By Dr Wong Wai Yee, Dental Specialist in Oral & Maxillofacial Surgery

Wisdom teeth (also known as the third molars) are the last teeth to develop and erupt into the oral cavity. They are called wisdom teeth as they erupt around the time when most individuals are reaching adolescence, a time of life also known as the “Age of Wisdom”.

Most people have 4 wisdom teeth and they will come in at the corner of the jaws. As our jaws are much smaller compared to our ancestors’, most of the time, there is not enough space in the jaws to accommodate the wisdom teeth by the time they erupt. As such, the wisdom teeth often become impacted, poorly positioned and may lead to a host of potential problems.

Reasons to have your wisdom tooth removed:

1. Recurrent gum infection

As there is not enough space for the wisdom tooth to come through, they may emerge partially with only a gum flap covering the tooth. The space underneath the flap is very hard to clean and often accumulates food and bacteria. This in turn will lead to gum inflammation and infection-causing pain, swelling and jaw stiffness. Some individuals may experience fever, lethargy, bad breath, unpleasant taste and sore throat. In more serious cases, it can lead to serious orofacial infections that can be life threatening.

2. Decay

A partially erupted wisdom tooth in a slanted position tends to trap food particles between the wisdom tooth and the adjacent tooth. As the area is quite difficult to clean, this will eventually lead to decay of the wisdom tooth as well as on the tooth in front. It is very difficult to diagnose and treat this kind of decay and it may lead to more complicated and costly treatments for the tooth in front. Sometimes, a tooth with advanced decay may not be salvageable and thus, be extracted.

3. Chronic gum disease

Failure to keep the area between an impacted wisdom tooth and the tooth in front clean may cause chronic gum infection and disease, leading to severe bone loss distal to the tooth in front. Loss of bony support may weaken the tooth in front as well.

4. Pressure pain

Wisdom tooth that are trying to come out will cause some pressure on its’ neighbouring teeth and in some instances result in overcrowding or erosion of these teeth. In some cases, wisdom teeth may grow outwards toward the cheek and rub against the inner side of the cheek, leading to frequent ulcer formation and pain.

5. Cyst formation

A cyst (fluid-filled sac) can develop around the crown of a completely buried wisdom tooth- causing insidious bony destruction, jaw expansion, damages and displacement of nearby structures such as neighbouring teeth and nerves. If undiagnosed, cysts can grow very large over the years, causing obvious facial disfigurement and higher risk of pathological fracture of the jaws.

6. Preventive reasons

Wisdom teeth problems usually surface secondary to stress and fatigue. It tends to be prevalent in people with a hectic work-life and during stressful periods like examinations, competitions or even traveling. Wisdom teeth problems add on to their stress and further inconveniences them.

By electing to remove the wisdom teeth before the problems begin, one can prevent interference with school, work, sports, travel and other special events.

For females who are planning to start a family, it is advisable to have your wisdom teeth removed prior to getting pregnant since pregnancy will put you at a higher risk of getting gum infection surrounding your wisdom teeth. However, if you are pregnant and have wisdom teeth problems, the best time to remove the tooth will be during your 2 nd trimester of pregnancy.

When is the best time to remove your wisdom tooth?

The AAOMS/ OMSF study strongly recommends that wisdom teeth be removed by the time the patient is a young adult in order to prevent future problems and to ensure optimal healing. This is when the roots of the wisdom teeth is not completely developed and the bone is more elastic- rendering easier removal and minimising risks associated with the surgery such as nerve injury.

How is the procedure performed?

Your surgeon may have to make a small incision on your gums to expose the tooth. A small amount of bone may have to be removed as well if your tooth is buried within the bone. Once the tooth is exposed, it may have to be divided into segments so that it can be removed easily and safely.

The incision in your gums will be closed back with stitches.

The wisdom teeth can be removed under local anesthesia, with or without intravenous sedation. Some cases may be indicated for removal under general anesthesia.

You can discuss with your surgeon on the types of anesthesia suitable for you.

What to expect after surgery?

There is usually some swelling and discomfort over the surgery site for the first two to three days after surgery. Some may experience bruising on the face as well. It is very important to follow the post-operative instructions given by your surgeon to facilitate uneventful healing.

You can use some ice packs and prescribed pain medications to help relieve the swelling and discomfort. You are still expected to brush the rest of your teeth and keep your mouth clean. An antiseptic mouthwash is usually prescribed to help with the healing process.

A follow-up visit may be scheduled to allow your surgeon to ensure that your wound is healing properly.

What are the restrictions after surgery?

Try to rest as much as you can, especially during the first 24 hours after surgery. This is to minimise the risk of bleeding problems. Avoid smoking, exercising and using a straw for the first 24-48 hours. Do not take alcoholic drinks while you are still on prescribed medication.

You may wish to keep to a liquid or soft diet for the first three days before slowly resuming normal diet thereafter.

Are there any risks involved?

As with any surgery, there are risks associated with wisdom tooth surgery. An impacted wisdom tooth may develop in close proximity to the nerve within the lower jaw, which can be injured during its removal. When this happens, it may manifest as temporary numbness or tingling of the lower lip, chin or tongue. Only on rare occasions does this numbness end up being permanent.

However a more common complication is the occurrence of a dry socket whereby a blood clot failed to form over the socket. This can sometimes occur for no apparent reason, but is often caused when patients use a straw, smoke, spit or do any type of sucking action too soon after the surgery. This can be very painful and will usually resolve by itself.

For more information or to make an appointment, please call our appointment hotlines or email us at dental@raffleshospital.com

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