Wisdom teeth are your third molars in the far back of your mouth to form a complete set of 32 adult teeth. Some people have them, others do not. Some people only have 1, 2 or 3, instead of 4. And believe it or not, in extremely rare cases, 1 or 2 out of a hundred people have 8 wisdom teeth.
These days it is common to have wisdom teeth extracted because they are impacted (there is not enough space in the mouth for them to erupt) or only partially erupted. Not all impacted or partially erupted wisdom teeth need to be extracted. Always consult with your dentist to get advice on your individual needs and your specific oral anatomy.
It is believed that evolution is responsible for a change in the size of our jaws. Scientists say, the big change came from civilization’s transition from hunter-gatherers to farmers. Studies show that the lower jaws of the world’s earliest farmers are not only smaller versions of those of the predecessor hunter-gatherers, but that the lower jaw underwent a complex series of shape changes commensurate with the transition to agriculture.
Previously, big, strong jaws to chew uncooked vegetables and meat were needed as opposed to early farmers who consumed cooked foods like beans and cereals that didn’t demand such a high level of mouth strength. For this reason, there was also an evolution of wisdom teeth.
It is believed that eventually, one of our ancestors had a change in one or more of their genes and never grew that third set of molars. Today roughly a fifth of the world’s population has no wisdom teeth or is missing one or more. Some experts believe that humans will eventually lose them altogether.
If you are lucky enough to have enough space in your mouth for your wisdom teeth to erupt properly, and you have enough space around them to keep them clean, there is no reason why you should have them removed.
It is always advised to go for regular dental examinations and professional cleanings at least twice a year to ensure optimal dental health and to discuss your individual dental needs with your dentist and hygienist.
Reasons for removal of wisdom teeth
Impacted wisdom teeth
Probably the biggest reason for extraction of wisdom teeth, is the fact that there is not enough space for them to erupt. They can either be completely impacted, which means, they don’t break through the gum, or partially erupted, where they break through the gum, but still don’t have enough space to fully erupt.
An unerupted, impacted wisdom tooth can damage the root of the adjacent tooth. This damage to the root of the adjacent tooth can cause root resorption and ultimately leads to losing the tooth.
Decay
A partially erupted wisdom tooth can easily get decayed and cause decay of the adjacent tooth due to the accumulation of plaque and food in the area, and the inability to clean properly.
If a wisdom tooth is decayed, it is difficult or impossible to restore with a filling and extraction might be the only option.
Pericoronitis
A partially erupted wisdom tooth can cause pericoronitis (inflammation of the gum tissue around the wisdom tooth). In some cases, the choice of treatment might be to cut away the operculum (piece of gum tissue overlying the partially erupted wisdom tooth) rather than extraction.
This will be a decision taken by the dentist after discussing the different options, risks, and considerations with you. c
Creating space
If there isn’t enough room for the wisdom teeth to erupt and/or other teeth are crowded, it might be necessary to remove the impacted wisdom teeth to create more space.
Dental hygiene
Sometimes, even when the wisdom tooth is fully erupted, because of its position so far back, it might still be difficult to clean well. Therefore, although enough space allows for eruption, not enough space is available to clean well, and extraction is recommended to be able to practice better hygiene.
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Cyst
Before the tooth erupts, the sack of tissue around it can grow into a cyst which can lead to bone loss in the jaw. 
Do you need to have wisdom teeth taken out in hospital?
When your wisdom teeth are fully erupted, but extractions are recommended, you might be able to have it done under local anaesthetic in the dental surgery. Consultation with your dentist will give you more clarity on what is best for you.
Not all dentists enjoy and/or prefer to remove wisdom teeth and would rather refer you to a maxillo-facial surgeon. It will be different for every person and therefore it is not recommended that you give advice to friends and family based only on your experience.
Some wisdom teeth are removed with very little or no complications, swelling or pain, and others are complicated with lots of pain and swelling afterwards. This has very little to do with how good the surgeon was who performed the extractions, but rather depends on the position of the teeth and how integrated they were in the jawbone. These are the factors responsible for swelling and pain afterward.
When your wisdom teeth are impacted and surgical removal is recommended, it is often better to have it done in hospital under general anaesthetic.
A third option is to have the wisdom teeth extracted under sedation (administration of sedative drugs and local anaesthetic). This can be done in a dental surgery by the dentist or a maxillo-facial surgeon. Not all dental professionals offer this option, and it is not recommended for everyone. Again, always ask your dentist for advice on your individual needs and situation.
