Have you ever wondered why a wisdom tooth is called a ‘wisdom tooth’? Most of our permanent teeth erupt in childhood at 7-8 years of age. Wisdom teeth erupt in adolescence or young adulthood – almost at a time when kids become wiser.
Wisdom teeth, also known as third or final molars, are teeth that erupt in your late teens or early twenties. A randomized cross-sectional study investigated the prevalence of impacted wisdom teeth. The results of this study show that more than 45% of people experience impacted wisdom teeth. Both genders are equally affected by impacted wisdom teeth, and the typical age for diagnosis is approximately 30 years.
Impacted wisdom teeth
Wisdom teeth often appear in an impacted condition which may cause excruciating pain. Impacted means they fail to erupt within an expected timeframe and may be associated with other dental anomalies.
Impacted wisdom teeth are often associated with unpleasant symptoms such as excessive pressure on the second molars, pain, or even swelling. A wisdom tooth can get impacted either completely or partially due to lack of space, abnormal positioning, or obstruction of the structure of the posterior molars.
Impacted wisdom teeth can also occur due to the following factors:
- insufficient bone growth,
- delayed maturation of wisdom teeth,
- macrodontia (larger than normal size), and
- systemic factors such as Down syndrome, or
- cleidocranial dysplasia.
Typically for diagnosing impacted wisdom teeth, a dentist will perform an oral exam and take x-rays of the oral cavity. The angle of the impacted tooth is determined by ‘Winter classification.’ For instance, a wisdom tooth may push on the crown of the second molar, or its root may push on the second molar's roots.
From a structural point of view, impacted wisdom teeth can be completely or partially covered by bone and soft tissue. Wisdom teeth that are visible in the dental arch and grow abnormally may erupt and not occupy an available position.
People with impacted wisdom teeth do not always experience pain or pathological signs. These are known as disease-free or asymptomatic wisdom teeth. However, when impacted wisdom teeth begin to cause pathological signs such as pain, tenderness, and swelling, they are no longer disease-free. Dentists also examine x-rays for other abnormalities such as a cyst or tumor5.
Managing impacted wisdom teeth
The structure of the jaw plays an important role in the occurrence of impacted wisdom teeth. As such, impacted wisdom teeth cannot be prevented. However, you can take some precautions to reduce the chances of complications associated with an impacted wisdom tooth, e.g., gums become infected and sore.
- Good oral hygiene is important to prevent infection and swelling of gums around wisdom teeth. Brushing teeth regularly twice a day is highly recommended. Using a mouthwash, oral rinsing, flossing, etc., are some of the practices recommended for good oral hygiene. Adequate drinking water intake will help you clean food debris in your teeth and mouth. Avoiding sugary foods is also a wise precaution to prevent the growth of bacteria on the gums and wisdom teeth.
- The most recommended treatment for impacted wisdom teeth is extraction. An estimate suggests that ten million wisdom teeth are removed each year in the US. But about two-thirds of these extractions are unnecessary. Dental extractions run a risk of associated iatrogenic injuries such as nerve damage. Hence, extraction needs to be done cautiously.
Sometimes dentists suggest extracting wisdom teeth before other treatments such as braces. If there are no additional symptoms, some dentists monitor impacted wisdom teeth and extract them only if pathological conditions occur later in life. However, some dental professionals prefer to extract wisdom teeth before the roots are fully formed. Research has shown that there may not be significant benefits of this strategy. It is important to discuss your situation with a dentist early on.
It is a misconception that impacted wisdom teeth can push all fourteen teeth in front of it to cause crowding in the mouth. However, surgery for impacted wisdom teeth is performed to prevent damage to the adjacent molar structures. Surgical procedures for impacted wisdom teeth have various levels of difficulty according to the accessibility of the wisdom teeth to be extracted.
When to expect a difficult extraction procedure
If the impacted wisdom tooth is buried deep in the gums, the extraction procedure will be more difficult than the tooth that has penetrated the gums. The accessibility of wisdom teeth depends on several essential factors such as root morphology, the structure of the neighboring molars, and the position of the molars in the bone tissue.
However, the extraction procedure of impacted wisdom teeth can lead to unwanted complications. Several pathological conditions can occur after the surgical procedure of impacted wisdom teeth, such as postoperative infection, alveolar osteitis, inferior alveolar nerve injury, bleeding, damage to neighboring molars, and inflammation.
A study showed that the risk of complications from the extraction of impacted mandibular wisdom teeth is always present. Alveolar osteitis is the most common complication. It is a condition where the tooth socket becomes dry for about three days after the wisdom tooth is extracted. Other reported complications include root tip fracture, paresthesias of the lingual nerve, and other dental problems.
To prevent the risk of infection after the extraction of impacted wisdom teeth, antibiotics are often prescribed after the surgery. A systematic review and meta-analysis indicated that the most widely used antibiotic was amoxicillin with or without clavulanic acid. However, reports have suggested increased bacterial resistance to penicillin due to improper use. Thus, it is necessary to control and supervise the use of antibiotics after the surgery.
Although impacted wisdom teeth cannot be prevented, timely intervention is necessary. A routine annual oral exam may help diagnose any problems associated with wisdom teeth.
A. Agrawal, A. Yadav, S. Chandel, N. Singh, and A. Singhal, 'Wisdom Tooth--Complications in Extraction', J Contemp Dent Pract, 15 (2014), 34-6.
Ferhat Ayrancı, Mehmet Omezli, Efe Can Sivrikaya, and Zeki Orhan Rastgeldi, 'Prevalence of Third Molar Impacted Teeth : A Cross-Sectional Study Evaluating Radiographs of Adolescents', JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS, 8 (2017), 50-53.
T. B. Dodson, and S. M. Susarla, 'Impacted Wisdom Teeth', BMJ Clin Evid, 2014 (2014).
J. W. Friedman, 'The Prophylactic Extraction of Third Molars: A Public Health Hazard', Am J Public Health, 97 (2007), 1554-9.
H. Ghaeminia, M. E. Nienhuijs, V. Toedtling, J. Perry, M. Tummers, T. J. Hoppenreijs, W. J. Van der Sanden, and T. G. Mettes, 'Surgical Removal Versus Retention for the Management of Asymptomatic Disease-Free Impacted Wisdom Teeth', Cochrane Database Syst Rev, 5 (2020), Cd003879.
Kerdoud Ouassime, Aloua Rachid, Kaouani Amine, Belem Ousmane, and Slimani Faiçal, 'The Wisdom Behind the Third Molars Removal: A Prospective Study of 106 Cases', Annals of Medicine and Surgery, 68 (2021), 102639.Diana Sologova, Ekaterina Diachkova, Ilana Gor, Susanna Sologova, Ekaterina Grigorevskikh, Liana Arazashvili, Pavel Petruk, and Svetlana Tarasenko, 'Antibiotics Efficiency in the Infection Complications Prevention after Third Molar Extraction: A Systematic Review', Dentistry Journal, 10 (2022), 72.