Written by Dr. Dominique Laatz MSc. MSc. (Oral Surgeon, German Dental & Dermatology Center, Doha, Qatar)
The frequency of wisdom teeth-related problems is so high, that the question about how to deal with them, is affecting the lives of a strong majority of families around the globe. And, given the widespread (and to some extent justified) fears about wisdom teeth extractions, this isn’t a casual topic in most cases. Unjustified, overblown fears, on the other hand, can create a vicious cycle of neglecting a worsening condition.
For this reason, the patients and, in many cases, the parents of underaged children need a clear understanding of the common risks involved in a wisdom tooth extraction. But, as important as understanding the risks may be, even low risks never justify an invasive medical procedure, if its benefits don’t outweigh these risks significantly. So I will also try to explain the potential benefits in the following.
The wisdom tooth dilemma explained
Wisdom teeth are very frequently found throughout the global population. They are also called third molars and are the most likely of all teeth to be either fully- or semi-impacted and dislocated in position and angulation. This is due to lack of spacing within the jaw, which anthropologists usually explain as an evolutionary process. Humans simply don’t seem to need a bigger jaw giving space to a greater number of teeth – hence wisdom teeth can be understood as rudimentary in the evolution of the human being.
Unfortunately, obstructed and mispositioned wisdom teeth – if left untreated – can cause pain, infection, swelling and destruction of adjacent tooth structure. In other cases, they might interfere with a planned orthodontic tooth movement.
In both scenarios, wisdom tooth removal might be inevitable.
So, what are the most common risks?
Impacted wisdom teeth frequently display a close proximity to the lip nerve in both sides of the lower jaw. Among other areas, this nerve is mainly responsible for the sensitivity of the lip and the adjacent soft tissues of the chin area, which extends to the facial midline from each side. Hence, damaging the nerve while wisdom teeth extractions can cause reversible or – in more severe cases – irreversible numbness in the corresponding lip and chin area.
Incidents of this sort though, are very rare and can – in the opinion of the author – be almost completely evaded by leaving the tips of entangled roots around the nerve structure in cases of severe proximity. This technique is a slightly modified form of what specialists came to call “coronectomy”.
Infection after wisdom teeth removal:
The most relevant and most feared infection type after wisdom teeth removal in the dental clinic , is the so-called “dry socket”. This term describes a condition of delayed healing after loosing the protective blood clot in the aftermath of a tooth extraction. It usually occurs in the back of the lower jaw and can cause severe pain and abscesses due to a bony infection inside the empty extraction socket.
In my experience the most frequent cause is spitting, which can easily discharge the unstable blood clot within the first two days after extraction. Other causes can be associated to under-pressure, which is why the patient should temporarily refrain from drinking through straws. Also excessive food impaction may induce or purport a dry socket
If this is clearly communicated to the patient, dry sockets are a very rare problem.
And what are the benefits?
Prevention of wisdom teeth associated infections:
Especially partially impacted wisdom teeth can become a dangerous “food trap”. Dangerous, because this usually leads to a chronic infection which at one point, and often after many years, can cause abscesses in the cheek and in the area under the jaw.
Your dental specialist can best evaluate your specific risk profile and determine if a preventative removal may be indicated.
The question whether wisdom teeth can cause crowding in the jaws, can’t be answered with final certainty. The majority of the scientific literature suggests no significant influence of wisdom teeth on tooth alignment, but some practitioners and parts of the literature disagree.
But wisdom teeth can be an obstacle when it comes to solving certain orthodontic problems like uprighting or rearward movements of lower molars.
Your orthodontist is best equipped to see, if there might be a significant interference in your specific situation.