What are wisdom teeth?
“Wisdom teeth” (technically known as ‘third molars’) are the teeth normally found in the very back corners of your mouth. They are the eighth teeth from the front and hence are sometimes called ‘eights’. There is usually one wisdom tooth in each corner of the mouth, for a total of four wisdom teeth all together. Some people may naturally fail to develop one or more wisdom teeth and (if they’re really lucky) may fail to develop them all together.
Why do we get them?
There is some debate about this, but it is commonly believed that they were important teeth many thousands of years ago when humans had larger jaws and did more heavy-duty chewing than we do now (think of the drawings you see of cave-men with large jaws and you’ll know what we mean).
As we have evolved, our diets have become more refined and the need for large jaws full of extra teeth is diminishing. Gradually, evolution is ‘catching up’ with the idea that our jaws are getting smaller and the need for third molars is diminishing. Hence some people (usually with small jaws) never develop wisdom teeth, and some people (usually with large jaws) do develop them and they erupt out of the gum and function perfectly like a normal set of teeth.
Most of us, however, fall in the ‘in-between’ category, where our jaws may be big enough that wisdom teeth still develop, but not so big that they erupt out of the gum correctly. This can cause problems that may require them being removed.
My friend never got their wisdom teeth- why is that?
It’s possible that your friends jaw was small enough that the wisdom teeth never developed in the first place. It’s also possible that the wisdom teeth did develop, but are under the gumline and not visible unless a special x-ray is taken of the jaw to see if they are there. It’s important that X-rays are taken to check to see if the wisdom teeth are there, because they can still cause problems even if they do not erupt through the gum.
When are wisdom teeth supposed to come through?
Usually wisdom teeth erupt through the gum sometime from the late teenage years to the early twenties. However, if the jaw is a little too small, sometimes the teeth get ‘stuck’ or ‘impacted’ underneath the gumline and do not erupt into the mouth. This is why it is important to get the jaw X-rayed to see if they are present, even if they appear not to be there ie: Just because they haven’t come through by your early twenties, doesn’t mean they’re not hiding deep in the jaw somewhere!
How do I know if mine are through?
Get your dental professional to check inside your mouth and on a jaw X-ray (called an orthopantogram or ‘OPG’).
Do I have to get them out?
This is again is a subject of some debate. In the past many dental practitioners have advised removing all wisdom teeth pre-emptively to avoid them causing problems in the future. However, all surgery- however simple- comes with some degree of risk, and it is important to weigh the risks associated with wisdom teeth removal against the benefits that we hope to achieve.
Discuss your individual case with your dental professional. Not all wisdom teeth need to be removed, but some certainly do, and some fall into an ‘in-between’ category, where it may be more suitable to monitor them for signs of future problems and remove the teeth only if such problems occur.
If I leave them, will they cause problems?
Depending on the nature of your individual case, leaving your wisdom teeth in place when they strictly speaking should be removed may lead to risk of problems in the future. These include decay, gum-disease, cysts, possible damage to other teeth in the area, and infections of the jaw.
Again, however, everyone’s individual risk is different, and it is important to ask your dentist whether you are likely to have problems by leaving your teeth in.
Will it hurt?
The procedure of removing a wisdom tooth is generally not painful. Some post-operative swelling, bleeding and sensitivity may occur afterwards, however. If this is managed well, with the use of appropriate pain killers and anti-inflammatories etc, in most cases the post-op pain and swelling can be minimised.
Who can take them out for me?
Depending on the level of complexity, some wisdom teeth can be removed by your general dentist. More complex extractions may require referral to an oral surgeon. This is more likely if the tooth is buried partly or entirely under the gum-line.
Do I have to go to hospital to be ‘knocked out’ to have it done?
Depending on the level of complexity of the tooth removal it may be wise to be placed under a general anaesthetic to take the wisdom teeth out. Sometimes people may elect to have their wisdom teeth removed under general anaesthetic also known as sleep dentistry, simply so they don’t have any awareness of what’s going on, regardless of how difficult the tooth removal might be.
Some wisdom teeth however are easy enough to remove in the dental chair under local anaesthetic, just like you would if you were having a filling.
