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See also impacted teeth
What are wisdom teeth?
'Wisdom teeth' is the commonly used name for the adult 'back
teeth' that dentists call third molars (or 'No 8' in the row counted
from the front).
Having wisdom teeth is no guarantee of wisdom but they are usually
the last teeth to grow into the mouth (erupt) and often at about
18 years +.
Why do wisdom teeth cause problems?
Some people have no problems at all with their wisdom teeth
and they form useful, healthy members of the mouth (dentition).
However, in many people there is not enough room in the jaws
for them to come through at all or completely.
Some, therefore, remain buried and others come through partially,
particularly if other teeth have been lost or removed.
Why isn't there space for some wisdom teeth?
We should probably blame evolution (and migration) for the problems
we might have with wisdom teeth.
Ancient humans had larger jaws and larger teeth than modern humans
- maybe because we don't need to chew as much nowadays.
Some people don't develop wisdom teeth at all, which might show
that we are at a transitional stage in evolution (they might not
be 'more evolved' in other respects than those who need to have
their wisdom teeth removed).
The basic problem is 'too much tooth for the space'. The solution
is often to remove the extra tooth.
What problems can wisdom teeth cause?
Some babies and children suffer 'teething pain' when their teeth
are coming through. This can just be some soreness on the gum
or can make them feel quite ill. This soreness usually settles
down when the tooth is through.
Adults can develop similar problems when their wisdom teeth are
coming through. If the teeth 'get stuck' (impacted), which tends
to happen more with lower wisdom teeth than upper ones, they can
develop further problems:
-
Some soreness of the gum, which usually settles when the
tooth is fully through.
-
Some wisdom teeth (especially the lower ones) erupt part
of the way but get stuck against the tooth in front; A flap
of gum might cover part of the wisdom tooth and this can become
painful and swollen, especially if food debris collects and
infection develops.
-
An infection in the gum around the tooth (called pericoronitis),
might need to be treated before any further treatment (eg
removal of the wisdom tooth).
-
Some wisdom teeth become decayed and cannot be restored (especially
if they are impacted next to a tooth).
-
Sometimes wisdom teeth can 'rub away' at the tooth they are
impacted against.
-
If the upper wisdom teeth come through normally but the lower
ones are impacted, the top ones can overgrow and bite into
the lower gums, which can be sore.
-
Occasionally wisdom teeth have cysts
or other lesions around or next to them.
How do I know if I have an infected wisdom tooth?
If you have an infected, impacted wisdom tooth you might feel
quite unwell (including having a fever) and have one or more of
the following:
-
Soreness and swelling of the gum around the tooth;
-
Swelling of the face and lymph glands in the neck.
-
Pain or difficulty when opening your mouth;
-
Have either bad breath or an unpleasant taste in your mouth.
If I have an infection of the wisdom teeth, what should I do?
Infected wisdom teeth can make you feel quite unwell and it
is best to go to see a dentist as soon as possible to prevent
further problems.
If you can't get to see a dentist, your GP should b able to help
you (eg give you some antibiotics). Treatment and care can include:
-
Depending on how far the infection has spread, a course of
antibiotics and painkillers might be necessary.
For your own health and to prevent antibiotic resistance in
the population, always complete the course of antibiotics
as instructed.
-
Taking simple painkillers if you need them.
Be careful not to exceed the recommended dose. Your doctor
or dentist might give you stronger ones if necessary.
-
If you fell unwell or have a fever, then taking plenty of
fluids and rest will help.
-
Keeping the mouth clean by continuing to gently brush and
clean the teeth;
-
Bathing the mouth as often as possible with antiseptic or
warm salty mouthwash. Mouthwashes soothe the area and help
to keep the gum flap clean.
-
Do not apply heat to the outside of the face because
if there is an infection this can draw it out into the deeper
structures and onto the face (you want it to drain into the
mouth).
Should my wisdom teeth be taken out?
Whether or not to take out wisdom teeth that are not (yet) causing
problems remains contentious.
Most dentists will recommend that impacted wisdom teeth are removed,
particularly if there has already been an infection.
If the teeth are only partially erupted teeth, they are more
likely to become decayed and infected. Gum disease might develop
and the next tooth in the row can become decayed.
It is usually lower wisdom teeth that give problems and often
the upper ones will be removed to prevent problems (they are often
very easy to remove too).
How will my wisdom teeth be taken out?
