Wisdom Teeth
Wisdom teeth, also known as third molars, are the last teeth to
erupt in your mouth. This generally occurs between the ages of 17
and 25, a time of life that has been called the "Age of
Wisdom."
Anthropologists note that the rough diet of early humans resulted
in the excessive wear of their teeth. Normal drifting of the teeth
to compensate for this wear ensured that space was available for
most wisdom teeth to erupt by adolescence. The modern diet, which is
much softer, and the popularity of orthodontic tooth straightening
procedures produce a fuller dental arch, which quite commonly
doesn't leave room for the wisdom teeth to erupt, thereby setting
the stage for problems when the final four molars enter the mouth.
What is an Impacted Tooth?
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Complications from Impacted and Partially Impacted Wisdom
Teeth
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(a) Infection
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(b) Crowding, damage
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(c) Cyst
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Complications may arise from
partially impacted teeth (fig. a and b) and totally impacted
tooth (fig. c).
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A tooth becomes impacted when there is a lack of space in the
dental arch and its growth and eruption are prevented by overlying
gum, bone or another tooth. A tooth may be partially impacted, which
means a portion of it has broken through the gum, or totally
impacted and unable to break through the gum at all.
How Serious is an Impacted Tooth?
Impacted and partially impacted teeth can be painful and lead to
infection.They may also crowd or damage adjacent teeth or roots.
More serious problems may occur if the sac surrounding the
impacted tooth becomes filled with fluid and enlarges to form a
cyst. As the cyst grows it may hollow out the jaw and permanently
damage adjacent teeth, the surrounding bone and nerves. Rarely, if a
cyst is not treated, a tumor may develop from its walls and a more
serious surgical procedure may be required to remove it.
Despite the considerable concern regarding impacted third molars,
a recent study sponsored by the American Association of Oral and
Maxillofacial Surgeons and the Oral and Maxillofacial Surgery
Foundation finds that third molars which have broken through the
tissue and erupted into the mouth in a normal, upright position may
be as prone to disease as those third molars that remain impacted.
Must the Tooth Come Out if it Hasn't Caused Any Problems Yet?
Not all problems related to third molars are painful or visible.
Damage can occur without your being aware of it.
As wisdom teeth grow, their roots become longer, the teeth become
more difficult to remove and complications become more likely. In
addition, partially or totally impacted wisdom teeth are more likely
to cause problems as patients age.
No one can predict when third molar complications will occur, but
when they do, the circumstances can be much more painful and the
teeth more difficult to treat. It is estimated that about 85% of
third molars will eventually need to be removed.
When Should I Have My Wisdom Teeth Removed?
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Wisdom Teeth Growth by Age
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12 years
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14 years
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17 years
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25 years
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Wisdom teeth are easier to remove when the
patient is younger, since their roots are not completely
formed, the surrounding bone is softer, and there is less
chance of damaging nearby nerves or other structures.
Removal of wisdom teeth at a later age becomes more
complicated as the roots have fully developed (may involve
the nerve), and the jawbone is denser.
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It isn't wise to wait until your wisdom teeth start to bother
you. In general, earlier removal of wisdom teeth results in a less
complicated healing process.The AAOMS/OMSF study strongly recommends
that wisdom teeth be removed by the time the patient is a young
adult in order to prevent future problems and to ensure optimal
healing.The researchers found that older patients may be at greater
risk for disease, including periodontitis, in the tissues
surrounding the third molars and adjacent teeth. Periodontal
infections, such as those observed in this study, may affect your
general health.
What Happens During Surgery?
Before surgery, your oral and maxillofacial surgeon will discuss
with you what to expect. This is a good time to ask questions or
express your concerns. It is especially important to let the doctor
know about any illness you have and medications you are taking.
The relative ease with which a wisdom tooth may be removed
depends on several conditions, including the position of the tooth
and root development. Partially or totally impacted wisdom teeth may
require a more involved surgical procedure.
Most wisdom tooth extractions are performed in the oral and
maxillofacial surgery office under local anesthesia, intravenous
sedation or general anesthesia. Your oral and maxillofacial surgeon
will discuss the anesthetic option that is right for you.
What Happens after Surgery?
Following surgery, you may experience some swelling and mild
discomfort, which are part of the normal healing process. Cold
compresses may help decrease the swelling, and medication prescribed
by your Oral and Maxillofacial Surgeon can help manage the
discomfort. You may be instructed to modify your diet following
surgery and later progress to more normal foods.
ORAL AND MAXILLOFACIAL SURGEONS: AN IMPORTANT LINK
Oral and maxillofacial surgery is the specialty of dentistry that
includes the diagnosis, surgical and adjunctive treatment of
diseases, injuries and defects involving both the functional and
aesthetic aspects of the hard and soft tissues of the oral and
maxillofacial region.
An oral and maxillofacial surgeon is a graduate of an accredited
dental school who has completed an additional four or more years of
training in an accredited, hospital-based oral and maxillofacial
surgery residency program.
Oral and maxillofacial surgeons are an important link in the
referral network for primary care providers. Through appropriate
referrals, patients can be provided with expedient and
cost-effective health care for conditions relating to the specialty
of oral and maxillofacial surgery.
© 2005 American Association of Oral and Maxillofacial Surgeons (AAOMS).
All rights reserved.
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