impacted wisdom teeth / wisdom tooth extractions

Why do impacted wisdom teeth need to be extracted?

The precise reasons why a individual's wisdom teeth should be extracted should be explained to them by their dentist, after an examination which almost certainly will need to include x-rays. While each person's situation is different, some of the more common topics dentists discuss when describing to a person why their wisdom teeth should be removed are listed below.

The first group of reasons given here each relates to the fact that wisdom teeth, either partially or fully erupted, can often be very difficult to clean effectively. The term "erupted" means that the wisdom tooth has, at least to some degree, penetrated through the gums.

Any location in the mouth where plaque is allowed to accumulate and persist, such as around a partially erupted wisdom tooth, a person will run the risk of developing dental problems such as tooth decay ("cavities"), periodontal disease ("gum disease"), or reoccurring infections. Typically it is the partially erupted impacted wisdom tooth which is more unpredictable or troublesome for a person than an impacted wisdom tooth which has never broken through the gums.

Reoccurring Pericoronitis.

A common condition that occurs in the presence of impacted wisdom teeth is one termed "pericoronitis". Pericoronitis specifically refers to an infection located in the tissues surrounding a wisdom tooth that has not fully emerged through the gums and into its proper position (this type of tooth positioning would be termed "partially erupted").

Gum tissue is attached to all teeth in pretty much the same way, and at the same level. If just a portion of a wisdom tooth has poked its way through the gums an opening will have been created which connects with a space which lies between the gums and the crown of the wisdom tooth. (The "crown" portion of a tooth is the "non-root" part, the portion of a normally positioned tooth that is visible above the gum line. Gum tissue is not attached to the crown portion of a tooth.)

Plaque will accumulate in this space and, unfortunately, there is no way for a person to effectively clean it out. As a result, it is not uncommon that from time to time the bacteria contained in the plaque will cause an active infection, which then spreads to the tissues surrounding the wisdom tooth. Dentists give the name "pericoronitis" to this type of infection.

The signs of pericoronitis are tenderness and swelling in the gums surrounding a wisdom tooth. There can also be severe pain, an unpleasant mouth odor, and even a bad taste coming from the infected area.

Persons who have pericoronitis should be seen by their dentist. Typically a dentist will place a patient on antibiotics and also show them how to flush out the space between the tooth and gum (the area that harbors the bacteria causing the infection).

Even wisdom teeth that eventually do come into position properly will go through a transitional period where they are only "partially erupted". This is because it takes some time for a tooth to fully penetrate through the gums and reach its final position. And anytime a tooth is only part way through the gums it is at risk for developing pericoronitis.

A dentist who evaluates you during a period when you have pericoronitis will have to determine whether the pericoronitis is just a transient phase of the normal eruption process of the wisdom tooth or if the wisdom tooth is impacted, and thus it is likely that pericoronitis will be a reoccurring phenomenon. In the later case, extraction of the offending wisdom tooth is usually indicated.

New or recurrent tooth decay on the wisdom tooth.

Cavities develop in teeth as a result of plaque being allowed to remain on a tooth's surface for prolonged periods of time. If the position of a wisdom tooth is one where you are not able to clean it thoroughly, then the tooth will be at risk for developing decay.

If decay does begin wisdom teeth often can, just like any other teeth, have their cavities fixed by the placement of a "filling", especially in those cases where the amount of decay is small. Sometimes, however, a dentist will advise against filling a wisdom tooth. The decay on the tooth might be in such an awkward location that the dentist feels they cannot adequately access it so to place a filling. As you can imagine, if a tooth has been hard for you to clean with a toothbrush and floss, it is likely your dentist will have the same problem of access also.

Even if a filling has been successfully placed, if a wisdom tooth still cannot be cleansed properly and plaque is allowed to continue to accumulate on its surface you run the risk of developing recurrent decay on the tooth. The term "recurrent decay" simply means that a new cavity has formed on an aspect of a tooth adjacent to an existing filling. If a tooth can't be cleansed properly and has developed a cavity it is possible that the best, and possibly even the easiest and cheapest, solution is to have the tooth extracted.

New or recurrent tooth decay on a wisdom tooth's neighboring tooth.

