Your wisdom teeth (the common term used to refer to your third molars) usually emerge in your late teens or early twenties, about the same time that society begins to consider you “wise” enough to be considered an adult. You’ll grow four wisdom teeth, at the extreme right and left sides of your other teeth. And it is very possible that you – like 20% of the population – will be lucky and never develop any problems when your wisdom teeth “come in.”
For the rest of us – the 80% – nature has played a cruel trick on us as we evolved; our mouths are too small to accommodate these four new teeth properly. If your wisdom teeth are misaligned – angled horizontally, angled towards the second molars or away from them, or angled outward towards the front of the jaw or inward towards the back of the mouth – they can cause problems. The most common problems are that they may crowd existing other teeth, causing misalignments or more serious problems to them, and in extreme cases cause damage to the jaw and nerves.
Your wisdom teeth can also emerge covered by the soft tissue or bone of the jaw, and thus become entrapped. Entrapped wisdom teeth are referred to as impacted. And just as your other teeth can cause pain, swelling, or actual disease when they become impacted, so can your wisdom teeth.
What can I do about this problem?
Your dentist can examine your wisdom teeth as they begin to emerge, and make appropriate recommendations. The dentist will take X-rays to see how the third molars are emerging, and whether there is going to be room in your mouth for them to emerge without problems. If you are in the lucky 20%, nothing may need to be done about them.
If, however, a dental examination reveals that you have or are likely to develop problems with your wisdom teeth, in most cases the recommendation is to have them extracted.
What can you expect if you have your wisdom teeth removed?
The answer to this question depends to some extent on how your wisdom teeth are emerging. If they are fully visible above the gum line, wisdom teeth can be extracted as easily as any other tooth. If one or more of the teeth are impacted, and hidden beneath the gum line or bone of the jaw, then oral surgery will be required. This isn’t as scary as it sounds.
If you require oral surgery to extract your wisdom teeth, in most cases a local anesthetic – applied directly to the area around the tooth to numb it – may be all that is required. If the tooth is seriously impacted, or if your dentist recommends that you have all four wisdom teeth extracted at once, or if you have high anxiety about dental procedures, your dentist may recommend “twilight sedation” or general anesthesia, enabling you to sleep through the whole process.
The actual process of removing the teeth may be simple, or if the teeth are heavily impacted, more extensive. With impacted wisdom teeth, the first step is to make an incision in the gum tissue to reveal it, and then separate it gently from the bone by rocking it. If the tooth is impacted so badly that it is completely or partially hidden, some of the bone may need to be removed. In all cases that require an incision, after the extraction the dentist may stitch it up to enable it to close properly and heal.
What can I expect afterwards? How long will it take to heal?
Because extraction of the third molars is real, honest-to-goodness oral surgery, you may experience residual pain and swelling in the days following the procedure. The pain can generally be handled by over-the-counter analgesics such as aspirin or ibuprofen, and if the pain is more severe your dentist can prescribe stronger medications. Swelling usually goes down within a day or two, and this process can be speeded up by the application of ice packs on the external jaw.
The incisions themselves may bleed in the first 24 hours, but this usually stops very quickly. For most patients, all residual effects of having their wisdom teeth removed go away within one or two days, and so do the potentially serious problems that could have been caused by leaving them in place. So the “bottom line” is that although no one enjoys having teeth extracted, having potentially problematic wisdom teeth removed really is the wisest choice.