Wisdom tooth

The wisdom tooth—also known as the third molar—is the last tooth to erupt in the dental arch, typically appearing in late adolescence or early adulthood. A dentist may recommend extraction if there is insufficient space for it to erupt properly, resulting in an impacted or partially impacted tooth, or if it causes inflammation, cavities, or damage to adjacent teeth.

Below, you will learn when wisdom tooth extraction is necessary, what impacted or partially impacted wisdom teeth are, what complications may arise, and what the recovery process entails.

The wisdom tooth is the third molar and appears in the rearmost part of the upper and lower jaws respectively. These molars require space in the fully developed dental arch to erupt normally. This is why they erupt at a later age than other permanent teeth, namely when the dental arches have fully developed.

Generally, wisdom teeth appear between the ages of 17 and 21. There are, however, exceptions. For example, the Guinness World Records lists the case of a young boy who had his first wisdom tooth extracted at the age of 9, whilst a 94-year-old man discovered, following a routine check-up, that a wisdom tooth was erupting at that age. Consequently, wisdom teeth can appear at practically any age.

Normally there are four such molars, two upper and two lower, which serve to chew, cut and break down the food consumed. However, there are people who do not have four wisdom teeth, but only a few. Wisdom teeth are only useful if they develop correctly and are healthy. Otherwise, they can lead to gum infections, damage to other teeth and other problems, in which case extraction is necessary.

An impacted wisdom tooth is one that fails to fully erupt into the oral cavity, remaining partially or completely trapped within the bone or beneath the gum. This situation often arises when there is insufficient space in the dental arch or when the tooth is positioned unfavorably for eruption.

A partially impacted wisdom tooth erupts only partially, leaving a portion of the tooth covered by the gum. Food debris and bacteria can accumulate in this area, potentially leading to gum inflammation, local infections, and tooth decay.

An impacted or partially impacted wisdom tooth does not necessarily require extraction in every case. The decision is made following a clinical and radiological assessment, taking into account the tooth's position, symptoms, the risk of damage to the adjacent tooth, and the presence of complications.

If the impacted tooth causes pain or recurrent infections, damages the adjacent tooth, develops cavities, or is associated with other lesions, the dentist may recommend surgical extraction.

Wisdom tooth extraction is not necessary in all cases. The recommendation is made following an assessment of the molar's position, its eruption pattern, associated symptoms, and the risk of complications.

Extraction of a wisdom tooth may be indicated when it causes pain or recurrent infections, remains impacted or partially erupted in a problematic position, develops cavities that are difficult to treat, affects the adjacent molar, or is associated with other pathological changes observed clinically or radiologically.

Reasons why wisdom teeth need to be removed 

The problems that can arise with wisdom teeth relate, in particular, to the position in which they develop and the way they erupt. From this perspective, the following situations are serious reasons why extraction might be recommended or even necessary: 

• the molar erupts only partially and favors the accumulation of bacteria and the appearance of inflammation or infection;
• the wisdom molar remains included or semi-included and has a position that can affect the neighboring tooth;
• there are repeated episodes of pericoronaritis, with pain and inflammation in the gum around the molar;
• there are extensive caries at the level of the wisdom molar or the neighboring tooth, and conservative treatment is difficult or impossible;
• the molar exerts pressure on nearby structures or contributes to their damage;
• cysts or other pathological changes associated with the tooth are identified;
• sanitizing the area is very difficult and there is an increased risk of local complications.

The decision to extract is determined individually, based on clinical examination and, when necessary, radiological investigations.

Symptoms

The American Dental Association recommends the extraction of wisdom teeth if certain symptoms or signs appear in the area of these molars, such as:

• gum pain;
• bleeding gums;
• cysts or swelling in the molar area;
• repeated infections of the soft tissue behind the wisdom tooth;
• tumours;
• damage to adjacent teeth;
• gum disease;
• extensive tooth decay;
   

When a wisdom tooth does not need to be removed

However, wisdom tooth extraction is not always absolutely necessary. If the tooth is healthy, has fully erupted through the gum, is correctly positioned, makes good contact with the other teeth during chewing, and can be easily cleaned when brushing your teeth, then extraction is not essential. Similarly, wisdom tooth extraction is not necessary if they are embedded in the bone and do not affect chewing in any way.

A very important point is that some dentists recommend wisdom tooth extraction as a preventive measure, because, as you have seen, they can cause countless problems once they are allowed to develop. Many researchers and public health experts do not, however, agree with this approach, especially if the wisdom tooth is healthy. Therefore, if your dentist suggests preventive extraction and you are unsure whether you should go ahead with it, it would be advisable to seek a second opinion.

As well as becoming impacted in the gum or erupting only partially, wisdom teeth are positioned in such a way that they are difficult to clean. All of these factors can lead to a number of problems that you should not ignore when deciding whether or not to follow your dentist’s advice to have them extracted:

• Infection of the gums around the wisdom teeth (pericoronitis) – this is one of the main reasons why wisdom teeth need to be removed. It is an infection that can become serious and causes pain and swelling. Sometimes, however, the symptoms may be milder.
• Tooth decay – can occur on the wisdom tooth or the tooth next to it. Tooth decay may not be an emergency, but if it ends up affecting the tooth’s nerve, an abscess may form. This will be accompanied by pain.
• Periodontal disease – wisdom teeth can be affected by periodontal disease or can contribute to its development in the adjacent tooth. You may have no symptoms, but over time, due to bacteria, complications can arise.
• Cyst formation – this is quite rare, occurring when the molar has not broken through the gum to erupt. All teeth develop within a sort of sac, and sometimes this expands like a balloon. Over time, it can grow larger and must be removed.