Poorly aligned wisdom teeth can have a positioning which creates a trap for plaque and debris between the wisdom tooth and the next molar forward (the 2nd molar). Because this debris trap cannot be cleansed properly not only is the wisdom tooth placed at risk for developing decay but the 2nd molar is also. The worst case scenario in this type of situation is that decay will begin on both teeth and it will advance to such a great extent that both the wisdom tooth and the 2nd molar will need to be extracted.

Periodontal disease ("gum disease").

Whenever a tooth cannot be properly cleansed (brushed and flossed), the bacteria found in the plaque that accumulates on and around the tooth can lead to the development of periodontal disease ("gum disease"). If allowed to advance, periodontal disease can significantly damage not just the gums but also the bone surrounding the tooth. Enough damage can occur that the tooth may need to be extracted.

It may seem a bit of a conundrum that a dentist will recommend the removal of a wisdom tooth now just so you won't develop periodontal disease around it and subsequently have to have the wisdom tooth extracted later. What you need to realize is that a portion of the gums which surround the wisdom tooth are the same gums (and bone) which abut the back side of the next molar forward (your 2nd molar). Gum disease is not an isolated event around an individual tooth, it also affects a tooth's neighboring teeth. It would be a shame to damage or loose a valuable 2nd molar simply because a wisdom tooth you could not clean properly was not extracted.

This second grouping of reasons for having one's wisdom teeth removed each adopt a philosophy that if a wisdom tooth does not or cannot erupt into proper position then the tooth has few benefits to offer and instead will be a potential source of problems. Listed below are some of the types of problems that can develop in association with impacted wisdom teeth.

Cysts and tumors.

While not a common occurrence, cysts and tumors can develop in the tissues associated with impacted wisdom teeth. (If a decision is made to not remove impacted wisdom tooth a dentist will often recommend that a x-ray should be taken of the tooth periodically. This allows the dentist to evaluate the tooth and the tissues that surround it for changes that might suggest a cyst or tumor is developing.)

Tooth crowding.

There is a theory in the dental community that impacted wisdom teeth, as part of their efforts to come fully into place, can put pressure on a person's other teeth and cause them to become misaligned (crowded and shifted). The misalignment of a person's lower front teeth, especially, is frequently blamed on pressure created by a person's wisdom teeth.

This theory, while possibly being true, has never been conclusively proven by scientific studies and is not universally accepted by the dental profession. This is not to say that people don't have teeth which do shift, but rather that the shifting which does occur has not been scientifically proven to be caused by a person's wisdom teeth coming in.

Damage to neighboring teeth.

While uncommon, the attempted eruption of a misdirected impacted wisdom tooth can cause damage to a person's 2nd molar (the next tooth forward of the wisdom tooth).

This event is somewhat similar to what happens to baby teeth. Baby teeth, when they fall out, look as though they have no root portion. The tooth did have a root at one time, but the action of the permanent tooth erupting up underneath the baby tooth causes the resorption of the root, hence the baby tooth looks rootless.

Similarly, when misdirected wisdom teeth attempt to erupt they can cause resorption on the root of the 2nd molar. The worst case scenario in this instance is that both the offending wisdom tooth and the damaged 2nd molar will have to be extracted.

In some cases a dentist simply will not be able to know for certain that a person's wisdom teeth will definitely create a problem for them. In other cases, even after being informed of the potential risks their wisdom teeth may pose, some patients will prefer to not have them removed. In these instances your dentist will probably recommend that your wisdom teeth be re-evaluated periodically, including evaluation using a x-ray.

Impacted Wisdom Teeth:

• Page 1
  What are impacted wisdom teeth?
  What are the classifications of impacted wisdom teeth?
  
  
• Page 2
  Why should impacted wisdom teeth be extracted?
  
  
• Page 3
  At what age should wisdom teeth be removed?
  What are the complications and risks associated with impacted wisdom teeth removal?
  
  
• Page 4   The wisdom tooth extraction process.
  What to expect.
  Numbing the wisdom tooth.
  Sedating the patient.
  Post extraction recovery.
  
  
• Page 5
  How much do impacted wisdom teeth extractions cost?