Wisdom Teeth – The Sooner the Better …

When it comes to wisdom teeth, early evaluation and careful diagnosis is crucial.  In most instances, wisdom teeth need to be removed to avoid the initiation of problems with other adjacent structures like gum tissues, cheek, jaw and other teeth.  The ideal ages for evaluation and treatment are between 18-24.  The sooner wisdom teeth are evaluated, the better.  It is important to understand that  not all wisdom teeth need to be extracted.  I still have mine.  They are all fully erupted and functional and I have no intentions of parting with them.

Wisdom teeth are the third and final set of molars that most people get in their late teens or early twenties. Sometimes these teeth can be a valuable asset to the mouth when healthy and properly aligned, but more often, they are misaligned and require removal.

Potential Problems

Wisdom teeth present potential problems when they are misaligned – they can position themselves horizontally, be angled toward or away from the second molars or be angled inward or outward. Poor alignment of wisdom teeth can crowd or damage adjacent teeth, the jawbone, or nerves.  In addition, wisdom teeth can be entrapped completely within the soft tissue and/or the jawbone or only partially break through or erupt through the gum. Teeth that remain partially or completely entrapped within the soft tissue and /or the jawbone are termed “impacted.” Wisdom teeth that only partially erupt allows for an opening for bacteria to enter around the tooth and cause an infection, which results in pain, swelling, jaw stiffness, and general illness. Partially erupted teeth are also more prone to tooth decay and gum disease because their hard-to-reach location and awkward positioning makes brushing and flossing difficult.

The Effect of Wisdom Teeth on Second Molars

Wisdom teeth that are crowded or impacted can cause potential damage to adjacent second molars (the tooth in front of the wisdom tooth). If misdirected wisdom teeth are erupting adjacent to a second molar, resorption of the root or decay in the crown of the second molar can develop which will cause the second molar to either need a root canal or become extracted. This is the worst case scenario if both molars have to be lost.  If found early enough the second molar can be saved with root canal treatment.  Better yet, if evaluated between the ages of 18-24, the need for extraction of the wisdom tooth can be determined and the second molar would never have any insult.

What justifications are given for wisdom tooth extractions?

  • Valid reasons to extract wisdom teeth.
    ◦Pericoronitis / Infection associated with a wisdom tooth.
    ◦Complications associated with tooth decay.
    ◦Periodontal disease (gum disease).
    ◦Pathology (cysts, tumors) associated with a wisdom tooth.
    ◦Chronic pain or discomfort.
    ◦Risk of damage to adjacent teeth / Root resorption



Comments

  1. Sharri Tola says:

    Thanks for sharing such valuable information not found anywhere eles. I need some advice about tooth decay and possible extraction. 1 week ago I noticed that a small part of my 1st bi cuspid tooth (upper) had chipped away. I went to see my dentist who took a couple of xrays. She told me that I had calcification of my root canal therefore I needed the tooth removed as root canal was not an option. I don?t have any pain at all therefore this seems a bit extreme. I really don?t want the tooth removed if it is not necessary and would really appreciate some advice.

  2. Dr. Ronald C. Taylor says:

    Hello Sharri,
    I am all too familiar with your situation. The specialty of endodontics has made vast improvements in technology in the past 15 years. The use of microscopes to enhance visualization and illumination and the addition of ultrasonic instrumentation have enabled root canal specialist to successfully treat the most complex of calcified root canal systems. Unfortunately some general dentists are not totally clear on the full scope of what an endodontist can do and for this reason they may recommend extraction of a tooth without even proposing the option of referral to a specialist. I would recommend getting a consultation from your local endodontist. Make sure he is a certified endodontist. Some endodontists have a masters degree and have completed extensive research in the field and defended a thesis. Twenty five percent of endodontists are board certified or Diplomates of the American Board of Endodontics. They have gone through a rigourous process on their own will, which includes a series of examinations to attain this level of distinction.

