Wisdom teeth! Most people have them, a few lucky ones never get them, another very lucky few have room for them in their mouth, but most of us need to get them removed. Why?
First, if a wisdom tooth is impacted, it needs to be removed because the developmental cyst in which the tooth forms can occasionally enlarge, sometime changing form into other more problematic types of cysts and very very rarely transform into a cancerous cyst. Impacted wisdom teeth also can damage the roots of the 12-year molar when they are growing in at a forward-facing angle. These lesions on the 12-year molar are difficult to clean, hard or nearly impossible to restore sometimes and can result in loss of that tooth as well. So, what is impacted? Impaction basically means non-erupted. It can be full bony, partial bony or a soft tissue impaction depending on the amount of bone covering the tooth. They can also be described as angular, depending on the tip of the tooth as well as the dreaded horizontal impaction which looks like the tooth is laying on its side within the jaw. All this said, there are occasions when the surgeon will choose to leave an impacted wisdom tooth if it is dangerously close to a nerve or high up in the skull deep in or adjacent to the maxillary sinus. Those teeth must be monitored regularly via x-ray to be certain no cyst development occurs.
Sometimes the wisdom tooth partially erupts into the mouth behind the 12-year molar. This is another bad situation as it is impossible to clean this tooth that is exposed to the oral environment. It is prone to infection (pericoronitis) from food debris, plaque, or tartar getting caught under the gum as well as development of a cavity. Removal of these teeth is also recommended.
Sometimes a wisdom tooth will erupt in, for lack of a better description, a weird spot! Tipped toward the cheek or tongue and not in the arch creating another cleaning issue. The uppers that erupt this way can cause painful ulcerations on the cheek. Extraction is the best remedy.
The majority of patients in my practice just don’t have adequate space behind their 12-year molars to fit wisdom teeth in. We usually take a panoramic x-ray to view the position and root formation of the 3rd molars (wisdom teeth) at age 16. Obviously, if a new person comes to the office, we do the same to look at their 3rd molars. But being 16 offers an opportunity to remove the wisdom tooth before it has its roots completely developed and when it is still within the developmental cyst, but intimately surrounded by bone.
I wish I had a really good explanation as to why so few people have room for their wisdom teeth, but I really have none. I read that 10 million 3rd molars are removed annually in the United States alone, so I’m not alone in my recommendation of removing them before they cause any of the previously mentioned problems.
Therein lies my knowledge and thoughts about wisdom teeth, removal of which is one of the rites of passage from adolescence to adulthood!
Until next time.
Dr. C Mark Fort