.
You are urged to have your wisdom teeth clinically and radiographically examined if you are experiencing any of the following symptoms:
- tenderness and/or pain in the back of your mouth close to your gums
- chewing difficulties
- reddening of the area where your tooth surfaces
- swelling of your jaw
- persistent bad taste in your mouth
- red, tender, swollen and/or bleeding gums
- unpleasant odour on your breath.
Dr Nikhita Arora
BDS GDipDent (Melb)