Manchester Dental Hospital Information Guide on Wisdom Teeth and What to Do If They Are Causing You Discomfort. By Dr John Mantel At Isnare.com Ezine Articles

As the last tooth to erupt , the third molar or wisdom tooth is the most likely to be prevented from doing so in a crowded mouth. Tooth and jaw size incompatibility or possibly an evolutionary tendency towards decreased jaw size could be the cause of discomfort.

Not all wisdom teeth need to be removed. Those which have space to erupt into a normal functional position usually are left to do so. Also those which are deeply buried or completely covered in bone are frequently asymptomatic and are best left undisturbed.

Upper wisdom teeth do not cause symptoms as often as the lowers. However they can be tilted towards the cheek and cause constant food lodgement, creating an area difficult to clean or restore. In such instances extraction could be considered as they could decay and also might cause cavities in the adjacent teeth.

Most often it is the lower wisdom teeth that cause symptoms, usually in the 18 -28 yr olds. The tooth usually breaches the overlying gums but does not have adequate space for complete eruption. The gum overlying the partially erupted tooth forms a sleeve/pocket for food lodgement. This leads to a condition called ' Pericoronitis'. There is infection and swelling up of the gums causing symptoms like pain, swelling, difficulty in opening the mouth or a foul taste/smell. If the upper wisdom tooth is present it might add to the symptoms by traumatising the swollen gums around the lower tooth.

Treatment options:-

On presenting with acute symptoms, the dentist should carry out a full examination.
X-rays are taken to determine the position of the tooth, degree of impaction, the root shape, proximity to the surrounding vital structures and density of the bone.
The sleeve of gum can be washed with hot salt water or an antimicrobial mouthwash. Pain killers and antibiotics can be prescribed. Advice should be keeping the area as clean as possible.

The opposing wisdom tooth, if it is present and adding to the symptoms, is best extracted to decrease the trauma.

Once the acute symptoms have settled there is a chance that they may not re-occur.

However it is justified to extract the wisdom teeth if:

there are repeated incidences of pericoronitis,
the tooth has deep cavity or is resorbing
is causing decay or resorption in the adjacent tooth
is associated with cyst or tumour
is in line of a fracture of the jaw

Extraction could be done under local anaesthesia , sedation or general anaesthesia depending on the condition. Frequently the gum flap is raised, bone around the tooth trimmed and the tooth sectioned for extraction.

Pain, swelling or difficulty in opening of mouth are common post operatively. As a complication there is a rare chance of Lingual nerve damage during extraction which could lead to numbness in the tongue or inferior dental nerve damage causing numbness and burning sensation of the lip.

On occasions where the dentist suspects the chances of nerve damage due to the proximity of the roots to these nerves, only the crown of the tooth is sectioned and removed (coronectomy). This leaves the roots inside the bone to eventually erupt with time making it easier to extract.

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