Wisdom teeth, also known as third molars, are the last teeth to erupt in your mouth, if there is sufficient room for them. This generally occurs between the ages of 17 and 25, a time of life that has been called the "Age of Wisdom."
Anthropologists note that the rough diet of early humans resulted in the excessive wear of enamel between their teeth. Normal drifting together of the teeth, to compensate for this wear, ensured that space was available for most wisdom teeth to erupt at the end of the dental arch by the time a person reached the age of approximately 21. The modern diet, however, which is much softer, does not wear down the contacts between the teeth, and the popularity of orthodontic tooth straightening procedures whereby bicuspids are not usually removed, produces a fuller dental arch. Therefore, there is insufficient room for wisdom teeth to erupt. The stage then is set for problems, when the final four molars try to erupt into the mouth.
When these teeth cannot erupt, they are termed "impacted," which means there is insufficient space in the dental arch: The wisdom tooth's pathway into the mouth is obstructed by gum tissue, bone, or the adjacent second molar. Complications then ensue, such as:
- Infection: Impacted teeth can become infected, leading to localized infection in the gum or more serious infection that can involve the throat, jaw, and face
- Bone loss around an adjacent tooth: Periodontal bone loss can occur behind the second molar which may not regenerate and may require grafting to ensure the second molar remains healthy.
- Formation of a cyst or tumor: More serious problems may occur if the sac surrounding the impacted tooth becomes filled with fluid and enlarges to form a cyst. As the cyst grows, it may hollow out the jaw and permanently damage adjacent teeth, the surrounding bone, and nerves. Rarely, if a cyst is not treated, a tumor may develop from its walls, and a more serious surgical procedure may be required to remove it.
- Crowding or damage to an adjacent tooth: If the top portion of the impacted wisdom tooth is lying against the relatively softer root portion of the adjacent molar, it actually can dissolve a portion of the root over time, making the second molar irreparable.
Despite the considerable concern regarding impacted third molars, a recent study sponsored by the American Association of Oral and Maxillofacial Surgeons (AAOMS) and the Oral and Maxillofacial Surgery Foundation (OMSF) finds that third molars which have broken through the tissue and erupted into the mouth in a normal, upright position may be as prone to disease and decay as those third molars that remain impacted.
Do all third molars have to be removed?
Not all problems related to third molars are necessarily painful or visible. Damage can occur over time without your being aware of it.
As wisdom teeth grow (up to the age of about 22), their roots become longer. The teeth then become more difficult to remove, and complications during surgery become more likely. No one can predict when third molar complications will occur, but when they do, the circumstances can be much more painful, and the teeth more difficult to treat. It is estimated that about 85% of third molars eventually will need to be removed for one reason or another.
When should I have my wisdom teeth removed?
Wisdom teeth are easier to remove when the patient is younger; their roots are not completely formed, the surrounding bone is softer, and there is less chance of damaging nearby nerves or other structures. Removal of wisdom teeth at a later age is more complicated; roots are fully developed (may involve the nerves that give feeling to the lip and tongue), and the jawbone is denser.
Dr. Strahs recommends an evaluation of your wisdom teeth at about the age of 17. It is unwise to wait until your wisdom teeth start to bother you. In general, earlier removal of wisdom teeth results in a less complicated healing process. The AAOMS/OMSF study strongly recommends that wisdom teeth be removed by the time the patient is a young adult, in order to prevent future problems and to ensure optimal healing. The researchers found that older patients may be at greater risk for disease, including periodontitis, in the tissues surrounding the third molars and adjacent teeth. Periodontal infections, such as those observed in this study, may affect your general health.
What happens during surgery?
Before surgery, Dr. Strahs will discuss with you what to expect. This is a good time to ask questions or express your concerns. It is especially important to let her know about any illness you have and any medications you are taking.
The relative ease with which a wisdom tooth may be removed depends on several conditions, including the position of the tooth and root development. Impacted wisdom teeth may require a more involved surgical procedure.
Most wisdom tooth extractions are performed in the oral and maxillofacial surgery office under local anesthesia, local anesthesia and nitrous oxide analgesia, intravenous sedation, or general anesthesia. Dr. Strahs will discuss the anesthetic option that you prefer and that is right for you. Please see our anesthesia services.
Following surgery, you may experience some swelling and mild discomfort, which are part of the normal healing process. You will be instructed to take some time off from your normal school, work, and exercise schedule. Cold compresses and prescribed medication may help decrease the swelling. You will be instructed to modify your diet immediately following surgery. Later, you progress to more normal foods. Please see our instructions for care of your mouth following oral surgery.