| Wisdom Teeth |
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Most people have 4 wisdom teeth. Just as with other teeth in your mouth, they develop from a tooth bud. Each tooth or tooth bud can be at different stages in development as well as in different positions. Often by 10-12 years of age, the developing wisdom tooth buds can be seen on a Panorex x-ray. Wisdom Teeth What happens when 32 teeth try to fit into a size 28 mouth? In most people, wisdom teeth (third molars) begin to erupt into the mouth during their late teens and early twenties. Often the normal pattern of eruption is complicated by a lack of space, which can result in impaction. A tooth is considered to be impacted when it becomes trapped in the jaw under bone and gums. The chief causative agent in the delayed eruption and impaction of wisdom teeth is the lack of space. Learning how wisdom teeth develop and the potential problems associated with inadequate room for their proper development can help you understand why they often need to be removed.  A Panorex x-ray shows your dentist a panoramic view of your jaws, teeth and developing tooth buds. These tooth buds or wisdom teeth develop gradually over a period of many years. Because of this slow development, harmful problems or changes may occur very gradually. Regular dental visits and periodic x-rays (Panorex) can help your dentist evaluate these developing teeth and recommend treatment when necessary prior to any damage being done. Partially erupted wisdom tooth  Figure A Teeth that only erupt partially into the mouth, create a situation where a portion of the tooth is covered by a flap of tissue. This tissue is referred to as an operculum and often runs the risk of repeated small acute infections, which become chronic and can gradually escalate over the period of months and years to a condition known as pericoronitis. (Fig. A) Some of these cases can result in major infections of the head and neck region. The second molars adjacent to these partially impacted wisdom teeth are at risk of bone loss and decay. Wisdom teeth that remain completely impacted for many years are at risk of developing tooth related cysts and other pathologic conditions. Horizontal impaction Another common complaint, often associated with unerupted or impacted third molars of the mesioangular and horizontal types, is the feeling of pressure during the attempted eruption of these teeth. (Fig B) Many investigators believe that these anteriourly directed forces may result in crowding of the mandibular anterior teeth.  Figure B What are the advantages of early removal of wisdom teeth versus just waiting until they create a problem? Undeveloped Roots  Figure C Younger patients (14-21 yrs.) generally heal with a shorter recovery time and less complications. This is in part due to the development of the roots of the wisdom teeth. Often, wisdom teeth that do not have sufficient space to erupt normally will have roots that have grown into close proximity with the sinuses in the upper jaw or nerves in the lower jaw. In these cases, their removal can be more traumatic resulting in additional discomfort and a prolonged recovery. The wisdom teeth of younger patients have undeveloped roots which do not compromise either the sinuses or the nerves. Compare Fig. A with Fig. C. Why should I have my wisdom teeth removed if they're not bothering me right now? If they're impacted, you may not even know you have wisdom teeth - until they become painful due to pressure or infection. You may not know that your developing wisdom teeth are pushing on the roots of adjacent teeth - until those teeth start to shift. If your wisdom teeth do erupt, they may be hard to clean, so the odds of decay or infection of the surrounding gum tissue are high. The results of expensive orthodontic work can even be ruined if your wisdom teeth crowd adjacent teeth, causing them to shift position. Consultation Appointment A consultation appointment is necessary to evaluate each patient's individual conditions and needs. This is accomplished with the help of a Panorex (x-ray) and a thorough oral evaluation. At your consultation, all surgical and anesthetic options will be discussed. It is most common for patients having their wisdom teeth removed to have either intravenous sedation or a general anesthetic. Surgical Appointment On the day of your surgery, you should wear loose, comfortable clothing. A short sleeve shirt or top is preferable. When having a sedation or general anesthetic, you should not have anything to eat or drink for at least 6 hours prior to surgery. Patients under the age of 21 should be accompanied by a parent or guardian. You should not operate or drive an automobile for the remainder of the day. Post operatively, with the combination of improved surgical and anesthetic techniques, we can remove wisdom teeth more efficiently through smaller incisions and in less time. This usually minimizes and often completely eliminates the post operative swelling. Because of this we normally see less discomfort and a shorter recovery time. In conclusion, whether your wisdom teeth are symptomatic or not, you can rely on your dentist's expertise to diagnose any existing or potential problems. Normally, a Panorex x-ray can be taken and the decision to remove or observe your wisdom teeth can be easily made. |
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