People usually have thirty-two (32) teeth—four of which are wisdom teeth or third molars. These wisdom teeth usually cause more harm than good because of the position they occupy within the jaw. Wisdom teeth are not always problematic and in some groups of people do not pose any large-scale problems. However, in many Americans there exists a situation where the teeth are proportionally larger than the bone structure of the jaws, which ultimately results in impacted or malposed teeth. A malposed tooth is one that is merely crooked or misplaced in the dental arches relative to the other teeth. Impacted teeth are either below the gum tissue and/or bone and are classified as soft-tissue, partial bony or complete bony impactions.
There is a debate as to whether or not wisdom teeth should be removed. If they are a problem, Dr. Zech would recommend removal. It is in the asymptomatic situation that confusion exists. Some experts say let "sleeping dogs lie." Dr. Zech believes that this theory is acceptable in certain instances. However, pain often is a poor indicator of problems as the damage done may be more insidious.
- Wisdom teeth may cause bone loss around the adjacent molar teeth, which may ultimately result in the loss of those molars.
- Wisdom teeth may cause damage to the adjacent molar teeth themselves resulting in the need for extensive repair work or loss of the adjacent tooth.
- Wisdom teeth may become infected. Occasionally there are cysts associated with impacted wisdom teeth, which in a very low percentage of cases may become aggressive benign lesions or malignant lesions with local aggressiveness.
- Most often wisdom teeth just cause discomfort and disruption in a person’s life.
- Recent research data indicates that pockets greater than 5mm between wisdom teeth and second molars confirmed an increase risk of long term problems.
- As the wisdom teeth try to erupt, they can cause crowding and overlapping of the other teeth, causing a misalignment.
The ideal solution to the wisdom tooth situation is early evaluation. (14-15 years of age is often not too early). A panorex x-ray will show whether or not teeth will be useful. If they fall into the non-useful category early removal is best as the risk of post-operative problems is at its lowest. Dry socket the most common problem is at a minimum in this age group as well as the other minor risks of numbness in the lip/chin/tongue or sinus involvement. Recovery time is also shortest. Most children can return to school in a couple days. Older people may require additional recovery time.
If the decision is made for removal, then it is usually best to remove all the impacted or non-functional wisdom teeth at once as recovery is generally not prolonged by multiple extractions. The procedure can sometimes be done under local anesthesia alone, but is usually performed in conjunction with IV sedation as an office procedure. If the case is done under IV sedation, then pulse oximetry, ECG and intermittent blood pressure determinations will be monitored. The total time for the removal of all four wisdom teeth is usually 45min--1hour including anesthesia. Recovery time is variable.
In summary, early evaluation is best followed by early removal if indicated. Pain as a symptom does not begin until 17-18 years and it peaks in the mid 20’s. Gum disease problems begin in the mid to late 30’s, as do cystic problems. Of course there is the usual human variability with timing.