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Wisdom Tooth

WISDOM TOOTH

Dr. T. Elangovan. M.D.S., D.M.L.E.,
Consultant Oral & Maxillofacial
Pathologist & Dental Surgeon. 

Wisdom teeth are the third and final set of molars that most people get in their late teens or early twenties (ideally between the ages of 17-25). Although formally known as third molars, the common name is "wisdom teeth” because they appear so late – much later than the other teeth, at an age where people are presumably "wiser" than as a child, when the other teeth erupt. The term probably came as a translation of the Latin: dens sapientiae. 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. Poor alignment of wisdom teeth can crowd or damage adjacent teeth, the jawbone, or nerves.Wisdom teeth can more often be impacted -- enclosed within the soft tissue (gums) and/or the jawbone or only partially erupt through the gum. Partial eruption of the wisdom teeth allows 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.

HISTORY: Wisdom teeth are vestigial third molars that used to help human ancestors in grinding down plant tissue. The common postulation is that the skulls of human ancestors had larger jaws with teeth, which were possibly used to help chew down foliage to compensate for a lack of ability to efficiently digest the cellulose that makes up a plant cell wall. As human diets changed, smaller jaws gradually evolved, and hence the third molars, or "wisdom teeth", which are last teeth to erupt, suffer from lack of adequate space resulting in improper or malpositioning.

REMOVAL OF WISDOM TOOTH:
The best treatment option for a malpositioned wisdom tooth is removal or extraction. The relative ease at which your dentist or oral surgeon can extract your wisdom teeth depends on their position and stage of development. Your dentist or oral surgeon may recommend that your wisdom teeth be extracted even before problems develop. This is done to avoid a more painful or more complicated extraction that might have to be done a few years later. Removal is easier in young people, when the wisdom teeth roots are not yet fully developed and the bone is less dense. In older people, recovery and healing time tend to be longer.

PROCEDURE:
Before your wisdom teeth are pulled, the teeth and the surrounding tissue will be numbed with a local anesthetic. If you are too anxious about the procedure, in addition to the local anesthetic to numb the pain, your dentist or oral surgeon may decide to even give you a sedative.After having your wisdom teeth removed, the speed of your recovery depends on the degree of difficulty of the extraction (a simple extraction of a fully erupted tooth versus a tooth impacted into the jawbone). In general, here's what to expect.

During the first 24 hours·        
Bleeding may occur for few hours after tooth extraction. To control it, position a piece of clean moist gauze over the empty tooth socket and bite down firmly. Apply constant pressure for about 45 minutes. Repeat this process if a small degree of bleeding continues; if heavy bleeding continues to occur, contact your dentist or oral surgeon. Avoid rinsing or spitting for 24 hours after tooth extraction, avoid "sucking" actions (for example, don't drink beverages through straws or smoke) and avoid hot liquids (such as coffee or soup). These activities can dislodge the clot, causing a dry socket (see below) to develop.·        
Facial swelling in the area where the tooth was extracted typically occurs. To minimize swelling, place a piece of ice, wrapped in a cloth, on that area of your face on a schedule of 10 minutes on, followed by 20 minutes off. Repeat as necessary during this first 24-hour period.·        
Pain medications can be taken for minor pain. Your dentist or oral surgeon may prescribe potent pain relievers, if necessary.·        
Antibiotics that may have been prescribed prior to tooth extraction (to treat any active infection around the wisdom tooth to be extracted) should continue to be taken until the full prescription is gone.·        
Foods should be restricted to a liquid diet until all the numbness from anesthesia has worn off. Eat soft foods for a few days. Also avoid alcohol if you're also taking narcotic pain medication.·        
Continue to brush your teeth, but avoid the teeth directly neighboring the extracted tooth during the first 24 hours. On day two, resume the gentle brushing of your teeth. Do not use commercial mouth rinses -- these can irritate the extraction site. 

After the first 24 hours  

• Facial swelling in the area of the tooth extraction should be treated with heat after the first 24 hours of ice. Apply a moist warm towel to the area on a 20-minute on, 20-minute off schedule. Repeat as necessary. 
• Rinse your mouth with warm salt water (1/2 teaspoon of salt in a cup of warm water) after meals and before bed. Do not use commercial mouth rinses.·     
• Stitches , if used and if not of the self-dissolving type, need to be removed by your oral health care provider in about 1 week. ·      
• Watch for signs of dry socket (described below). This condition requires treatment by your oral health care provider.·      
• Complete healing doesn't occur for a few weeks to a few months following the extraction. However, usually within the first week or two, enough healing has taken place for use of your mouth to be reasonably comfortable in the area of the extraction. Your dentist will explain what to expect in your specific case.

What Are Potential Complications of Wisdom Tooth Removal?·        
Dry socket. Dry socket is a common complication that occurs when either a blood clot has failed to form in the extracted tooth socket or else the blood clot that did form has been dislodged. Without clot formation, healing will be delayed. When it happens, dry socket typically occurs 3 or 4 days following the extraction and is accompanied by pain (ranging from "dull" to moderate to severe) and a foul mouth odor. Your dentist or oral surgeon will treat the dry socket by placing medication in the socket.

Paresthesia. Paresthesia is a rarer complication of wisdom teeth extraction. Wisdom teeth entrapped in the jawbone are often close to nerves. Sometimes these nerves can be bruised or damaged during the tooth removal process. The result is a numbness (called a paresthesia) of the tongue, lip, or chin that can last a few days, weeks, months, or may even be permanent. 

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