Wisdom tooth growth

A wisdom tooth, or the third molar, is the most posteriorly located permanent tooth in the mouth. A wisdom tooth when present usually grows and erupts after the age of 17. Some individuals may never develop wisdom teeth. Wisdom teeth may erupt normally, as for the other molar teeth without causing any serious symptoms.
Impacted wisdom teeth may erupt fully or only partially. An impacted wisdom tooth may grow at an anterior, posterior, horizontal, or right angle to the adjacent teeth. When it grows straight upwards but confined by the adjacent anatomical structures, it may get entrapped within the jawbone.
On the other hand, some individuals may develop wisdom teeth which are angled, impacted, or pushing the front teeth, due to the fact the insufficient space for them to normally develop and erupt into the mouth normally.

Problems with impacted wisdom teeth

The impacted wisdom teeth may result in none or some of the following temporary or long-term symptoms, hence require surgical removal.
  • Pain, infection
  • Tooth decay, food entrapment, bacterial infection, or gum disease (periodontal disease)
  • Interference with the health maintenance of the adjacent teeth
  • Damage to the adjacent teeth or the surrounding bone
  • Development of peripheral pericoronitis in case of a partial eruption
  • Development of peripheral fluid-filled sac (retention cyst)
  • Interference with the orthodontic movement
Please see above the OPG radiograph enclosed in the page the carious upper wisdom teeth causing toothache.
Please also see the mesio-angulated carious lower wisdom teeth causing toothache and migration of the anterior teeth.

Wisdom tooth extraction

It is difficult to predict future problems with impacted wisdom teeth. Although some dental specialists may disagree about the value of extracting the asymptomatic wisdom teeth, there are some rationales for their preventive extraction:
  • Bacterial infection around semi-erupted wisdom teeth.
  • Difficulties in accessing and proper cleaning.

Surgical risks and complications

While there is less risk for serious surgical complications in younger adults, older adults may experience more surgical complications after surgery. Most wisdom tooth extractions don’t result in long-term complications. However, removal of impacted wisdom teeth occasionally requires a surgical approach that involves making an incision in the gum tissue and removing bone. Rarely, complications can include:
  • Root and tooth fracture, which may render their removal detrimental to the adjacent nerves or other structures.
  • Damage to adjacent teeth 
  • Variable levels of damage to the Inferior Dental or Lingual Nerve which is located in the close vicinity of the wisdom teeth and provide sensory nerve branches to the lower teeth, lower lip, chin and taste to that side of the tongue. This damage may cause numbness of the lower teeth, lower lip and chin and loss of taste on that side of the tongue which may be temporary (6–12 months) or permanent.
  • There is a slight risk of jaw fracture during the procedure or during the healing period
  • Removal of the upper molars close to the sinuses may cause a communicating hole between the mouth and the sinus which calls for a reparative surgical operation.
  • Infection of extraction socket by bacterial entrapment
  • Painful exposed alveolar bone causing dry socket (alveolitis sicca) due to loss of post-surgical blood clot.

Surgical procedures

The extraction of fully erupted wisdom teeth may be performed in the office by your dentist. However, in cases of deeply impacted wisdom teeth, following a referral, an oral surgeon may undertake your wisdom tooth extraction as an outpatient procedure.
  • Gum incision to expose and partially remove the peripheral covering bone
  • Division of tooth into sections to facilitate the removal of the tooth
  • Cleansing the surgical site from the residual tooth and bone debris
  • Wound closure to promote healing

Please see the link below to see the protocols for surgical AFTERCARE