What are wisdom teeth?
Wisdom teeth are another name for any one of four third molars found in the permanent dentition. These teeth are the last or most posterior teeth in the dental arch. Although most people have wisdom teeth, it is possible for some or all of the third molars to never develop. It is also possible for a person to have more than four wisdom teeth. In many individuals, the wisdom teeth aren't visible because they have become impacted (not normally erupted through the gums) under the gingival tissue.
How do I know if I have wisdom teeth?
You know if you have wisdom teeth by examining your mouth and finding three permanent molars in each dental quadrant. However, if the tooth is impacted under the tissue, presence of the tooth needs to be verified by a radiograph. A panoramic radiograph is usually the preferred X-ray to help assess the angle of eruption and state of development of the tooth. Most wisdom teeth can be visualized erupting through the gingiva in early adulthood, between the ages of 16 to 23. Sometimes, a person will feel the effects of the wisdom teeth before they are able to visualize them in their mouth. Erupting wisdom teeth will usually produce a feeling of pressure or dull throbbing in the back of the jaws. Your general dentist will often be able to inform you of the condition of these erupting teeth.
Do all wisdom teeth need to be extracted?
Not all wisdom teeth need to be extracted. When a wisdom tooth erupts cleanly through the tissue without compromising the adjacent tooth, the wisdom tooth can be retained in the mouth with little concern as long as the person is able to brush, floss, and clean it thoroughly. However, removal of the wisdom tooth is indicated if the tooth has partially erupted through the gingival tissue, causing inflammation and/or infection. A soft-tissue growth over a partially erupted wisdom tooth is referred to as an operculum. If bacteria become trapped under the operculum, an infection called pericoronitis can develop.
Pericoronitis is one of the most common indications for emergency extraction of a wisdom tooth and typically happens when there isn't enough room for all of the teeth in the lower jaw. The symptoms of this infection are red, inflamed gum tissue behind the last visible molar, bad taste/smell, pain with biting on back teeth, and sometimes pus oozing and draining from the area. Occasionally the infection will lead to swelling of the gum tissue, cheek, or other area around the affected side of the jaw.
The wisdom tooth can also erupt at an angle such that the adjacent molar can become difficult to keep clean and free of dental caries. Sometimes the position of the wisdom tooth will cause deep periodontal pockets or gum recession around the adjacent tooth, and should be removed before too much damage is caused to the much more critical second molars. If the third molar has erupted through the tissue but is without opposing occlusion (contact with other teeth), extraction should still be considered. Considering the posterior position of an erupted wisdom tooth, these teeth are often difficult to keep clean.
Sometimes the wisdom teeth cause pain, but a person can avoid extracting them with a few modifications of the surrounding tissues or oral hygiene habits. If there is a small flap of tissue barely covering the back of the tooth, a person may have pain from biting down on that gum tissue. If there is otherwise enough room for the wisdom tooth, the gum tissue can be removed from the back of the tooth to remedy this problem. Changing the angle of tooth brushing and increasing the frequency of flossing both in front and behind the wisdom teeth can help keep the gum tissues healthy and avoid the potential of painful gingivitis or infection around the wisdom teeth. The condition of the wisdom teeth will change a lot between the ages of 16 and 23; it is imperative that wisdom teeth are examined regularly by a dental professional to determine the proper diagnosis and course of action in this age group.