Frequently, in both my professional and personal life I am asked about wisdom teeth. For most oral surgeons, treatment of wisdom teeth is a significant part of their professional practice. The summer months of June, July, and August are by far the most popular time for patients to be evaluated and treated regarding wisdom teeth. In this two part column I will discuss some background about wisdom teeth and their treatment.
Third molars, more commonly known as wisdom teeth, are the last teeth to develop and the last teeth to erupt into the oral cavity. Normally there are four total third molars, 2 in the upper and 2 in the lower jaw. Third molars begin their development at 7-8 years of age, and may erupt or emerge into the mouth anywhere from 18 to 25 years old when the third molar root nears completion of development.
Wisdom teeth display many different types of presentations, ranging from fully erupted to fully impacted. Impaction simply means that a tooth has failed to fully erupt through the gum line. There are different types of impaction, soft tissue impaction, where all or part of the tooth is covered by gum tissue, and bony impaction where the tooth is partially or fully covered by a layer of bone.
Third molars may or may not present with symptoms, which can include pain, sensations of pressure, swelling, fevers, traumatic biting of the cheek, cavities or periodontal problems. Symptomatic wisdom teeth are indicated for extraction in nearly 100% of cases. Asymptomatic wisdom teeth however present a different set of circumstances. There are numerous well-established reasons for prophylactic, or preventive, removal of wisdom teeth. I will very briefly list some of the more common reasons below. For a more detailed discussion of these factors please visit www.aaoms.org or discuss them with an oral surgeon.
Oral hygiene is paramount in the discussion regarding the extraction of wisdom teeth. Third molars create situations that often compromise the ability of patients to properly care for not only the third molar but also the second molar anterior to it.
Additionally, wisdom teeth create an environment that lends itself to the development of infections. Third molar position may create a scenario where the gum tissue around the tooth becomes inflamed and later infected, known as pericoronitis.
Experiential and subjective data provide a great deal of support for the theory that erupting third molars may exert some pressure and cause movement of other teeth.
Fully impacted third molars show a higher prevalence for cyst or tumor formation with increasing age. Estimates indicate that as many as 11% of fully impacted wisdom teeth may form cysts or tumors.
In the next installment of this column I will discuss the risks and possible complications involved with removal of wisdom teeth, and what to expect the day of surgery and in the days following surgery.