FAQs on Wisdom Teeth

When should wisdom teeth be removed?

Removal of wisdom teeth is the most common procedure performed by oral and maxillofacial surgeons. There is currently no totally accurate way to predict which wisdom teeth will cause problems and which won’t. As a result of this, dentists are subjective on whether wisdom teeth, that are not causing discomfort, should be removed or not.

Since dentists are divided in their decision–making process, it may be of some benefit for you to understand some of the risks and benefits in deciding if you should keep them or lose them. First we will discuss some of the possible risks and benefits of leaving them alone.

When is it necessary to remove wisdom teeth?

Wisdom teeth are a valuable asset to the mouth when they are healthy and properly positioned. Often, however, problems develop that require their removal. When the jaw isn’t large enough to accommodate wisdom teeth, they can become impacted (unable to come in or misaligned). Wisdom teeth may grow sideways, emerge only part away from the gum or remain trapped beneath the gum and bone.
Extraction of wisdom teeth is generally recommended when:

• Wisdom teeth only partially erupt. This leaves an opening for bacteria to enter around the tooth and cause an infection. Pain, swelling, jaw stiffness and general illness can result.
• There is a chance that poorly aligned wisdom teeth will damage adjacent teeth.
• A cyst (fluid–filled sac) forms, destroying surrounding structures such as bone or tooth roots.

Patients should ask the dentist about the health and positioning of their wisdom teeth. The dentist may make a recommendation for removal or send the patient to an oral surgeon for further evaluation.

What do you risk by not having your wisdom teeth removed?

One of the most common reasons is that impacted (angled forward) wisdom teeth push the other teeth forward and cause crowding. It is difficult to believe that one lowly wisdom tooth can push two molars, two premolars, and a canine tooth and create anterior tooth crowding. Some dentists still claim this can happen, but prevention of crowding is not a justifiable reason to remove the wisdom teeth. An impacted wisdom tooth can cause damage to the tooth in front of it. This is true, but only in less than two per cent of the population.

Periodontal disease around the wisdom tooth

This is possible, but in young adults less than one per cent showed signs of gum or bone problems. Lack of good oral hygiene increased the chance of periodontitis similar to any other tooth. Pericornitis, an infection that can lead to abscess formation, is most commonly seen in wisdom teeth partially covered with gum. It is a common reason for wisdom tooth removal. The development of cysts and tumors is often mentioned. This is very rare. Often cysts are confused with other normal X–ray features and their is much disagreement in dentistry about how frequently they actually occur. Tumors are found in less than one percent of unerupted wisdom teeth.

What are the benefits of not removing your wisdom teeth?

Keeping the wisdom teeth allows the patient full potential for growth and development of the teeth and jaws. Complete eruption into a functional position allows a complete of teeth for function. A wisdom tooth can also, under the proper conditions, be transplanted to the position of a premature tooth loss elsewhere in the jaw. You are not exposing yourself to surgical risk. The risks and benefits of removal should also be examined.

What do you risk by having your wisdom teeth removed?

Minor complications found with wisdom tooth removal include nerve damage, alveolitis (dry socket), infection, trismus (difficulty in opening the mouth), hemorrhage, fractures, periodontal injury, and damage to the adjacent tooth. Alveolitis, or dry socket, is the most common complication, and is more common in patients older than 25 years and in women. It is also seen more often in patients who had to have their tooth removed than patients who elected to have them removed. Alveolitis will occur in one to five per cent of patients regardless of the dentist’s skill or surgical method chosen. Nerve damage is rare, but can involve paresthesia (lingering numbness) of the lip or tongue.

Major complications include dysesthesia (a sensation of being pricked by needles or something crawling on the skin) and infections. Most nerve injuries heal after a certain period, but permanent injuries do occur. Any damage lasting beyond six months is likely to be permanent. Infections are usually minor but occasionally can lead to cellulitis, endocarditis, and brain, liver or heart abscesses.

What are the benefits of having the wisdom teeth removed?

The younger the patient at the time of extraction, the fewer the complications. If a tooth has been targeted as problematic, it should be dealt with as soon as possible. The degree of difficulty and post–operative complications increase with age.

You don’t have to endure the procedure later in life after the roots have completely formed and the jaw has completely calcified. These factors along with a lessened healing response make wisdom tooth removal a more involved procedure.
Wisdom teeth

Typical Procedure

An incision is made and overlying bone is removed, exposing crown of the impacted tooth. Tooth is extracted whole or surgically sectioned. The site is sutured closed.
To ease any discomfort and promote healing:

• Use ice packs on the cheek for swelling, alternating on and off every thirty minutes.
• Apply biting pressure with clean gauze to stop bleeding.
• Eat soft foods and drink extra liquids.
• Avoid hard or crunchy foods in the tender area.
• Brush carefully the day after surgery.
• Take prescribed medications and follow all instructions as directed

The cost of the whole procedure is between Rs. 800 to Rs. 2500 Slight bleeding after an extraction is normal. A clot will usually form within one hour.

If bleeding continues, place a thick gauze pad over the extraction site. Apply pressure to the area to control the flow of blood.

If bleeding still persists, you may try soaking a tea bag in water, placing it inside a thin gauze pad, and apply pressure for one hour.

The tea leaves contain minerals which may aid in the clotting procedure. If bleeding has not stopped after several hours, it is important that you contact your Dentist.

Call your dentist or physician immediately in case of excessive bleeding or swelling, persistent, severe pain or fever.