When we are born we usually come into the world toothless, but as we age, teeth appear in our mouths on a somewhat regular schedule. For example, our first molars (large grinding teeth at the back of the jaw) usually appear when we are 6 or 7 years old, our second molars when we are 12 or 13 and our third molars (wisdom teeth) when we are typically between 18–20 years old—when we are much “wiser.” 20 was a wise old age a few hundred years ago when life expectancy was much younger.
Over time, human jaws have decreased in size. The cooking and processing of foods has reduced the need for massive grinding. It seems we are evolving away from the need for wisdom teeth. Most people have four wisdom teeth, one on each side of the upper and lower jaws. However, wisdom teeth are the most common teeth to be genetically missing. Some people have only one–three wisdom teeth and some have no wisdom teeth at all, lucky them!
About 80 percent of people with wisdom teeth do not have room for them to erupt in their jaws. In these cases, the wisdom teeth either erupt incorrectly or stay impacted in the jawbone. Of the 20 percent of people that have room for their wisdom teeth, only about 20 percent can keep them clean. The other 80 percent develop gum disease, due to the difficultly of cleaning teeth so far back in their mouth.
Wisdom teeth impactions
A wisdom tooth impaction occurs when the tooth does not erupt completely. The wisdom tooth may lie totally in the jawbone, called a boney impaction. A wisdom tooth that only partially breaks through the gum is called soft tissue impaction.
Impaction is not a good thing. An impacted wisdom tooth can cause serious health problems. Severe pain can occur from an abscessed wisdom tooth or from a gum or bone infection around a wisdom tooth. A crowded out impacted wisdom tooth can cause other teeth to become crooked and more prone to decay. The roots of the second molar can be harmed by pressure from the impacted wisdom tooth. One of the more serious problems is the development of a cyst. If not treated, the cyst can form a tumor and cause jawbone destruction.
Infections of wisdom teeth
Infections from soft tissue impactions are the most common wisdom teeth problems. An infection in the soft tissues that surround a partially erupted wisdom tooth is called periocoronitis. ‘Peri’ is the Latin word for surrounding, ‘corona’ means crown [the top of a tooth] and ‘itis’ is Latin for inflammation. Enamel is the hard, protective, top part of a tooth. Gum tissue does not attach to enamel. Therefore, when a wisdom tooth partially pushes up through the gum tissue, it leaves a small flap of gum covering an area on the top of the tooth. This allows bacteria to travel around the top of the tooth causing a bacterial infection that cannot be cleaned. Tiny food particles slip under that tissue flap and bacteria feed on the trapped food particles causing an infection. It is impossible to brush or floss a partially erupted wisdom tooth.
The resulting infection can produce pain, swelling, a stiff jaw (difficult to fully open the mouth) and bad breath. The infection can spread to the cheek and neck. Usually antibiotics can reduce the infection until the wisdom tooth can be removed. Now for the really scary part: life-threatening problems can occur when a wisdom tooth infection is left untreated. The infection can migrate to other soft tissues in the mouth. A lower wisdom tooth infection can proceed down along the throat and even cause swelling to the point of closing off the windpipe. An upper wisdom tooth infection commonly invades the sinus area and can even travel to the brain!
Ideal age to extract wisdom teeth
If treated early, during teenage years, complications from impacted wisdom teeth seldom arise. If not treated until later years, after 20-years-old, complications are more likely to occur. During the teenage years, the jawbone is not as dense and hard as it is as the person ages. Roots of teeth develop last, that is, the top of a tooth, the enamel develops first. Therefore, the tooth roots are shorter and easier to remove at a younger age. Also a tooth heals more quickly than an older individual.
The ideal time for wisdom teeth removal is when the teeth have erupted as far as possible but the roots have not totally formed. That is usually age 15 to 18 in girls and 17 to 20 in boys. During these ages, it is best to have a panoramic x-ray, which shows a full view of the wisdom teeth in the jaws, to determine the need and ideal time for wisdom teeth removal.
After age 25, the wisdom teeth are locked into the jawbone with completely formed long roots. People rarely have problems with their wisdom teeth until after this age. After age 25, extractions become more difficult. So don’t wait till it hurts!
Digital Panograghy is best taken for wisdom teeth extractions
The digital panographic x-ray, called a pan for short, is a machine that shows the entire mouth in just one image. The name comes from the word panoramic, a full view. The pan shows all the teeth, both jaws and other important landmarks in one full image. Impacted wisdom teeth are vividly shown in relationship to important items like the sinuses and main nerve channels in the jaws. Abscesses, cysts and tumors can also be seen well.
Sometimes a CBCT [Cone Beam Computed Tomography] is needed in complicated wisdom teeth extractions. CBCT is an amazing technology that allows a three- dimensional computer image of the jawbones and teeth and can determine the exact location of other important structures, like the position of nerves, arteries and sinuses, as well as cysts and tumors. CBCT is not needed for routine wisdom teeth extractions, but definitely has a place for many surgical related treatments, especially implant placement.
If you are concerned about your wisdom teeth, talk to your dentist. Your dentist will advise you about the risks, complications and outcomes related to keeping or removing your wisdom teeth.
ENJOY LIFE AND KEEP SMILING!
George Malkemus has a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@ malkemusdds.com. Visit Dr. Malkemus’ Web site at www.malkemusdds.com