‘Wisdom Teeth’ / 3rd Molars
Why do we have Wisdom Teeth?
Adults can have a maximum of 32 teeth. The wisdom teeth are the last to come through, right at the back. They usually appear between the ages of 17 and 25, although sometimes they appear many years later. Nowadays, people often have jaws that are too small for all 32 teeth; 28 is often the most we have room for. So, if all the teeth are present and healthy, there may not be enough space for the wisdom teeth to come through properly.
What is an impacted Wisdom Tooth?
If there is not enough room, the wisdom tooth may try to come through, but will get stuck against the tooth in front of it (“impacted”). The impacted wisdom tooth can be angled in a number of different ways and this can indicate how difficult the tooth may be to remove.
What can I do to help myself?
A hot saltwater mouthwash or an antiseptic mouthwash such as Corsodyl will help to reduce gum soreness and inflammation, getting into areas your toothbrush cannot reach. Painkillers, such as Paracetamol or Ibuprofen can also be useful in the short term.
Are X-rays needed?
The tooth will need to be X-rayed to see the position of the tooth, its angulation / impaction and whether there is any disease process present that compromises the wisdom tooth or its adjacent teeth.
Are Wisdom Teeth difficult to take out?
It all depends on the position and shape of the roots. You will be told how easy or difficult to remove each tooth is likely to be after having an X-ray. Upper wisdom teeth are often more straightforward to remove than the lower ones, which are more likely to be impacted. Very occasionally, there is a possibility of some numbness of the lip ± tongue after the removal of a lower tooth (this can be a permanent or temporary numbness). You will be told if this is likely in your case. A more comprehensive list of warnings can be found here.
What should I expect after a Wisdom Tooth is extracted?
The amount of discomfort will depend on how easy the removal of the tooth was. There is usually some swelling and discomfort for a few days afterwards and it is important to follow any advice you will be given about mouthwashes etc, to help with the healing. Painkillers, such as Paracetamol or Ibuprofen will usually deal with any pain. It is best to stay fairly quiet and relaxed for 24-hours afterwards to make sure there are no problems with bleeding. There may be some stitches to help the gum heal over; these are dissolvable.
Do they always cause problems?
No. If there is enough room they will usually come through into useful positions and cause no more problems than any other tooth. Often there will be some slight discomfort as they come through, but this is only temporary and will disappear once the tooth is fully in position.
What problems should I be prepared for?
If part of the wisdom tooth has appeared through the gum and part of it is still covered, the gum may become sore and perhaps swollen. Food particles and bacteria can collect under the gum edge and it will be difficult to clean effectively. You will be advised whether this is a temporary problem that can be dealt with by using mouthwashes and special cleaning methods (and possibly antibiotics) or whether it is better to have the tooth removed.
What if these don’t help?
If the pain doesn’t go or if you find it difficult to open your mouth or get repeated infections around the crown of the tooth, then it is likely that you will need medication or extraction.
What are the main reasons for taking Wisdom Teeth out?
- When there are repeated infections associated with the wisdom tooth
- If the wisdom tooth is decayed or causing decay in the adjacent tooth.
- If the wisdom tooth is causing gum disease.
- If there develops around the wisdom tooth cysts or tumours.
- If the wisdom tooth is in the line of surgery.
The indications for Wisdom Tooth / Teeth removal, in the UK (outside Scotland – Scotland uses the SIGN Guidelines) and in the NHS, is governed by the NICE Guidelines.
Will it make any difference to my face or my mouth?
Removing wisdom teeth may produce some swelling for a few days but as soon as the area is healed, there will be no difference to your face or appearance.
Your mouth will feel more comfortable and less crowded, especially if the teeth were impacted.
Useful Articles & Websites
JOMS 2004. Clinical outcome of third molars in adults followed during 18 years
NHS Direct Best Treatments 2006 – Removing Wisdom Teeth
BAOMS Advice Regarding Wisdom Teeth
BMJ Clinical Evidence 2010 Impacted Wisdom Teeth
BJOMS 2011. Technical Note. A method for extraction of impacted upper 3rd molars
BDJ 2012. The Effects of NICE Guidelines on the Management of 3rd Molar Teeth
JOMS 2012. What Has Been the United Kingdom’s Experience With Retention of Third Molars
Get Well Soon (RCS England) – Wisdom Teeth Extraction (2012)
JOMS 2013. Predicting 3rd Molar Surgery Operative Time – A Validated Model
Cochrane Review 2014. Review. Surgical techniques for the removal of mandibular wisdom teeth
JADA 2014. The Indications for Third-Molar Extractions
BDJ 2015. Cost Effectiveness Modelling of a ‘Watchful Monitoring Strategy’ for Impacted Third Molars vs Prophylactic Removal under GA – an Australian Perspective
J Oral Maxillofac Surg 2015. Orthodontic Extraction of High-Risk Impacted Mandibular 3rd Molars in Close Proximity to the Mandibular Canal – Systematic Review
Cochrane Database of Systematic Reviews 2016. Surgical Removal vs. Retention for the Management of Asymptomatic Disease-Free Impacted Wisdom Teeth
Dental Update 2017. Treatment Planning for Mandibular Third Molars
Rev Bras Odontol 2017. Prophylactic Removal of Unerupted Asymptomatic Third molars – Is It Justifiable?
Austr Dental J 2018. The Contemporary Management of Third molars
Ortho Update 2018. NICE Guidance on the Extraction of Wisdom Teeth − Time for a Rethink
EC Dental Science 2019. Are Impacted Third Molars Always Necessary to be Removed – Part II
Medicina 2019. How to Manage Impacted Third Molars – Germectomy or Delayed Removal. A Systematic Literature Review
American Association of Oral & Maxillofacial Surgeons. Wisdom Teeth