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Wisdom Teeth

Wisdom teeth ( third molars), are the last 4 teeth to emerge from the jaw bone at the age between 17-21 years.  They are prone to complications throughout their eruption when jaw bone is too small to compensate them.

Consequently, wisdom teeth might emerge sideways, partly, or fully trapped (impacted) inside jaw bone, resulting in discomfort, decay of adjacent tooth, infection, gum disease, and formation of cyst. Sometimes immediately extraction after they erupt are necessary to avoid more complications.

Historic study found that diet of earlier human beings resulted in a great deal of worn teeth created space between each tooth. Normal shifting of the teeth to close the space help make certain that space was available for wisdom teeth to erupt by adolescence. The current diet, which is much more delicate and soft,  and also the wide spread of orthodontic treatment don't leave much room in the dental arch for the wisdom teeth to emerge, thereby creates  problems when the last four molars can not emerge in the oral cavity. This condition called impacted teeth which can be unpleasant if it follows by an infection and ruin adjacent tooth or roots.

Other complications
  • Cyst - when sac around the impacted tooth is filled up with fluid and grows larger to form a cyst. The growing cyst replaces part of jaw bone causing hollowed bone. Occasionally this cyst becomes large and may cause damage to adjacent roots, tooth, bone and nerves. Surgically removal of cyst is recommended.
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  • Pericoronitis - an inflammation of gum tissue over partially erupted tooth or partially impacted wisdom tooth. The most common site for pericoronitis is the mandibular third molar regions. The heavy flap of gingival tissues covering portions of the crown of the wisdom tooth makes an ideal pocket for food particles accumulation and bacterial incubation, resulting in inflammation and infection. In the acute stage, pain and swelling in the area are prominent features, follow by sore throat, trismus (difficulty in opening the mouth and swallowing).
    Treatment involves gentle cleaning underneath the flap and irrigation with salt water (1/2 teaspoon salt to 6 oz. of water) water should be as hot as one can tolerate, and rinse vigorously for about 2 minutes at least every 2-3 hours.  Hot saline rinses are very helpful in relieving pain and hastening drainage of pus. Some people find it helpful to use Gengigel Hyaluronan Mouthrinse (150ml), massaging Gengigel Gel - 20ml to the affected gums enhances healing process and reduce a number of recurrent episodes. In advanced case, antibiotics may require. In some cases, the dentist may incise the gingival flap to provide access for cleaning to remove infected material. Although pericoronitis can be managed with antibiotics, it tends to recur until the wisdom tooth is extracted.
Regardless of the substantial problem concerning impacted third molars, a current research provided through the American Association of Oral and Maxillofacial Surgeons and the Oral and Maxillofacial Surgery Foundation (AAOMS/OMSF) discover that third molars that have emerged from gum tissue and erupted in to the oral cavity in a normal, vertical position might be as vulnerable to disease as those third molars that continue being impacted.

When Should Wisdom Teeth be Removed

Wisdom tooth in younger patient
Wisdom teeth are less complicated to extract when patient is at a younger age, due to the shorter size of their roots which is at the incomplete development stage results in less chance of damaging to nearby nerves and other structures. Removing wisdom teeth at a later age when all their roots are fully developed, the size of the roots are longer and larger and the bone is denser, the extraction becomes more complicated and difficult to avoid nerves injury.

Wisdom tooth in older patient
One must weigh between the risk of wisdom teeth being presence, and the potential benefits of wisdom tooth removal. It is not recommended to wait until wisdom teeth begin to create problems before having them extracted. Usually, removing wisdom teeth earlier helps minimize complication during extraction and improve healing process.

The AAOMS/OMSF study strongly supports the removing of wisdom teeth in early age to prevent complications and to have optimal healing. The researchers also found that older age may be at greater risk of periodontal disease around wisdom teeth and adjacent teeth.

Most extractions on wisdom tooth are performed in the Oral and Maxillo-facial Surgeon's office either under local anesthesia, intravenous sedation or general anesthesia. You and your dentist will select the option that is right for you.

To locate an Oral and Maxillofacial Surgeon, click here.


Different stage of wisdom tooth development

Erupted wisdom teeth should be removed if the tooth is nonfunctional, badly decayed, at risk for periodontal disease.

Symptom of wisdom tooth erupting:
  1. Pain at the area behind second molar
  2. Facial swelling
  3. Tender gums at the third molar area
  4. Swelling of the gums adjacent to second molar
Instruction After Surgery

1. Do not brush or rinse your mouth for the first 24 hours as that will disturb the wound.  After 24 hours; gently rinse with warm salt water.
2. Apply pressure to gauze by biting to allow blood clot for 30-60 minutes or longer if necessary.  Change to new gauze when it soaked up with saliva and blood.
3. Do not smoke or use tobacco products for the first 72 hours after extraction because they can promote bleeding, delayed healing, and infection.
4. Do not use straw because this will promote bleeding and slow down healing process.
5. During the first 24 hours; Apply ice pack or cold towel alternately 15-20 minutes on and 15-20 minutes off to the outside of your face in the area of extraction for 6 hours or bedtime will prevent swelling. 
6. Diet; soup or soft foods e.g., mashed potatoes, cream of wheat, etc.  No crunchy or hard to chew food. 
7. No alcohol drinks for the first 48 hours after surgery.
8. Resting - no activity for the first 24 hours to prevent more bleeding.
9. Read "How to prevent dry socket" from here.


