Wisdom Teeth Extractions

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What are wisdom teeth?

The third molars, which we commonly refer to as wisdom teeth, are the final set of teeth to emerge in our oral cavity. These teeth are present in a total of four numbers, two in the upper arch( Maxilla) and two in the lower arch(Mandible), one each on the right and left sides. Generally, these teeth start to erupt when we are between 17 to 25 years of age.

History

We, humans, have evolved over the years. In our ancestors, wisdom teeth served a functional purpose as their lifestyle required them to consume raw and unprocessed food, necessitating the need for all 32 teeth. However, as we evolved and our way of life changed, so did our dietary habits. We began to eat a more refined and cooked diet. Now we did not use our jaws that much as our ancestors used to, As a result, nature adapted to these changes, and our jaw sizes gradually decreased. Consequently, the lack of space in smaller jaw sizes has made wisdom teeth less and less useful for us.

The current scenario

Smaller-sized jaws, a sign of evolutionary change, typically do not provide enough space for the eruption of wisdom teeth, similar to other teeth in our jaws. This can lead to three scenarios:

Wisdom teeth fully erupt like other teeth without causing any issues,
Wisdom teeth partially erupt and become stuck, resulting in impacted teeth,
Wisdom teeth fully erupt and compress the cheeks and surrounding skin.

Very few of us are lucky enough to belong to Situation 1, and the majority of us end up in either Situation 2 or Situation 3.

When teeth are partially erupted in Situation 2, they may create a gap between themselves and the second molar ahead of them. This gap can be difficult to clean while brushing and can become an area where food lodges, potentially resulting in tooth decay not only in the wisdom tooth but also in the second molar. Unlike the wisdom tooth, the second molar is useful to us. If this situation goes unnoticed or untreated, the second molar may also decay and require a filling, root canal treatment, or even extraction in severe cases. Additionally, there may be an area between the wisdom tooth and the posterior skin where food can lodge, leading to localized swelling or pus formation.

In Situation 3, when wisdom teeth fully erupt and compress the cheeks and surrounding skin, we may experience difficulty opening our jaws or accidentally biting our cheeks when closing our mouths, which can result in painful ulcers.

In addition, keeping our wisdom teeth clean through brushing and flossing, which is typically used for our other teeth, can be a challenging task. This increases the likelihood of developing decay and infection in the area surrounding the wisdom teeth.

So what can be done?

From a treatment perspective, Situation 1 is the most favourable, as it typically requires no treatment apart from regular cleaning.

For situations 2 and 3, treatment should be based on the presenting symptoms:

If the symptoms are mild, attempting localized cleaning and disinfection is recommended as the initial treatment.
In cases of moderate symptoms, an operculectomy can be performed, which involves cutting a portion of the posterior skin that covers the tooth.
If the symptoms do not resolve or are severe from the beginning, extraction of the wisdom teeth should be planned.

Problems associated with wisdom teeth

Wisdom teeth which cannot erupt completely either due to lack of space or due to the wrong orientation of the tooth may cause some problems

Food lodgement
Pain
Swelling
Cheek bite
Restricted mouth opening
Crowding of front teeth

What is the procedure for removing my wisdom tooth?

To plan a wisdom tooth extraction, a comprehensive check-up is conducted followed by an IOPA radiograph. Before proceeding with any extraction, we will obtain a comprehensive medical history from you, including checking for allergies, pre-existing medical conditions such as high blood pressure or diabetes, and any heart-related ailments. We will also take into account any medications you may be taking. Once we have ensured that all these factors are suitable, we will proceed to plan the procedure.

Depending on the angulation and degree of eruption of the wisdom tooth, extraction can either be a non-surgical or surgical procedure.

Non Surgical Extraction

The process of wisdom tooth extraction begins with the administration of local anesthesia to numb the tooth and surrounding area. The next step involves luxation, where specialized instruments are used to loosen the tooth in its socket. Once the tooth is sufficiently loose, special forceps are employed to gently extract it. Following the extraction, the site may either be left to heal naturally, or sutures or stitches may be used to facilitate the healing process. If stitches or sutures are used, they can be either self-dissolving or non-dissolving, and the latter may require removal after a few days.

Surgical Extraction

In certain situations, the extraction of a wisdom tooth may necessitate minor surgery. This could be the case when the tooth is tilted or only partially erupted, making non-surgical removal challenging. To begin the process, local anaesthesia is administered to numb the tooth and the surrounding area. Next, the gums around the wisdom tooth are reflected to expose the tooth completely, and some space is created around the tooth to facilitate its loosening in its socket. Once the tooth is suitably loosened, it may be extracted in one piece or, in some instances, it may need to be sectioned and removed in two or three pieces. Following the extraction, the gums are approximated, and stitches or sutures are used to close the extraction site. stitches or sutures used can be either self-dissolving or non-dissolving, and the latter may require removal after a few days.

Recovery after Extraction

A patient can fully recover from wisdom tooth extraction within 3 to 7 days, depending on the body’s healing ability.