Wisdom teeth are the permanent third molars. Most people have four wisdom teeth − two in the upper jaw and two in the lower jaw. Wisdom teeth are named as such because they usually erupt between the ages of 16 and 21 which is a period where an individual gains maturity and wisdom.
An impacted wisdom tooth is a third molar that fails to fully erupt into the oral cavity due to inadequate space or obstruction from surrounding structures. These structures may include neighbouring teeth, overlying bone or excess gingiva.
X-ray depicting four impacted wisdom teeth
Impacted wisdom teeth are breeding grounds for bacteria and may cause tooth decay of the wisdom tooth and adjacent second molar.
Infection and inflammation of overlying gums can occur, resulting in pain and swelling and loss of supporting bone around adjacent second molar (periodontal bone loss).
More serious problems such as the development of cysts or tumours around an impacted tooth can occur, leading to destruction of the surrounding jawbone and neighbouring teeth.
These conditions may require complex and extensive treatment, as problems can develop silently without symptoms in the early stages. A check-up with your dentist is advisable.
Your initial visit to the dentist would include an examination of your mouth and x-rays to determine the position of the wisdom teeth, their condition and the status of the adjacent teeth and bone.
A wisdom tooth is impacted when it is obstructed from erupting fully into the mouth, either by the tooth in front of it or the surrounding bone or gums. In some situations, it may be advisable to remove them prophylactically.
What to expect during consultation and what tests are required
• Your dentist will require a full medical history, so, do bring your medications for verification purposes
• Dental radiographs will be taken to assess the wisdom tooth/teeth
• Investigations such as vitality testing of teeth adjacent to the wisdom tooth may be performed.
Most impacted wisdom teeth are best treated by surgical removal. Surgical excision of an impacted wisdom tooth is a minor surgical procedure which can usually be performed under local anaesthesia or general anaesthesia.
Your surgeon will advise you on the type of anesthesia most appropriate for your needs. The surgery involves uncovering the tooth by lifting the overlying gums to expose the tooth and bone.
The tooth may need to be sectioned in order to remove it. The gums are then stitched back in place.
• Prior to wisdom tooth surgery, it will be helpful to maintain good oral hygiene, and to comply with medication prescribed by the dentist
• If you are a smoker, it is advisable to cease smoking at least 1 week prior to surgery, and at least 2 weeks after surgery
After surgery, some minor bleeding from the wound can be expected, which can be controlled by biting on a piece of gauze over the operated area for about half an hour.
Facial swelling and bruising of the overlying skin may also develop, increasing for the first 72 hours and subsiding thereafter. You may not be able to open your mouth as wide as usual for a few days.
Painkillers, antibiotics and an antiseptic mouthwash are usually prescribed after the surgery. It is advisable to maintain good oral hygiene and also to keep to a soft diet for a few days following surgery.
