A pretty common experience with people who have ever visited a dental clinic for “tooth pain and swelling in the last tooth” with “difficulty in chewing and closing the mouth”.
The dentist generally gives a prescription for 3-5 days and advices “Surgical removal” of the tooth as “it is the wisdom tooth, an extra tooth which either hasn’t erupted completely or serves no purpose as it is”
The BIG Question: Is the extraction REALLY required or as the common perception goes “Dentists ALWAYS advice for tooth removal”
Revealing the secrets of when you REALLY need to undertake the SURGICAL REMOVAL
Let’s start with the basics first
What is a wisdom tooth and why is it called so?
Wisdom tooth is the last molar. There are two of them in each jaw and 4 in total. They are one of the total of around 80 vestigial organs in the body (the organs which have no known purpose and are indicators of our evolution).
Called so because they supposedly erupt when a person gets “wise”, that is around 16-23 years. They are the last tooth to erupt in the mouth. Sometimes, due to lack of space in the jaw or the improper positioning of the tooth, they might erupt partially or nor erupt at all. They might also erupt in the wrong position (the upper wisdom teeth tend to erupt towards the cheek) thus leading to constant “accidental” biting of the cheek while chewing.
When do they cause pain & how is this pain different from any other tooth pain?
If properly erupted and positioned in the jaw, the wisdom tooth would cause toothache for reasons similar to that for any other tooth i.e. due to a cavity and infection in the tooth or gums (they are the most known causes of toothache although there are many other reasons as well). Being the last tooth in the jaw, they are more prone to cavities and tooth infections as the food tends to get stuck there and people tend to ignore the area during brushing.
The added difficulties of conditions that are associated with a wisdom tooth arise typically when the tooth didn’t erupt in the proper position or hasn’t erupted at all. The improper position or non-eruption of the wisdom teeth is prevalent in around 50%- 60% of the population.
The types of issues that can arise due to such situations include
a) If the wisdom tooth is improperly positioned, it can cause:
Cheek or tongue biting during chewing due to the improper positioning of the teeth
Cavities in the adjacent teeth due an overlap that results in the food getting lodged between teeth
Pericoronitis: If the tooth doesn’t erupt completely it is covered by a flap of soft tissue of the gums. This flap has the tendency to entrap food. Once the food gets lodged there it decomposes and causes infection and swelling of this flap, known as Pericoronitis. This swollen gum tissue then constantly comes in contact with the upper wisdom tooth causing its ulceration. Pericoronitis along with the ulceration of the swollen tissue is very painful and causes difficulty in opening the mouth, chewing and can at times lead to throat infection as well.
Fatal infections: Being the last tooth it is very close to the collection of naturally occurring collection of loose fatty tissue at the back of the mouth. Any swelling/infection in this area can escalate and spread quickly to the throat, base of the eye and finally to the heart, lungs or the brain making it potentially fatal.
b) If the wisdom tooth does not erupt in the mouth:
In case the tooth has partially or completely formed, but not erupted in the mouth it can cause various issues including:
Damage to the roots of the adjacent tooth: an un-erupted wisdom tooth can cause damage to the roots of the adjacent teeth by applying pressure on it, resorbing the root. This situation if ignored might require the surgical removal of both the teeth.
Formation of a cyst around the un-erupted tooth: The un-erupted wisdom teeth are the most common site for a tooth associated cyst (a fluid filled cavity) of a non-infectious origin. These cysts might grow for years together without any pain or changes, with suddenly resulting in widening of the bone or loosening of adjacent teeth. These cysts can be pre-cancer and if ignored can result in cancerous growths.
How to know if you have any of the above listed conditions associated with your wisdom teeth?
Step 3: DO NOT ignore any swelling or pain in the last tooth region. Get proper medication to combat the infection.
Step 4: Find out the best procedure that suits you to get your wisdom tooth issues resolved.
When should you get it surgically removed?
It is generally advised to get the wisdom tooth removed by the age of 20 years (if it is known that it would not erupt correctly or not erupt at all).
If you believe that you have issues with the last tooth with difficulty to open your mouth or chew, the treatment would involve the following steps
Step 1: Get rid of the infection. Get the proper medicines to combat the infection. The invasive process cannot be started until the infection subsided.
Step 2: Get opinion about the best treatment option for you. There are multiple available options for the treatment of wisdom tooth which might NOT REQUIRE surgical removal. This could include medication and proper oral hygiene practices for the maintenance or just the removal of the gum flap above the tooth that entraps the food.
Find out if your case could be resolved by a minor intervention or no intervention at all.
Make an informed choice about the fate of your wisdom tooth wisely.