Also known as Third Molars, they are the last teeth to erupt, usually between 17 and 21 years of age. Generally there are four wisdom teeth, one in each corner of the dental arch. However it is not uncommon for one or more to be missing.

Wisdom teeth generally cause problems because of limited space for them to erupt into.

In some patients, wisdom teeth erupt normally into the arch and cause no problems whatsoever. In the majority of cases though, these teeth only erupt partially or remain under the gum—referred to as “Impacted”. Impacted teeth may grow in different directions and can cause potential problems at a later time.

Potential Problems

Partially erupted or impacted teeth can cause the following problems:

• Gum infection—debris and bacteria can get in below the flap of gum over a partially erupted tooth.
• Pressure on an adjacent tooth can cause structural damage such as resorption, decay, or a change in position.
• Decay in the wisdom tooth due to the difficulty in proper brushing.
• A poorly positioned wisdom tooth can irritate the tissues of the cheek or tongue.
• About 10% of unerupted teeth could result in cyst formation later in life. If unnoticed, this will result in considerable damage to the jaw bone.

Assessment

This begins with a clinical and radiographic examination. A panoramic X-ray provides an overall view of both jaws, the position of the teeth within the bone and their relationship to important anatomy, and the shape of the roots.

Depending on the extent of the extraction the removal may either be done in the office, or you will be referred to an oral surgeon for the procedure.

Post Surgery

Depending on the type of extraction, post operative pain and swelling can be expected. This will vary depending on the ease or difficulty in removing the teeth. Swelling, if it occurs, will generally peak at 72 hours, and bruising may appear as the swelling subsides.

“Arnica” is a natural product that if taken beforehand reportedly reduce the amount of post operative inflammation and swelling. You can discuss this your pharmacist or naturopath to get more information.

Informed Consent

Removal of Wisdom teeth is a surgical procedure and involves some risk. The patient needs to aware of the following:

• The procedure can result in a variable amount of pain, bleeding, swelling and bruising. This will be controlled with medication, pressure and icepacks.
• Wisdom teeth are close to important anatomic structures such as nerves, fossae and sinuses. During the procedure unintentional damage may occur to regional nerves, or in the case of upper teeth the sinuses can become exposed. These complications, though sometimes foreseen, can not always be predicted and may become obvious either at the time of surgery or afterwards.
• Damage to local nerves will present as a residual numbness long after the local anesthetic has worn off. Sensation will generally return over time, and this period will depend on the extent of the initial damage to the nerve.
• Post operative healing is generally uneventful, but occasionally a socket may become infected and healing can be delayed. This can be painful and again be controlled with socket dressings and medication.