  3. Richard Melenson says:

    Several years ago, I had a cavity filled in the wisdom tooth at the upper left part of my mouth. I am seventy years of age and still have all four of my wisdom teeth which all are fully erupted and functional. The filling was so large that it butted right against the nerve of the wisdom tooth. This wisdom tooth has always been sensitive to cold and heat but I have tried to protect this tooth by avoiding very hot and cold foods and drink. Just recently, this tooth has become very sensitive and I have had severe pain from this tooth. My dentist tells me that I can either have this wisdom tooth extracted or have root canal work and a crown placed on this tooth. If I have the tooth extracted, I will lose about 20% of the occlusion for this tooth. If I have root canal work done on this tooth and then a crown placed on it, I am concerned that the occlusion will not be perfect and I will have pain from the tooth. Since most people have their wisdom teeth extracted, I am wondering just how much experience entodontists have doing root canals on wisdom teeth and would I suffer because of their relative inexperience. I really don’t know what to do and would be grateful for any advice you can give me. The cost to do a root canal and crown is about $1,000 compared to about $200 for an extraction. My dentist tells me that an extraction would be relatively easy because there is only one root to this wisdom tooth.

    • Hello Richard,
      If your wisdom tooth is in occlusion and funtional you can save it with root canal treatment and a crown. Putting the crown in it’s correct occlusion shouldn’t be an issue. If you extract the tooth, the opposing wisdom tooth should be extracted as well or it will super-erupt and may even cause some shifting.

  4. Rio Beckwith says:

    My situation is almost identical to Mr. Melenson’s. I am 72 yo and had a gold crown installed on my right maxillary wisdom tooth 5 years ago. I still have all 32 teeth and all of my wisdom teeth are fully erupted and aligned. I brush twice a day and floss once a day and have usually had regular prophylaxis every six months.

    Unfortunately my dentist retired four years ago and the dentist who replaced him immediately wanted to extract all four of my wisdom teeth. I demurred and have been searching for a new dentist since then. I recently started experiencing pain in the subject tooth and finally selected a very well qualified and highly recommended dentist and he found I had an abscess under the tooth. He put me on a course of Penicillin and scheduled me for a root canal in four weeks. He showed me the infection on the x-ray and said the tooth is dead and described how he could drill through the existing crown to do the root canal and that a new crown would not be required.

    I trust my new dentist but it is perplexing that one dentist recommended a root canal and another was insistent about removing all my wisdom teeth. A night of research on the Internet shows me the same dichotomy of opinion among dentists. Can you give me your thoughts on the situation?

    Thanks.

    • summ says:

      I was also doing research regarding wisdom tooth, I got one extracted bottom left this March. Here are few observations I thought I would share -
      1. First dentist recommended to remove all 4. And three had erupted fully,one was partial erupted.
      2. I kept them for few years and one got infected so one had to be removed. The dentist did not extract herself, She send me to oral maxofacial surgeon. Very easy procedure. Was placed in liquid diet for three days then one week of discomfort. Routine check up after four days.
      3. Second dentist recommended removing four of them
      4. Third dentist recommended if wisdom tooth don’t bother me then don’t get them extracted.
      5. A dentist and dental hygienist said I need to remove only three of them.
      So it depends, if the tooth bothers you then get it extracted by dental surgeon or oral surgeon.
      They are specialists and do job better than dentists. Now I myself want to get one more bottom one removed because it is causing a pimple and slight gum swelling. So keep shopping for better dentist until you start to trust one. Do not hesitate to change dentist and get a second opinion.

      I hope that sheds some light on your situation also. I did my research on the net a lot before choosing my dentists.

  5. Kristi Neumann says:

    Hi,

    I am 22 years old and have recently had some pain in my upper right molars. My wisdom teeth have not yet come in, but the one on the upper right is on it’s way and I can sense that it is the cause of my pain. The last tooth in the back it turned, and it seems like the root it hitting the one in front of it, which is being pushed to the side. The pain is absolutely unbearable and its constant. I am a college student and have no dental insurance, my dad is out of work, and I just don’t know what to do. After reading your article I can see that something has to be done, or else I’m in serious trouble with my teeth. Do you have any advice?

    Kristi

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