One of the most common dental procedures is the removal of problematic, or potentially problematic, wisdom teeth. In order to make an informed decision about whether you need this treatment, it helps first to know what to look out for and secondly to understand the reasoning behind any treatment decision.
Signs that you may need to have a wisdom tooth removal assessed:
- Repeated episodes of tenderness in the area of a wisdom tooth
- A bad/metallic taste in the mouth
- Trauma to the soft tissues around the back of your mouth
- Development of a throbbing, spreading pain
- Routine dental examinations highlighting potential risks from an erupting tooth.
You can assist by being alert to these signs and consulting your dentist if you detect any of them.
Reasons to proceed with wisdom teeth removal
With all dental treatments, patients and clinicians alike are wise to consider the risks and benefits. We should always try to arrive at a decision that achieves a “net benefit” – whereby the positive outcome of intervention outweighs the potential downfalls. Luckily, when it comes to wisdom teeth removal, we have access to a comprehensive body of academic studies and clinical experience that offers us a definitive guide.
The fundamental problem with wisdom teeth is one of space: they often find themselves in strange positions or their eruption is impeded by a collision with the tooth in front due to a lack of “real estate” at the back of our mouths. This all too often makes them difficult or impossible to clean, leading to a series of potential problems. Also, our options to restore compromised wisdom teeth are often limited due to poor access and strange tooth anatomy. Adding to this, wisdom teeth often serve no particular function, so the effort and cost to restore them are usually unjustifiable.
Let’s look at four common scenarios in which to consider extracting wisdom teeth.
This is the clinical term for an inflammatory response of the gum around a partially erupted tooth. As a tooth erupts into the mouth, the gum remodels itself to form a neat collar around the crown. If the eruption is interrupted before the tooth is fully in the mouth, a flap of gum can be left over the biting surface of the molar. This can fall victim to trauma from your bite or lead to food debris getting trapped beneath; both can cause intense and prolonged discomfort from the affected gum tissue. Repeated bouts of pericoronitis are grounds for extraction of the partially erupted tooth.
2, Dental caries
Problematic positioning and partial eruption of a wisdom tooth can make filling it extremely difficult. Decay in wisdom teeth or threat of decay to a tooth in front are reasonable justification for wisdom teeth removal.
3, Irreversible pulpitis
If decay manages to extend into the pulp tissue of a wisdom tooth an abscess may result. Again, due to restricted access, extraction is indicated in this scenario.
4, Other matters
- If the tooth is in the area of planned surgical procedures
- Fractured tooth
- Some orthodontic considerations
- Angulation of the tooth threatening decay in the neighbouring molar
- Strange angulation causing soft tissue trauma (eg cheek)
- Some medical considerations meriting prophylactic extraction
Each person and each tooth must be considered individually to determine if intervention would have a net benefit in terms of oral and overall health. After completing a clinical and a radiographic assessment, your clinician will discuss your individual risks and benefits with you and together you can then make an informed decision.
Dr Ryan Sherry