What are wisdom teeth?

Wisdom teeth are the third set of molars to appear in the mouth. They usually arrive in one’s late teens or early twenties. If wisdom teeth are not properly aligned or there is insufficient room for them, they may become “impacted”, meaning that they will not finish their growth properly positioned. Impacted wisdom teeth are pretty common: between two thirds and three quarters of people have at least one.

What forms do impacted wisdom teeth take?

Basically, impacted wisdom teeth are classified by angle and degree of eruption. As far as angles go, wisdom teeth can be vertically impacted, horizontally impacted, or angled either mesially or distally.

ANGLE OF IMPACTION

Wisdom teeth can arrive at a variety of angles relative to the jaw and the neighboring teeth.

In addition, wisdom teeth can be positioned either further up or deeper into the gum and bone.

SOFT-TISSUE AND BONY IMPACTION

When should wisdom teeth be removed?

For a start, normally positioned wisdom teeth do not need to be removed. Whether to remove impacted wisdom teeth is however a matter of current debate.
Numerous reasons are offered as considerations on impacted wisdom teeth: they are sometimes seen as prone to decay or prone to infection; and they are sometimes considered to have negative impacts on other teeth, such as crowding of the other teeth in the jaw, or that they might cause and “erosion cavity” by pressing against the root of a neighboring molar. In addition, although less often, an impacted wisdom tooth can cause a cyst to form.

When a partially erupted wisdom tooth leads to a bacterial infection of the soft tissues in the area of the tooth (“pericoronitis”) pain, swelling, and redness can occur in the gum. If pericoronitis is persistent, it can be reason to remove a wisdom tooth.

Occasionally it can happen that an impacted wisdom tooth will cause an adjacent molar to begin “resorption”. In effect, the molar reacts as if it is a primary tooth, and its root begins to dissolve to make way for the arrival of a new tooth.

What should I do with impacted wisdom teeth?

Conventional opinion has been to remove impacted wisdom teeth preemptively, and at an early age. This approach has the benefit of avoiding virtually all the negative consequences of impacted wisdom teeth.

But removing impacted wisdom teeth has drawbacks as well as benefits: cost, pain and swelling, and risk of complications are all considerations to be weighed in the decision.

More recently, and more often in jurisdictions outside North America, asymptomatic impacted wisdom teeth are left alone. Some lack of information on numbers of extractions in Canada exists, but the more general trend has been to assess the costs and benefits of extraction before proceeding. A dentist’s expertise is invaluable in making decision on wisdom teeth.

The best approach is to find a dentist who is ready to evaluate your individual situation, rather than recommending automatic removal of impacted wisdom teeth. Because of the wide range of types of impaction, the potential problems arising from impacted wisdom teeth can also vary widely. A dentist is best able to assess the type of impaction, for example. Full bony impactions are less likely to cause problems than partially erupted wisdom teeth. Time is also a factor: it can sometimes take years for a tooth that seems to be impacted to in fact arrive properly in place.

Timing is another factor: because wisdom teeth rarely present an immediate problem, if extraction is the ultimate plan it may be possible to choose a time when the extraction poses minimal disruption.

Indeed, within a person’s mouth, not all wisdom teeth need to be treated as the same; some might merit removal, while others can be left alone. Whether to remove a wisdom tooth is really a decision meriting the expertise of a dentist.

Sherway Garden Dental Centre is well equipped to assess your particular situation and to help you decide the best strategy to manage your wisdom teeth.

Visit our office for a consultation