These are the most common complications that can arise if wisdom teeth are unhealthy and extraction is not carried out in good time. However, there may be other issues that a surgeon can explain to you, depending on the individual case.

Tooth extraction is a surgical procedure to remove one or more wisdom teeth. Most such procedures do not involve significant risks or long-term complications, but this depends very much on the technique used. However, in the case of teeth growing into the gum, an incision and bone removal may be necessary. Very rarely, complications that may arise include infections caused by bacteria or food debris that has not been properly cleaned, damage to neighbouring teeth, nerves, sinuses or the jawbone.

Therefore, even though it may appear to be a simple procedure, it is advisable to research the dental practice where you are having the procedure carried out very carefully, as modern technology can ensure safer conditions and help you recover more quickly. The duration of the procedure depends on the tooth and the complexity of the operation.
 

X-ray

During a simple routine check-up, your dentist may notice that something is wrong, but cannot tell what is going on inside your gums. Therefore, they will recommend a dental X-ray to establish a diagnosis and, subsequently, to determine the steps to be taken during the operation. It is possible that your mouth is too small for your wisdom teeth to develop normally, or that the teeth are growing into the gum in the wrong direction, affecting the roots of other teeth or even the jawbone.

The dentist’s decision to extract the tooth may not be made immediately, as there are situations where the development of the wisdom teeth needs to be monitored. Sometimes this can take several months. If, in the meantime, you start to experience pain, notice swelling or detect an unpleasant odour in the area where the tooth is located, do not hesitate to tell your dentist.
 

Surgical extraction 

Before the operation, the surgeon will decide on a type of anaesthesia, depending on the complexity of the extraction and your comfort level. Therefore, they will either administer local anaesthesia or sedate you intravenously and also administer local anaesthesia, or they will use general anaesthesia.

To give you a general idea of what the surgeon does during the extraction, here is a brief overview of the steps:

• they make an incision in the gum tissue to reach the tooth or the bone, in the case of impacted or partially impacted molars;
• they remove the bone blocking access to the tooth root;
• they cut the molar into two sections if it is easier to remove it in pieces;
• removes the molar;
• cleans the extraction site of any remaining tooth or bone;
• stitches the wound, although this is not strictly necessary;
• apply a sterile dressing to prevent bleeding and aid blood clot formation. These are very important in the recovery process as they prevent excessive bleeding, protect the wound from infection and the exposed bone, and aid the growth of new tissue. 

Wisdom tooth extraction is one of the most common dental surgical procedures. Recovery can take up to two weeks. Post-operative care is very important and helps you recover more quickly.
 

Recovery time

Sometimes stitches are needed to close the wound. The surgeon will usually remove the stitches one week after the procedure. You may experience bruising, swelling and pain following the operation, which means it will take a little longer to make a full recovery. Regardless of the situation, you will gradually return to normal, noticing an improvement every day. Recovery time varies from patient to patient. If infections or bleeding occur, it may take longer.

In short, the recovery process could be outlined as follows, in terms of the time it takes to make a full recovery:

• the first 24 hours – blood clots form;
• 2–3 days – swelling in the mouth and cheeks should subside;
• 7 days – the dentist can remove the stitches;
• 7–10 days – stiffness and pain in the jaw should disappear;
• 2 weeks – any slight bruising on the face should have healed.
   

Post-operative care 

For an effective and speedy recovery, it is advisable to follow your doctor’s advice. This may cover several aspects, such as:

• Bleeding – you may experience some bleeding on the first day. Try to avoid spitting too often, as this may dislodge blood clots. Remove the dressing only as instructed by your doctor;
• Pain – your doctor may prescribe a painkiller, especially if a piece of bone had to be removed. You can also apply an ice pack to your cheek to relieve the pain;
• Swelling and bruising – use an ice pack as directed by your dentist. Any swelling on your cheek should subside within 2–3 days. Bruises take longer to fade;
• How active you should be – after the extraction, try to rest for the whole day. Even in the days that follow, it is best to avoid activities that could dislodge blood clots, which, as you have seen above, are very important for the wound to heal;
• What you are allowed to drink – it is recommended that you drink plenty of water. In the first 24 hours, do not consume alcohol, fizzy drinks, hot drinks or drinks containing caffeine. Do not use a straw for at least a week to avoid damaging the clots;
• What you can eat – for the first 24 hours, stick to soft foods such as yoghurt or apple juice. Only start eating slightly firmer foods once you find you can tolerate them. Avoid eating foods that require vigorous chewing, are too hot or too spicy, as these can penetrate the freshly operated area or irritate the wound;
• Oral hygiene – it is very important to brush your teeth properly and do so three times a day, but in the case of a wisdom tooth extraction, it is recommended that, for the first 24 hours, you refrain from brushing, avoid rinsing your mouth too vigorously or spitting. After 24 hours, brush your teeth, but take care, especially around the operated area; rinse very gently with warm salt water once every two hours or after meals for a week;
• If you are a smoker – avoid smoking for at least 72 hours after the operation. If you chew tobacco, try not to do so for at least a week;
• Stitches – these may be dissolvable and will come out in a few weeks, or they may not have been needed at all. If the stitches need removing, do not do this at home yourself; instead, go to the dentist.

So, wisdom teeth require a little more special attention than the other 28 teeth. This is because they are in a difficult position and you cannot easily control either changes to their appearance or their cleaning. It is therefore essential to visit the dentist regularly to prevent any complications caused by them at an early stage, and if you do end up needing an extraction, follow the surgeon’s advice so that you can recover as quickly as possible.