Wisdom teeth

Cyst_-_wisdom_tooth

Wisdom teeth are the third set of molars to come through the gums. This usually happens between the ages of 17 and 25. They are called wisdom teeth probably because they are the only teeth to erupt when we are fully grown and supposedly wiser than when our baby teeth or second teeth came through.

Problems caused by wisdom teeth

In many people, the size of the jaw means that they have space for the 28 adult teeth that come through between the ages of 6 and 12 but not for an extra tooth in each corner. When a wisdom tooth starts to grow, it can be unable to get through the gum because it is trapped between the second molar and the jaw bone.

The lack of space can leave the tooth coming out sideways or at a strange angle, or just getting stuck. When this happens, the wisdom tooth is said to be impacted and this can become very painful.

  • Wisdom teeth can come out of the gum at an angle, facing the mouth opening and pushing into the second molar.
  • They can try to emerge straight up but not be able to get through the gum because they get stuck against the second molar and may even push it out of position.
  • Some wisdom teeth start coming through horizontally, pushing through the side of the gum.
  • Others are angled but face the throat rather than the mouth opening.

When wisdom teeth push against other teeth or the bone of the jaw, this causes inflammation and pain. Partly erupted teeth can also cause the gum to ulcerate and become infected as particles of food get stuck there and can’t be easily brushed away.

This can lead to different kinds of soft tissue problems:

  • Gingivitis – inflammation of the gums.
  • Pericoronitis – when the soft tissue surrounding the tooth itself gets infected. This can lead to an abscess under the wisdom tooth.
  • Cellulitis – the infection spreads to the inside of the cheek or to the tongue or throat tissue.
  • Osteomyelitis – the infection goes right into the jaw bone.

Treatment options for problem wisdom teeth

A wisdom tooth that causes gum problems as it emerges may take a while to erupt and does not necessarily need to be removed. The local inflammation and any infection can be treated using antibiotics and an antiseptic mouthwash.

An important part of the initial investigation will be to X-ray the jaw to find out if the wisdom tooth is impacted. A tooth that is impacted but not causing any pain or inflammation does not need to be removed but as soon as a tooth that is stuck leads to recurrent gum or soft tissue problems, wisdom tooth removal is the best option.