|Ah, wisdom teeth. The story is that these are called “wisdom teeth” because they tend to “come through” when a person is between the ages of 17 and 21 – an age where you would expect to have some “wisdom” – although now that 30 is the new 20, I don’t quite know WHAT you’d call wisdom teeth! Common complains amongst people of this age that either their wisdom teeth are causing their front teeth to shift OR they are having pain from the region.So why are wisdom teeth such a pain?Third molars, or wisdom teeth, are the last of the adult teeth to erupt and in most cases erupt into a jaw which is lacking in space to accept these large teeth.Anecdotal evidence suggests that as our diets become more and more processed and refined we just do not use our jaws (and jaw muscles) to the extend that affords the bony accommodation towards larger jaws – our foods are too soft and we don’t need strong muscles and concurrently large jaws to mash it all up!As such, if mom and dad fed you the occasional side of raw meat and chucked you some unprocessed grains to go with it whilst you were growing up, you’re likely to have well developed jaw muscles and a consequently large jaw! Commonly then, we end up with smaller jaws with less space for the wisdom teeth. Which become impacted (which is a fancy dental way of saying “stuck behind” something).There are many forms of impaction with the most common being soft-tissue impaction (stuck underneath gum tissue) and mesial impaction (stuck underneath the back of the second molar).Why remove wisdom teeth?
Well, firstly, it is not always necessary to remove these teeth and in some cases, removal would be more detrimental than leaving things as they are. The main reasons for the removal of these teeth are infection and the potential for the formation of an abscess and/or cyst in the jaw, damage to the molar tooth IN FRONT of the wisdom tooth due to resorption and decay with the potential for infection due to the inability to effectively clean the wisdom tooth.
It is really important to have your wisdom teeth assessed in your late teens and/or early twenties as any problems spotted early on can be treated more readily and with less complications!
The most common complication post-operatively is infection with subsequent pain and swelling, but the most dramatic complication of wisdom teeth extraction is nerve damage resulting in a numb lower lip or side of tongue – for life! Fortunately, the latter complication is rare and is a risk usually when the tip of the roots of the wisdom tooth come into close approximation with a rather important nerve that runs to your lower lip (or the nerve that runs to the side of your tongue)!
Most wisdom teeth operations are carried out under IV sedation, although general anaesthesia is also available.
As part of my standard practice, I normally request a CT scan if I have doubts as to the relationship between the nerve and the root, but this is not commonly asked for – partly because of the cost involved!
Before undertaking wisdom teeth surgery, make sure you ask your dentist for the reasons why your teeth need coming out, what are the possible complications (and always specifically ask about nerve damage), what are the post-operative complications, and the costs involved. In some cases, you may have to be referred off to a specialist surgeon for their removal.
Dr Adrian Tan is a general practitioner based on Auckland’s beautiful Viaduct Harbour. He has a special interest in surgery and cosmetic dentistry, which helps him feed his two little dogs. He makes regular contributions to New Zealand’s largest charitable organisation, the IRD.