How your wisdom teeth will be removed will depend on the condition
they are in, how far they are erupted, what their roots look like
and how fit you are generally.
The type of anaesthetic will be discussed with you before the
operation, together with any possible complications of the surgery.
It is possible to remove wisdom teeth painlessly using local
anaesthesia (an injection to numb the jaw and gum).
Some people prefer to have some sedation if this procedure will
take more than a few minutes.
If you have your wisdom teeth out under local anaesthesia, your
dentist or oral and maxillofacial surgeon will often do just one
side at a time. This is because it is more pleasant to have just
one side of the mouth 'numbed' with the injection at a time (you
are less likely to bite your tongue accidentally if you can feel
half of it).
Can I have my wisdom teeth out under general anaesthetic?
Nowadays, only the most difficult wisdom teeth are taken out
under general anaesthesia (whilst you are asleep). This is because
it is always best to avoid having a general anaesthetic (the risks
are higher to you and it will take you longer to recover).
How do you remove them?
It is easier to remove wisdom teeth that are healthy and erupted
than those that are decayed or partially hidden under gum or bone.
The first step is to numb the tooth and surrounding gum using
local anaesthetic (two or more injections). Upper teeth are often
really quick and easy to remove.
Lower teeth can be more difficult depending on what their roots
look like. If the teeth are buried or the roots are next to a
nerve, then the dentist or oral and maxillofacial surgeon will
need to gain access by peeling back a little of the gum, and chipping
away or drilling away some of the bone.
Once the tooth is exposed, it can be removed in one piece or
sometimes in chunks. The gum is then sewn up with dissolvable
sutures.
What should I expect after the operation?
How you will feel after the removal of your wisdom teeth will
depend on what has been done, whether you had a local or general
anaesthetic and how well you heal.
There is usually some swelling of the face and discomfort in
the mouth for at least a week.
It is normal to find it painful or difficult to open your mouth
for a few days.
Stitches to close up the gum are usually needed but these will
dissolve and don't need to be removed.
What might I expect after the removal of wisdom teeth?
What you will experience will depend on what you had done, how
easy it was to remove the teeth and how well you heal. Some short-term
or longer-term effects you might notice include:
-
After they have had lower wisdom teeth removed, a small number
of people might notice some tingling or numbness of the lower
lip or tongue. This is because the nerves to your lower lip
and tongue lie near to the wisdom tooth and can be bruised
or disturbed during the operation.
In most cases this gets better quickly. Occasionally, it persists
for several months and, in a very small number of patients
it may be permanent. This does not affect how the lip or tongue
muscles work or the way you look.
-
Rarely, people develop a 'dry socket', which is a type of
inflammation of the hole that the tooth was removed from.
If you have had one dry socket in the past, you are more likely
to develop another one. We are not sure what causes this in
an individual but it is probably a problem of healing. This
can be painful in the short-term but your dentist or oral
and maxillofacial surgeon can give you some strong painkillers
and usually packs the socket to cover it up and speed healing
How should I look after my mouth after having wisdom teeth out?
When you have any teeth removed (extracted) you are left with
a hole (tooth socket) in your jawbone, in which a blood clot forms
first and then heals over from the bottom with stronger gum.
For the first few days at least, it is important not to disturb
this clot and to keep the mouth and teeth clean.
Sometimes, when teeth are removed, the gum is peeled back by the
dentist or oral and maxillofacial surgeon and then sewn back in
place to help it heal together. Again, it is important that this
gum is not damaged afterwards to allow it to heal.
Things that you can do (and avoid) to help this healing include:
-
Until the local anaesthetic has worn off:
Avoid biting your tongue, lips and cheeks accidentally.
Avoid hot drinks (which can break down the clot).
Avoid eating especially anything spiky.
-
For the first 24 hours (after the numbness has worn off):
Avoid hot drinks (which can break down the clot).
Take only liquid or soft foods (spiky foods can hurt and get
stuck in blood clots or delicate gums).
Avoid vigorous mouthwashing to prevent the clot breaking down.
Why do I need to return to the dentist after having my wisdom
teeth removed?
It is important that you attend the review appointment after
you have had your wisdom teeth removed. This is usually 2-3 weeks
after the operation.
Most sutures are now dissolvable but your dentist or oral and
maxillofacial surgeon will want to check that the healing is good
and that you are not having any problems.
Usually the sockets where the teeth were removed take 3 to 4
weeks to settle down.
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