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Impacted Wisdom Teeth: Treatment and Prevention

Wisdom teeth are the third set of grinding teeth that typically erupt into a person’s mouth between the ages of 17 and 21, though they may emerge in a person’s mid-twenties or even later. Healthy and properly positioned wisdom teeth help a person to chew more effectively.

Unfortunately, wisdom teeth often fail to emerge through the gums (impaction) or are positioned incorrectly, causing complications. An impacted wisdom tooth may emerge only partially from the gum, or may grow in sideways, or remain completely trapped beneath both the gum and the bone.

Wisdom teeth are so prone to complications because they are the last to erupt and have to compete for space with other teeth that are already in place. Removing the problematic tooth is often the only solution to the problem and, in fact, about 85% of wisdom teeth must be eventually extracted. The likelihood of complications developing is lower if extraction occurs before the roots become fully imbedded in the jawbone, which happens by a person’s 40s.

Our ancient ancestors needed wisdom teeth to compensate for teeth lost due to lack of proper dental care. However, over time several factors have emerged that make complications related to wisdom teeth more common, including:

Jaw size evolution. Since the jaw is smaller in today’s people, wisdom teeth do not always have enough space to emerge in place where they were supposed to be. People with small jawbones may be, therefore, at greater risk of having problematic wisdom teeth.

Changes in diet. Because modern diets include fewer tough foods, there is less wear on the teeth and reduced space for wisdom teeth to erupt.

Improvements and greater availability of dental care. Humans do not lose as many teeth today as in the past, therefore, there is less extra room in the jaw.

Complications Related to Wisdom Teeth

In some cases, wisdom teeth that erupt only partially or not at all do not cause any complications. However, many people do experience problems if their wisdom teeth become impacted. Untreated impacted wisdom teeth not only push surrounding teeth out of place but they may also cause them to erode. Wisdom teeth are often difficult to reach during brushing, which leaves them prone to tooth decay.

Sometimes, a flap of gum grows over the wisdom teeth. If food and bacteria become trapped under the flap, an infection known as pericoronitis may set in. It often causes pain as well as jaw stiffness, tenderness or swelling around the gums and general illness. The infection may spread to the throat, cheeks and neck. In some cases, a cyst may form near the tooth and can damage the jawbone, nerves or tooth roots. Rarely, a tumor may also develop. Although such tumors are typically noncancerous, they may require removal of bone and surrounding tissue.

Other possible problems associated with impacted wisdom teeth (persistent or recurring) include:

  • Bad breath (halitosis)
  • Pain when chewing or biting
  • Difficulty opening the jaw (trismus)
  • Unpleasant taste when biting down on the tooth or the surrounding area
  • Ongoing headache, jaw ache or ear ache
  • Changes in tooth position or sensitivity of the teeth, or discoloration

Treatment and Prevention

Minor problems related to wisdom teeth can be treated with simple techniques, such as mouthwashes, saltwater rinses and over-the-counter pain relievers. If pericoronitis develops, the dentist may remove damaged tissue and pus and prescribe antibiotics to kill the infection. However, if x-rays reveal a wisdom tooth in an abnormal position beneath the gumline, or if the tooth is already causing problems, it will likely have to be removed.

In young patients aged 17-21 dentists usually prefer to remove problematic wisdom teeth. At those ages, the jawbone is less dense, the wisdom tooth’s roots are not as deep and large nerves are less likely to be involved in the root. However, most patients need to have their wisdom teeth extracted after age 21. The healing process takes longer with advancing age as the roots of teeth become embedded in the jawbone. If an infection of a gum flap (pericoronitis) is present, it will need to be eradicated before an extraction can be done.

Extraction can be usually performed by a dentist using local anesthetic. However, if impaction is more serious, an oral surgeon may need to perform the extraction. In some cases, general anesthesia may be required. If the tooth is particularly embedded, it may be necessary to remove part of the jawbone as well.

Sometimes, complications may develop after the extraction, including:

  • Infection may occur as a result of bacteria or trapped food particles.
  • Temporary numbness of the teeth, gums, tongue and chin may occur.
  • Sinus problems.
  • Weakening of the jawbone may occur as a result of bone damage or removal.
  • Dry socket, a painful condition may develop due to exposing underlying bone.

Unfortunately, it is not possible to prevent the complications associated with wisdom teeth. The best you can do is to reduce the risk of tooth decay, infection and other problems involving the gums with careful oral hygiene including regular brushing and flossing.