Aftercare for wisdom teeth extractions
You should be able to get back to your normal daily activities within a day or two. If you have the extractions done in theatre, you rarely stay overnight. You might want to use a cold pack against your jaw intermittently to help with possible swelling.
- Do not rinse your mouth vigorously and in doing so dislodge the blood clot that has formed.
- Stay away from alcohol, using tobacco products and hot beverages for 24 hours.
- Do not engage in strenuous exercise for the first 10 days after extractions.
- Eat soft foods that will not bother the area.
Keep the extraction site clean. After eating make sure you rinse your mouth gently to dislodge any food particles from the extraction site.
You might be given a mouth rinse to use for the next couple of days. These rinses normally contain chlorhexidine and is only recommended to be used short-term. Long-term use will cause staining of the teeth, therefore, only use as recommended.
Risk of staining can be reduced by not drinking any tea or coffee for at least an hour or two after rinsing as there is an interaction between the chlorhexidine and tea & coffee. A good alternative is to rinse with lukewarm salt water – this will speed up the healing process and reduce the chance of infection. Do this a couple of times per day for about a week after the extractions.
Avoid brushing directly over the extraction site till the extraction cavity has close. Brush and floss the other teeth normally.
It is normal to have to take some painkillers after an extraction. Over-the-counter painkillers should be fine. If your dentist/surgeon prescribed painkillers and/or other medication, take these as directed.
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Possible complications
A dry socket can form if a blood clot doesn’t form or gets dislodged by vigorous rinsing or when tobacco products are used after an extraction. This will cause the nerves and underlying bone to be exposed.
A dry socket may also form when food particles get trapped in the extraction cavity. It is possible for this to happen after a simple extraction or surgical extraction. A dry socket usually occurs within 3-5 days of an extraction and is more common in the lower jaw.
Symptoms include severe pain, a throbbing sensation, an unpleasant taste, fever or swollen glands. The pain and other symptoms can last for up to 7 days. Treatment and intervention by the dentist/surgeon will relief the pain quicker and healing can commence. It is recommended to call your dentist/surgeon immediate when an increase in pain and discomfort in the extraction site is felt.
When the wisdom teeth in the lower jaw is very close to the nerve, the nerve might get damaged in the extraction process. Although this is very rare, it can happen. This can lead to tingling or numbness of the lip, tongue, or chin.
It can last anything from a few weeks/months to being permanent. If the risk of nerve damage is high, but extraction is still the choice of treatment, the surgeon might do a coronectomy (only the crown of the tooth is removed, but the roots are left in situ). This procedure may be controversial, but it eliminates the risk of nerve damage.
There is always a chance of infection after an extraction. If infection is going to occur, it will happen within the first 14 days after the extraction.
When to call the dentist/ surgeon after extractions
- When you have a hard time breathing or swallowing.
- Blood won’t stop oozing after a day or two or pain lasts more than a week.
- Your face or jaw stays swollen for more than a few days.
- You have a fever.
- You feel numbness or notice pus or a foul smell.
Factors to consider
If your wisdom teeth are impacted and treatment is recommended, it will not get any better with time. Your jaw is fully developed in your early 20’s (for females slightly earlier). The sooner you deal with the situation, the quicker you will be free from discomfort and complications.
Healing after extractions is quicker when you are young. Often wisdom teeth extractions are more complicated when you are older.
As we get older, life gets busier, and it will cause more disruption dealing with extraction of wisdom teeth.
Like many other things, these conditions tend to flare up at times when we least can afford it – before exams, wedding day, while pregnant or times when the body is under more stress, and it is not possible or ideal to have extractions done.
If you do not have medical insurance, or experiencing problems while on holiday or living abroad, this might be a very costly exercise which can be eliminated when you are pro-active.
Sometimes it is difficult to get an appointment with a maxillo-facial surgeon and you might not be seen at your convenience.
Although a lot of general information is available on the internet, always consult with your dentist and get a professional opinion on your own individual dental condition and health, as it is not a case of “one size fits all”!
Also read: When should I take my child to the dentist for the first time
We all heard some of these iconic phrases: mouthwash kills germs that cause bad breath. Mouthwash can reach areas that your toothbrush can’t.