Discuss with your dentist any concerns you may have, and what the nature of your individual case is, as not every wisdom tooth requires you to be ‘knocked out’.
How much will it cost?
Fees for wisdom tooth extraction can vary depending on the complexity of the tooth removal and whether a specialist referral is required. Simple extractions could be expected to cost approximately $110-$140. More complex extractions may cost as much as $250 per tooth.
Keep in mind that sometimes there may be extra fees associated with X-rays, hospital admission fees etc. Ask your dentist to give you a fee estimate that you can check with your health insurer.
Will my health insurance cover it?
Depending on your level of cover, some or all of your wisdom tooth treatment may be covered by your health insurer. Ask your dentist for a fee estimate that you can check with your health insurer.
How long would I have to take off school/ work?
Simple tooth extraction in the chair under local anaesthetic may not require you to take any time away from school or work. More complex extractions however, may. If you are considering having teeth removed under general anaesthetic (ie: in hospital) then you should plan not only to take that day off school/ work, but to avoid driving/ operating heavy machinery/ signing important documents etc on the day of your surgery as the effect of the anaesthetic drugs may impair your judgment/ coordination. You may require a few days post-operatively to recover. Your dentist can write you a medical certificate if required.
Ask your dentist about your individual case and how much time off you may require.
Will I need antibiotics or special painkillers?
Depending on the level of complexity, over the counter pain medications such as panadol, panadeine or nurofen are usually sufficient to manage any post-op pain. More complex procedures may require stronger prescription drugs which your dentist can prescribe. Some of these medications may cause drowsiness in susceptible individuals, and this should be considered when planning how much time to take away from school or work post-operatively.
Simple extractions usually do not require anti-biotics, but more complex surgical extractions may. Ask your dentist about your individual risk. As a general rule, antibiotics are not prescribed following routine wisdom tooth extraction.
What are the risks of taking them out versus leaving them in?
Depending on your individual case, there are some risks to leaving wisdom teeth in if they are not erupted into the correct position and kept adequately clean.
Like other teeth, if not kept correctly clean, wisdom teeth can become decayed or cause gum disease. This can lead to abscesses and other infections in the jaw which can become painful and require more involved treatment.
Infected or compromised wisdom teeth may cause problems in otherwise healthy teeth in the surrounding areas. This is particularly a problem if the teeth are partially erupted (half-way through the gum).
Wisdom teeth that are unerupted (buried under the gum) can cause problems too. Cysts may develop around these teeth, and these can gradually grow larger and larger, causing destruction of surrounding teeth and bone. While these types of problems are rare, the consequences of them can be severe, so it is important that wisdom teeth be monitored fro problems even if they are not causing any pain.
Sometimes the act of removing a wisdom tooth may cause some damage to adjacent teeth or nerves. Nerve damage may result in tingling or numbness of the lower lip, chin, cheek and/or teeth . This altered sensation may take anywhere from a few weeks to 18 months to heal. It is rare that the altered sensation may be permanent, but it does occur in a minority of cases.
Ask your dentist whether the risks of tooth removal outweigh the benefits of tooth removal and make an informed decision about which is the best course of action to take for your individual circumstance.
What is a ‘Dry Socket?’
A dry socket is a term used to describe the failure of a wound to heal correctly after tooth removal. It can occur with wisdom teeth, and is more likely to occur in the lower jaw where there is more dense bone (and hence poorer blood supply) and in smokers and diabetics (where again, blood supply is often reduced)
Essentially what happens is the blood clot is washed away too quickly after the tooth is removed, leaving an area of exposed bone which gradually become painful 2-3days after tooth removal.
The pain is usually very easy to manage, but it requires treatment by your dentist. The area is usually washed with salt water and dressed with a antiseptic agent (a little like Betadine) to sterilize the area and promote the formation of a new blood clot.
Dry sockets can be avoided by limiting the amount of forceful rinsing and spitting that you do following your wisdom tooth removal (too much rinsing will dislodge the clot out) and by avoiding smoking in the lead up to and following your wisdom tooth removal.