Wisdom teeth (also known as third molars) usually start forming as a child enters their pre-teen years. On a dental X-ray they will appear as round, white fuzzy areas in the back of the mouth behind the other teeth.
While most people will develop four wisdom teeth (two upper/two lower), some people will develop only two wisdom teeth and there have been cases where patients have developed six wisdom teeth.
Contrary to popular belief, wisdom teeth do not make you wiser. Left in place, they can pose many threats to the neighboring teeth, hence the reason most dental practitioners recommend them for extraction.
Reasons for Extraction
Some patients just don't have room for the third molars to erupt (come in) and as these bigger teeth remain in place they will push against the existing teeth, moving them out of their ideal chewing position and increasing the forces on the TMJ (temporomandibular joint).
One of the most common reasons to remove wisdom teeth is if a patient is undergoing orthodontic treatment. The purpose of orthodontic treatment is to align the teeth and jaws in their ideal position for function. If wisdom teeth are not extracted they can affect the success of orthodontic treatment. They can affect the actual treatment itself or can cause teeth to shift after the orthodontic brackets (braces) are removed.
Many patients experience headaches and jaw aches associated with the presence of wisdom teeth, usually the result of the teeth being impacted - not enough room in the mouth for the teeth to erupt through the gum.
Potential Risks and Complications
The difficulty of the extraction process varies from patient to patient. Generally, most oral surgeons and other qualified dental practitioners will remove the wisdom teeth under IV sedation in a standard dental office. If the extractions are done in conjunction with other orthodontic treatments, they may be done in hospital under a general anaesthetic. Obviously, there is always the potential for the patient to react adversely to the medications administered both peri- and post-operatively. It is important that the dental practitioner know all pertinent aspects of a patient's medical history.
Some common side effects of surgery include numbness in lower jaw. This is because extraction of the lower teeth can injure the inferior alveolar nerve that supplies feeling to the lower lip, chin and jaw areas, depending on how close the roots of the teeth are to the nerve. While every effort is taken to minimize the risk of potential damage to the nerve, it can happen. Numbness can last up to six months after the procedure as the nerve heals. In very few cases, this numbness is permanent.
It is easier to remove upper wisdom teeth than lower, usually because the type of bone in the upper jaw is easier to work with. The jaw bones solidify more after the age of 25, so it is most beneficial for wisdom teeth to be extracted before this age. If there is swelling, there will probably be more in the lower jaw than the upper.
While many impacted wisdom teeth are right-side up, there are an equal amount of cases where the wisdom teeth are impacted sideways (either facing into or away from neighboring teeth). This makes extraction a little more complicated. This usually happens more in the lower jaw than the upper. There have also been cases where the wisdom teeth were upside down. In these extraordinary cases, there will likely be more swelling and pain than if the teeth were right-side up.
One of the most painful "complications" is the development of an abscess. This results from food particles or bacteria getting into the site due to improper or inadequate cleaning practices by the patient. As white blood cells try to protect the extraction site from the infection, a "ball" may form. This will need to be drained by your dentist or oral surgeon.
Also note that swelling, if there is any, will likely be worse on the third day following surgery and pain should be minimal. If the swelling persists and pain continues without lessening after this time frame, then visit your dentist/oral surgeon immediately.
Post-Op
Once the teeth have been extracted, the dental professional will close the site with dissolving sutures. For some patients these will dissolve completely within seven to ten days. Others will need to have them removed by their dentist. If these sutures are left in place they could become a source of bacteria and infection.
A patient will likely be prescribed - so long as there aren't any known allergies - an antibiotic (usually Penicillin V) and painkillers (usually Tylenol III with codeine). The patient will also be given detailed instructions on when they will be allowed to drive after the sedation medication, how to look after the extraction sites, how to brush and what signs of infection to look for.
Wisdom teeth or third molar extraction has almost become a rite of passage for young people. They will almost always be recommended for removal as a preventative measure. It is better to have them removed before they create problems than to leave them in and try to treat or address the issues they create.