What to do if there are complications after surgery:
1. Bleeding at home after leaving the dental office which may cause by removing gauze too soon, smoke cigarettes, use of straw, rinse your mouth too soon or accidentally brushed the wound. 

What to do:  Put a wet tea bag on the bleeding site and bite down firmly, hold in place for 10-15 minutes.  Tea has tannin, a component that helps coagulation. Repeat if needed. If the bleeding continue, make an appointment to see your dentist.

2. Dry socket (alveolar osteitis)
The pain at the socket which is improving during the first few days after extraction abruptly reversing to severe pain. If the extracted tooth is in lower jaw, a dull aching throbbing sensation pain can radiate to the ear and neck. The level of pain is moderate to severe.

The socket exposed bone surfaces, with a partially or completely lost blood clot.  A bad odor and taste may or may not be present.  More information can be found here.

What to do: Use of clove oil from over the counter, soaks in cotton pellet or small piece of gauze before carefully apply to the wound, has been successfully alleviate pain in most cases.  Care must be taken to apply only to the socket area and not to contact other soft tissue.

Use the syringe given by your dentist, with warm salt water to clean the socket after each meal. If the pain still present, contact your dentist immediately.

3. Pain
It is normal for the area to be tender for the first few days, and in most cases simple over-the-counter pain relievers are enough to ease any pain.  Use of aspirin is not recommended as its ability to thin the blood can create more bleeding at the wound. If you are taking daily medicine for your condition, check with the dentist or pharmacist for drug interaction before taking any pain relievers.

What to do: If pain persisted and you don't have access to the dental office
1. Application to the wound:
  • Use Clove Oil,  from over the counter, dip a cotton pellet or cotton swab in clove oil and apply to the affected area. Care must be taken to apply only to the socket area and not to other soft tissue as it will have burning sensation .  Clove oil is approximately 80% eugenol, which has antiseptic, analgesic, anti-bacteria, and antifungal properties. Clove oil is not recommend for nursing mother, pregnant woman,  a child under the age of 2, or those who are taking blood thinner. Clove oil may be diluted by adding 3 drops of of clove oil to 1 teaspoon of extra virgin olive oil, coconut oil, jojoba oil, or almond oil and swish the solution around in your mouth to help relieve pain.  For people over 65 , or older children, it is better to start with lower strength preparations before increase strength if needed.  Test for allergies with a small amount before using clove oil is recommended. 
  • Red Cross Complete Medication Kit, Toothache ; contains85% Eugenol.  Apply to the wound as in clove oil.
2. For temporary pain reliever, take over-the-counter pain medicines by alternating every 4 hours between 1000 mg of Acetaminophen (paracetamol); 2 extra-strength Tylenol (not to exceed 4,000 mg or 8 extra strength tylenol in one day) and 400 mg of ibuprofen; 2 tabs of Advil.  Do not use this regimen if you have history of peptic ulcer, liver disease, hypertension.  Do not take more than few days.

4. Swelling

For swelling 24 hours after surgery;
Apply ice pack or cold towel place outside of your face in the area of extraction alternately 15-20 minutes on and 15-20 minutes off for 6 hours or till bedtime.

For swelling more than 24 hours after surgery;
Apply moist heat (wet towel put in microwave for 10-20 seconds or dip towel in hot water) place outside of your face in the area of extraction alternately 10-15 minutes on and 10-15 minutes off.

Apply Gengigel Gel (main ingredient: Hyaluronic acid or commonly referred to as Hyaluronan) to the wound 3-4 times a day will enhance healing process, or use Gingigel with Hyaluronan mouthrinse (main ingredient: Hyaluronan)

Hyaluronic acid (Hyaluronan) is a mucopolysaccharide found naturally in most cells in the body. One of the function of Hyaluronic acid is acted as a ground substance for the connective tissue by separating and cushioning the living cell of the connective tissue. These functions allow the connective tissue to withstand great tension and to be able to bear weight as in periodontal ligament which is a dense fibrous connective that secure tooth to the jaw bone. Hyaluronic acid helps provide tensile strength to the periodontal ligaments and keeps the gums healthy.

Usage of extracted wisdom teeth:

Transplantation

Transplantation is an implant of an extracted wisdom tooth to other site of missing molar tooth of the same person. Tooth transplant surgery is usually successful if the extracted wisdom tooth is implanted in the mouth of the same person as it came from, but is not successful if the tooth to be implanted comes from other person.

Stem cells:

In August 2008, scientists in Japan revealed that they were able to successfully harvest stem cells from wisdom teeth.This is an important clinical discovery. Patients who have their wisdom teeth extracted are now able to have stem cells from those wisdom teeth isolated and saved, for future use.

Surgical Removal of Wisdom Tooth

 





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