Third molars, commonly referred to as wisdom teeth, are usually the last four of 32 teeth to erupt in the mouth, generally between the ages of 17 to 25. They are located at the back of the mouth (top and bottom), near the entrance to the throat.
In most cases, inadequate space in the mouth causes the wisdom teeth to erupt in haphazard or painful ways. This is often the result of the tooth becoming impacted (stuck) in an undesirable or potentially harmful position. If left untreated, impacted wisdom teeth can contribute to infection, damage to other teeth, cysts or tumors.
First Step: Wisdom Teeth Examination
A thorough examination of the wisdom teeth and surrounding structures must be performed to assess the complexity of possible extractions. Panoramic and other types of x-rays will be taken in order to evaluate the position of the wisdom teeth and determine if a current problem exists, or the likelihood of any potential future problems. Early evaluation and treatment is recommended in order to identify potential problems and to improve the results is an extraction is necessary. A thorough examination also helps in determining the level of impaction and complexity attributed to each tooth.
There are several types of impaction based on the actual depth of the teeth within the jaw:
- Soft Tissue Impaction: The upper portion of the tooth has penetrated through the bone but the gingiva (gum) is covering part or all of the tooth's crown and is not positioned properly around the tooth. Because it is difficult to keep the area clean, food can become trapped below the gum and cause an infection and/or tooth decay, resulting in pain and swelling.
- Partial Bony Impaction: The tooth has partially erupted but a portion of the crown remains submerged below the gum and surrounding jawbone. Again, because it is difficult to keep the area clean, infection will commonly occur.
- Complete Bony Impaction: The tooth is completely encased by jawbone. This will require more complex removal techniques.
Reasons to remove wisdom teeth
Wisdom teeth extractions are most often performed because of an active problem such as pain, swelling, decay or infection, or as a preventative measure to avoid serious problems in the future.
If impaction of one or more wisdom teeth is present, and left untreated, a number of potentially harmful outcomes can occur, including:
- Damage to nearby teeth: Second molars (the teeth directly in front of the wisdom teeth) can be adversely affected by impacted wisdom teeth, resulting in tooth decay (cavities), periodontal disease (gum disease) and possible bone loss
- Disease: Although uncommon, cysts and tumors can occur in the areas surrounding impacted wisdom teeth.
- Infection: Bacteria and food can become trapped under the gum tissue, resulting in an infection. The infection can cause considerable pain and danger.
- Tooth Crowding: It has been theorized that impacted wisdom teeth can put pressure on other teeth and cause them to become misaligned (crowded or twisted). This theory isn't universally accepted by all dental professionals, and it has never been validated by any scientific studies.
What does the removal of wisdom teeth involve?
Depending on the level of impaction, wisdom tooth removal is performed under increasing levels of anesthesia, including local anesthesia, local anesthesia + Nitrous Oxide inhalation ("laughing gas"), or local anesthesia + semi-conscious sedation ("twilight sleep"). The surgery does not require an overnight stay, and you will be released with post-operative instructions and medication to help manage any swelling or discomfort.
For more information, please contact our family dentist office in Midtown Toronto.
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