What are Impacted Wisdom Teeth

Adults normally have 32 teeth and they erupt into the mouth according to a timetable. Wisdom teeth, also known as third molars, are the last teeth to erupt in the mouth. These generally erupt between the ages of 17 and 25, a time of life that has been called the "Age of Wisdom.” Normally there are 4 wisdom teeth, one on each side of the upper and lower jaw.

The problem is that wisdom teeth usually try to grow into a jaw that's too small for them. A tooth becomes impacted when there is a lack of space in the jaw 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. Impacted wisdom teeth can cause pain, swelling, infection or damage to the teeth next to them. If the gum around the wisdom tooth is swollen the jaw may become stiff and sore. Infection at the back of the mouth can cause bad breath and a bad taste. The surgical removal or extraction of a painful wisdom tooth can relieve problems like pain, infection and gum swelling. If a check up shows wisdom teeth may cause problems, dentists will probably recommend that these troublesome wisdom teeth be removed.

Why Wisdom Teeth are removed
Because wisdom teeth are difficult to clean as they are far back in the mouth and are not fully erupted, there may be a build-up of bacteria, plaque, and food debris around them - something that causes pain, swelling, gum infection and decay in the wisdom teeth and adjacent teeth.

Followings are the common reasons for removal of wisdom teeth.

• Recurrent infection in the gums around the wisdom teeth called pericronitis
• Decay in the wisdom tooth that cannot be filled.
• Wisdom tooth causing an abscess.
• Disease of tissues around the tooth commonly called periodontal problems.
• Cyst formation around a wisdom tooth.
• Wisdom tooth is causing problems under a denture.

The American Association of Oral and Maxillofacial Surgeons and Oral and Maxillofacial Surgery Foundation study strongly recommends that wisdom teeth be removed when 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. It's also easier to remove the teeth in young adults, because the jaw bone is less dense and the tooth's roots are not yet fully developed and not closer to the nerves, which supply sensations to lip, tongue and chin. It is estimated that about 85% of third molars will eventually need to be removed.

How are Wisdom Teeth Removed
Wisdom teeth are removed free of pain. You may feel some pushing & pressure. Wisdom teeth are removed in different ways.

1. Straightforward cases can be carried out under local anaesthesia only (injection in the gum to numb the area).
   
2. Patients who are very nervous about the procedure, have their wisdom teeth removed with intravenous sedation (injection in the arm or hand to relax you and reduce anxiety) and with local anaesthesia (injection in the gum to numb the area). These patients will have little or no memory of the procedure due to intravenous Sedation.
   
3. Some would need general anaesthesia (completely asleep in a hospital) as they would be very nervous and cannot cope with wisdom tooth surgery without general anaesthesia.

You can discuss with your Surgeon which method is most appropriate for you.

The procedure can be a simple extraction as it is done for other teeth. It may be a surgical extraction by making an incision (about 1 centimetre cut) in the gum close to the tooth. In some cases a small amount of jaw bone is removed to remove the wisdom tooth.

Hospitals at which I perform surgery under general anaesthesia (completely asleep):

• Clane General Hospital, Prosperous Road, Clane, Co. Kildare
• Aut Even Private Hospital, Freshford Road, Kilkenny

Possible Side-Effects and Complications
Removal of wisdom teeth is a very safe and common operation but in very small number of cases there are some risks associated with it. The average recovery time is between 1-5 days. Some bleeding, pain, swelling, bruising and stiffness of the jaw can be expected in some cases depending on the degree of difficulty of extraction. A soft/semi solid diet will be required over the first few days. Some people may need to take some time off work.

Dry socket is a complication in which the socket doesn’t heal normally. It needs to be treated by cleaning and dressing the area with specific medication by your dentist. You need to contact your dentist/oral surgeon at this stage. Painkillers can help to relieve the pain. You are more likely to get dry socket if you smoke. There are two nerves very close to the roots of your lower wisdom teeth. These nerves supply feeling to your lower lip, chin and tongue. Sometimes these nerves may get damaged when a wisdom tooth is removed. This is related to the difficulty of the operation. This can cause a tingling sensation or numbness in your lip, chin or tongue. This is mostly temporary but in rare cases it can be permanent. Sometime broken tips of curved roots are left inside as trying to take them out will damage these nerves. This can be discussed in greater detail with the surgeon when an X-ray is available. In some cases adjacent teeth may be damaged if they are heavily filled with amalgam or crowned.