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WISDOM TEETH: WHEN TO KEEP, AND WHY TO TAKE OUT

Hello everyone!

Doctor Shervin here from Artistic Dental Studio with another blog.

I’m going to cover the topic of wisdom teeth for you today and I’m very excited, because it’s a very hot topic, as there are many questions around this, and I’m very happy to be able to address some of them.

Now let’s jump in and begin with why this topic is so important: the reason why it’s so important is because wisdom teeth are problematic! The reason could be either inadequate space for them to grow, or some kind of misalignment involved, or unusual shapes.

Now the question is why this thing is happening?

To answer this question, we need to get back to several thousand years ago, when the primary diet of human beings were somethings like fibrous foods and they were very hard to chew, mainly consisting of grains and vegetables. This is why jaws and the size of the face were much bigger than what it is right now. Our diet now is shifted to processed soft foods and these changes in the process of evolution overtime has caused human beings to have small faces, smaller especially lower jaws. Wisdom teeth are the teeth in the evolution process that have undergone major changes, as we can see many people without wisdom teeth nowadays. They are getting eliminated and in many people, they can’t grow or they just come out with different angles and in odd locations.

So, all these have contributed to the present problem of wisdom teeth.

Now the question is: what sort of problems does wisdom tooth create?

The most common problem is gum swelling, inflammation and infection.
The second issue is dental decay, as these teeth are located at the back, and it’s really hard to reach and as a consequence, they get decayed.
The third one is pain, which could vary between a mild to very sharp and intense pain.
The fourth problem is that it could cause food retention, it’s very hard to keep them clean and it could also cause bad breath as well.
Now the question is, when do we need to remove wisdom teeth?

This is the question that your dentist could answer very well, based on some findings:

First of all, if your wisdom teeth are not functional ones; let’s just assume patient has two lower wisdom teeth and there are no top ones. So, the lower ones are not doing anything in chewing cycle. This is the thing that could be a trigger for wisdom tooth removal. If this factor is combined with other factors that I will introduce to you in a minute, it could shift dentist’s opinion toward removal rather than to save them.
The second factor is the degree of misalignment. Wisdom teeth may not be as straight as the neighbouring ones. This could affect their functionality, hinder oral hygiene, and produce decay and gum disease around them and adjacent teeth. Some of these complications may not be treatable.
The third one is there are many cases in which there is a kind of lesion around the roots of wisdom teeth and we had better not take a risk. We prefer to take them out and clean up the lesion, just to make sure it will not get cystic or possibly in some rare cases, malignant.
The fourth one is the access. There’s no access in some cases to fix the wisdom tooth, even for a simple filling. So, we need to take the tooth out because it will ultimately get infected and cause even more problems. In many cases it’s very hard for patient to access that area to keep it clean. They can’t do brushing and flossing around it. So, that’s the thing that could trigger us to think about extraction, because it could cause some problems down the track.
The next one is food retention, which is very common around some wisdom teeth in the space between the wisdom tooth and front tooth. Also, some wisdom teeth are covered with a flap of gum, and saliva, food particles, and bacteria go underneath. It’s really hard to clean, if not impossible. As a consequence, inflammation and infection could happen, and removal of the tooth is strongly indicated.

Now I want to answer a myth about wisdom teeth: as a dentist I’ve been asked plenty of times about this: patients are under this impression that wisdom teeth apply pressure to the teeth on the front and cause crowding, and if wisdom teeth are taken out, the teeth will get back to normal. I need to say, this thing has no scientific back up. It’s not necessarily true and even if this is true (crowding), if the reason is eliminated, teeth will not get back to their original positions.

Let’s now dive into different types or different classifications.

Wisdom teeth are classified mainly based on three criteria:

The first one is classification based on the mode of impaction. Some wisdom teeth grow like a natural tooth, and in many cases, they are impacted. They’re covered with gum, so we need to do surgery to take them out. They could either covered with gum only, or they may be covered with bone as well. This largely determines the level of difficulty involved.
The second way of classification of wisdom teeth is according to the relationship of lower wisdom tooth to the nerve underneath. There is a nerve travelling from the angle of the jaw and coming forward underneath the wisdom teeth to the chin. It provides innervation and sensation to all areas of the lower Jaw, across to the midline. This nerve is really sensitive, and depending on the relationship of the wisdom tooth to this nerve, we decide on our approach, or whether extraction is beneficial or not (risk Vs benefit). Wisdom tooth might be well away from the nerve, just in vicinity, or connected. Any trauma to the nerve may cause alteration of sensation, or even numbness for a limited time, or even permanently.
The last classification of wisdom teeth is based on their location in relation to the front tooth. That’s very important. Wisdom tooth could be nearly parallel to the front tooth and straight ones are normally easier to remove. They could be located at an angle toward the tooth, or away from the tooth, which makes it more difficult to take out. It could be horizontal, toward, or away from the front tooth. In some cases, it is located horizontally, but toward the cheek or toward the tongue. Sometimes a combination of some of these could exist as well. This largely determines the hardship during the surgical procedure.

There are different approaches for wisdom tooth removal:

If wisdom teeth are easy to remove, it could be easily done in dental chair with local anaesthetic, unless patient is quite phobic about dentistry and extraction. In those cases, we need to do sedation to calm them down.
In cases when a harder extraction is anticipated, we may like to have the patient sedated, which could be done via oral (tablets) gas (happy gas) or parenteral (injections).
The last option is putting the patient under general anaesthetic. In these cases, it is quite possible to remove all four wisdom teeth in one go and finish the case.

Alright fellas!

I hope this blog could have answered some of your questions and concerns regarding wisdom teeth.

Have a good day,

Bye!

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