Wisdom teeth (third Molar Teeth) can be somewhat mysterious or vague; and many people often question the reason why we continue to be born with them at all. Experts believe that impacted wisdom teeth are the result of evolution; whereby our ancestors ate no or minimally processed foods (root vegetables, plant materials, nuts and raw meats), that required larger and more robust jaws that could more easily house the complete set of teeth (32) without impaction of the third molar teeth.
This third set of molars (wisdom teeth) develop in through late adolescence (from 14 years of age) and complete formation for most of us by 25 years of age. Most people with problematic or painful impacted wisdom teeth become aware of the issue from their early twenties (which is why they’re referred to as ‘wisdom’ teeth for some strange reason!); these teeth are the last to form in our mouths. Even though the teeth may have a normal shape and size, most people (especially those people who have had braces / Invisalign / Orthodontic treatment) will not have enough space in the mouths to accommodate these teeth in a healthy position. Thus the teeth are considered ‘impacted’ (blocked by gum, bone or surrounding teeth from attaining a fully erupted and healthy state). In this impacted state, the teeth do not contribute to chewing or speech and are considered ‘non-functional’. Impacted third molars (wisdom teeth) can cause other teeth to tip, overlap or become ‘crowded’ or ‘crooked’; in effect undoing the effects of Orthodontic straightening of the teeth. Impacted third molars are also a common cause of facial pain, temporomandibular (jaw joint) pain and can seed infection to the throat and tonsils, increasing your chance of developing illness.
As a Specialist Surgeon, I recommend the removal (surgical extraction) of wisdom teeth preferably before the teeth have fully developed root structures (even if the teeth are not visible in the mouth or partly erupted). Removal of the teeth at this early stage is a good idea because procedure is less technically difficult (lower risk of complications) and is associated with a quicker recovery for the patient. The roots are smaller and the investing bone is softer and more flexible and fore-giving; as a result they are less traumatic (easier) to remove the recovery from the procedure is faster. Early removal of wisdom teeth can also avoid the development of other dental problems (recurrent infections, pericoronitis, damage or erosion of adjacent teeth, cyst formation).
When is it ‘ok’ to keep your wisdom teeth?
- The teeth are fully erupted into your mouth and you’re not troubled with pain or swelling from the teeth.
- The teeth are impacted (partially erupted) and the risks associated with removal of the teeth exceed the risks related to retention of the teeth (ie the risk of the having procedure is less than the benefit of the procedure). This situation arises for some patients who have teeth that are in intimate contact to vital structures (nerves, blood vessels, sinuses, adjacent teeth) that be damaged during removal of the wisdom teeth. It may also present for patients who are greater than 40 years of age, as both the risks related to the procedure and the chance of incomplete recovery from possible complications increase.
As a Specialist Surgeon with many years of experience in these procedures, you can be reassured that advice you are given at Consultation is in your best interests (and is unrelated to my personal betterment). The decision to have the teeth removed or retained (and monitored) can be complex and every patient’s case is different; it can only be made after a thorough assessment of skeletal growth, tooth position, bone depth and possible impact on surrounding teeth.
Still confused? Here are 5 pretty clear reasons why your wisdom teeth need to be removed.
#1 – They are causing gum problems
Partially erupted or impacted wisdom teeth can crowd other teeth and cause pain and swelling because they are literally pushing themselves up through the gum tissue and jawbone trying to attain fully erupted position in the mouth. Wisdom can create deep gum pockets around themselves where food and bacteria can collect, which can lead to infection. This inflamed and infected tissue can continue to trap small particles of food and bacteria; making the teeth and gum tissue difficult to clean. This is known as pericoronitis and it can also occur around other teeth that are still beneath your gums.
When a sac next to a tooth becomes filled with fluid a cyst can develop, and if left untreated it can destroy roots, bones and surrounding structures. More rarely a tumour may develop and require additional surgery. These are all serious problems that negatively affect your overall health.
#2 – They are causing damage to or crowding of neighbouring teeth
If all of your wisdom teeth erupt in healthy positions in your mouth, then you’ll end up with thirty-two teeth in total. This outcome is unlikely for anyone who has had Orthodontic treatment (braces / invisalign etc). Often there’s just not enough room in your mouth for all of them! If your teeth are crooked and you are considering straightening your teeth with Orthodontics; removal of your wisdom teeth before treatment is likely to reduce the time needed in braces to straighten your teeth.
Impacted wisdom teeth can damage the roots of neighbouring teeth. This pressure can permanently damage adjacent teeth and may lead to recurrence of tooth crowding again after the Orthodontic treatment is complete (Orthodontic relapse).
Sometimes wisdom teeth will develop that have no possibility of contact with opposing teeth; these teeth are called ‘non-function’ teeth. Removal of these non-functional treatment is recommended unless the teeth are required for replacement of nearby teeth.
#3 – They are hindering chewing function and jaw movement
Wisdom teeth can also erupt into the mouth in an unusual position or angulation to the adjacent teeth; this can result in irritation of tissues (gum / teeth / bone) that they come in contact with, sometimes scraping or abrading the tissues of your cheek or tongue. In some cases the malposition of the wisdom teeth can contribute to jaw joint problems (Temporo-mandibular joint; TMJ; TMD).
#4 – They are causing pain, irritation or sinus issues
We’ve already mentioned some of the reasons why your dentist may recommend that your wisdom teeth need to be removed. Gum problems, damage to neighbouring teeth and issues with jaw movement and chewing function can all cause a significant amount of pain – in fact, some people believe that tooth pain is some of the worst pain anyone can ever experience.
Unfortunately wisdom teeth can also cause pain outside of the mouth as well. When the wisdom are incompletely developed, some patients experience ‘pressure’ type pain in the jaw behind the last molar teeth which extends toward both the ears and sinuses (beneath the eyes). When teeth and roots are developing in your upper jaw, they can also rub and push against your sinuses, creating pressure and sometimes leading to headaches, sinus pain and congestion. That’s when you know it’s definitely time for them to go!
#5 – They are causing cavities in or bone loss around adjacent teeth
The positioning of your developing wisdom teeth can also have a big impact on your ability to clean surfaces of adjacent teeth, where sneaky and resistant bacteria like to hide. If your gums become irritated, deep pockets can create areas where groups of bacteria (hidden within calculus and plaque) can collect and promote the development of tooth decay (dental caries) and / or periodontal disease (gum disease). This can lead to the development of cavities on neighbouring teeth, and potentially the premature loss of teeth. Just another reason those pesky wisdom teeth need to be removed!