Castle Dental Care, Tangmere Square, Castle Vale, Birmingham, B35 6DL

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Wisdom Teeth

These usually tend to erupt between 16 and 30 years of age. It has been suggested that wisdom teeth are a left over trait from when humans ate a highly abrasive diet which often caused tooth loss and reduced the size of molars. Modern diets include a lot of processed foods which cause much less wear of the teeth. Innovations in dentistry also mean that we retain our teeth for much longer. This has led to insufficient room being available for the wisdom teeth to erupt into.

Not everyone will have wisdom teeth, some patients may have one or two wisdom teeth and other patients may have all four. If there is enough space in the jaw then the wisdom teeth can erupt without causing any problems at all. If there is not enough space for the wisdom teeth then the wisdom teeth can become impacted , positioned horizontally or angled. This can lead to crowding, food packing between the wisdom tooth and adjacent tooth and lead to problems like tooth decay or periodontal disease or localised infection.

Treatment for wisdom tooth pain.

Wisdom teeth that are not causing any problems are best left alone. Often there is slight discomfort as they come through, but this is only temporary and will settle once the tooth is fully in position.

The most common reason for experiencing pain is usually infection associated with the wisdom tooth. This can lead to pain, swelling, stiffness, limited mouth opening, pain on chewing and a bad taste in the mouth. If an abscess has developed you may need a course of antibiotics followed by a deep clean and oral hygiene instruction to prevent further problems. A Single Tufted Tooth Brush (STTB) is very useful to help clean wisdom teeth.

What problems should I be prepared for?

If part of the wisdom tooth has appeared through the gum and  part is still covered, the gum may become sore and perhaps swollen. Food particles and bacteria can collect under the gum and it will be difficult to clean the area effectively. This is known as PERICORONITIS. This is a temporary problem that an be dealt with by using mouth rinses and special cleaning methods. In very severe cases antibiotics may be necessary. If the problem keeps affecting the same wisdom tooth then it may be better to have that wisdom tooth extracted. Your dentist will discuss the advantages and disadvantages of having wisdom teeth extracted.

What can I do to help myself?

A mouthwash or warm water with a teaspoon of salt will help to reduce the gum soreness and inflammation. Swish the salt water around the tooth, trying to get it into the areas that your toothbrush cannot reach.  Repeat this 3-4 times a day, especially after eating. An antibacterial mouthwash containing chlorhexidine can also reduce the inflammation. Analgesics such as paracetamol and ibuprofen can also be useful in the short term but speak to your dentist if the pain continues. The analgesics should be swallowed and under no circumstances should you place them on the affected area.

What if this does not help?

If the pain does not settle or if you find it hard to open your mouth then you should see your dentist immediately. At Castle Dental Care we have an emergency session every day for cases like this. Your dentist will check the cause of the problem and will advise you accordingly. You may need to have a thorough clean around the tooth and/or antibiotics may be necessary.

Are x-rays needed for wisdom teeth?

Your dentist will usually take xrays to check the position of the root and to assess whether there is room for the tooth to come through the jaw.

What are the main reasons for taking wisdom tooth out?

Far fewer wisdom teeth are now taken out than in the past. If the tooth is not causing any problems, your dentist will not want to remove it.

A dentist will only remove a wisdom tooth for the following reasons:

  • When it is clear that the tooth will not be able to come through into a useful position because there is not enough room and the tooth is also causing some pain and discomfort.
  • If the tooth is only partly through and is decayed, this is usually due to difficulty in cleaning the tooth.
  • If the tooth is painful and not responded to the above treatment.
  • If you get recurrent infections or abscesses associated with the same wisdom tooth.

Extracting wisdom teeth

If you experience regular pain and infections associated with the same wisdom tooth then it may be best to have the tooth extracted. Depending upon the complexity of the procedure this can be done under a local anaesthetic or under intravenous sedation. Usually if the wisdom tooth is fully or partially erupted the extraction is similar to any other dental extraction. If the tooth is mostly buried under the gum surface or impacted against the jaw bone then  a surgical procedure is necessary to remove the tooth. This involves a small incision being made into the gum directly above the wisdom tooth. Following this it is often necessary to remove a small amount of bone around the wisdom tooth. It is sometimes necessarily to divide the wisdom tooth into smaller parts to allow easier removal. After the tooth has been removed, sutures are placed and post operative instructions given.

Risk of extracting wisdom teeth

Wisdom teeth are only extracted if absolutely necessary. Your dentist will discuss the advantages and disadvantages of the procedure with you, before reaching a decision. The roots of the lower wisdom teeth can be very close to the Inferior Dental nerve which runs along the jaw bone and supplies sensation to teeth, gums lip and chin on that side of the jaw. An OPG (x-ray)  will be taken to help assess the risk of damage to this nerve during the extraction of a lower wisdom tooth.

Damage can be temporary numbness, ranging from a few hours to a few days or even permanent numbness.

If you are having a lower wisdom tooth extracted your dentist will complete a consent form and highlight the above risks to you. You will be given time to think about having the extraction done.

Are wisdom teeth difficult to take out?

It all depends on the position and the shape of the roots. Your dentist will advise you as to how easy or difficult each tooth will be to remove after looking at the xrays and checking your mouth. Upper wisdom teeth are often more straightforward to remove than lower ones, lower wisdom teeth are more likely to be impacted. Your dentist will advised you whether the tooth should be taken out at the dental practice or whether you should be referred to a specialist oral surgeon. Very occasionally there is a possibility of some numbness of the lower lip after the removal of a lower wisdom tooth, your dentist will discuss this in more detail with you.

Most wisdom teeth are extracted under local anaesthetic but intravenous sedation is also available for anxious patients. A General Anaesthetic can be used, this is where patients are put to sleep, but this is only available in a hospital setting.

Will it make any difference to my face or mouth?

Removing wisdom teeth may produce some swelling for a few days but as soon as the area has healed, there will be no difference to your facial appearance. After the initial healing your mouth will feel more comfortable and less crowded, especially if the wisdom tooth was impacted.

What should I expect after a wisdom tooth is taken out?

The amount of discomfort usually relates to how easy or difficult it was to extract the wisdom tooth. There is usually some swelling and discomfort a few days afterwards and it is important to follow any advice that you are given, to help with the healing. Painkillers such as paracetamol and ibuprofen will usually deal with any pain. It is best to relax, avoid smoking and alcohol for at least 24 hours (3 days would be better) afterwards to make sure there are no bleeding problems. You may have had some sutures to help the gum heal over, your dentist will want to see you again a week later to check the healing and remove any sutures.