Wisdom Teeth: All That Wisdom… and Still No Sense of Direction!
Updated: Oct 21
You would think that with a name like wisdom teeth, they would know how to behave!
Unfortunately, these late arrivals don't always make the wisest decisions. Some come through perfectly straight, others appear at awkward angles, and a few seem determined to grow in completely the wrong direction!
But despite their reputation for causing trouble, not all wisdom teeth need to be removed.
So, what exactly are wisdom teeth, why do they sometimes cause problems, and how do you know whether yours need attention?
Let's take a closer look.
What are wisdom teeth?
Wisdom teeth, also known as third molars, are the very last teeth to develop at the back of your mouth.
Most adults have up to four wisdom teeth, one in each corner of the mouth, although some people develop fewer or none at all.
They usually begin to appear between the ages of 17 and 25, although they can come through later in life.
The name wisdom teeth comes from the fact that they emerge when we are a little older and, supposedly, a little wiser!
For some people, wisdom teeth grow into the correct position without causing any problems. For others, however, there simply isn't enough space for them to emerge properly.
And that's when the trouble can begin.
What is an impacted wisdom tooth?
An impacted wisdom tooth is one that cannot fully emerge into its normal position, usually because there isn't enough room or another tooth is blocking its path.
Wisdom teeth can become impacted in several ways, some examples are:
Vertical impaction: The tooth is growing relatively straight but cannot fully emerge.
Mesial impaction: The tooth is tilted forwards towards the neighbouring molar.
Horizontal impaction: The tooth is lying sideways, sometimes almost completely horizontally.
Distal impaction: The tooth is angled backwards, away from the other teeth.
Some impacted wisdom teeth remain completely hidden beneath the gum, while others only partially emerge.
Interestingly, an impacted wisdom tooth isn't necessarily a problematic wisdom tooth.
Even one growing sideways may not require removal if it is healthy and isn't causing damage or disease.
What problems can wisdom teeth cause?
While many wisdom teeth never cause difficulties, others can develop problems, particularly when they are partially erupted or difficult to clean.
Some of the most common issues include:
1. Pain and swelling
As wisdom teeth emerge, they may cause tenderness or discomfort at the back of the mouth. Pain can also develop if the surrounding gum becomes inflamed or infected.
2. Gum infections (pericoronitis)
When a wisdom tooth only partially emerges, a small flap of gum may remain over it. Food particles and bacteria can become trapped underneath, sometimes leading to an infection called pericoronitis.
Symptoms may include pain, swelling, an unpleasant taste and difficulty opening your mouth.
3. Tooth decay
Wisdom teeth are often difficult to reach with a toothbrush, particularly if they're tilted or only partially erupted.
This can make them more vulnerable to decay and may also affect the neighbouring molar.
4. Gum disease
Difficulty cleaning around wisdom teeth can contribute to inflammation and gum problems around the wisdom tooth or the tooth immediately in front of it.
5. Cysts and other complications
Occasionally, a fluid-filled sac called a cyst can develop around an impacted wisdom tooth. Although uncommon, this can damage surrounding structures if left untreated.
Dental abscesses and damage to neighbouring teeth are other possible complications.
Do all wisdom teeth need to be removed?
Absolutely not!
This is one of the most important things we want our patients to understand.
In the UK, decisions about wisdom tooth removal are informed by guidance from the National Institute for Health and Care Excellence (NICE).
NICE guidelines advise against the routine preventative removal of impacted wisdom teeth that are free from disease.
In other words, simply having an impacted wisdom tooth, even one growing at an unusual angle, does not automatically mean it needs to come out.
Removal may be recommended when there is a clear clinical reason, such as:
Repeated episodes of gum infection (pericoronitis).
Significant decay that cannot be successfully treated.
Damage or disease affecting the neighbouring tooth.
A dental abscess or other serious infection.
A cyst or other disease associated with the wisdom tooth.
Certain circumstances involving other jaw surgery.
A first episode of pericoronitis, unless particularly severe, would not normally be enough on its own to justify surgical removal under NICE guidance.
At Devon Dentists, we believe that every patient and every tooth deserves an individual approach.
If your wisdom teeth are healthy and causing no problems, the most sensible option may simply be to leave them where they are and monitor them during your routine dental appointments.
Sometimes, doing less really is the wisest decision!
How do dentists assess wisdom teeth?
If you are experiencing discomfort or your dentist has concerns about a wisdom tooth, an examination is usually the first step.
We will look at the surrounding gums, assess the condition of the neighbouring teeth and discuss any symptoms you've been experiencing.
An X-ray may be recommended to help establish the position of the wisdom tooth, whether it is impacted and how close its roots are to important surrounding structures.
For lower wisdom teeth, particular attention is paid to their relationship with the nerves supplying sensation to the lower lip, chin and tongue.
Once we have a clearer picture, we can explain our findings and discuss whether monitoring, treatment or removal would be appropriate.
What happens during wisdom tooth removal?
If a wisdom tooth does need to be removed, the procedure will depend on its position, how deeply it is impacted and the complexity of the extraction.
Some wisdom teeth can be removed relatively simply, while others require a surgical approach.
Before the procedure
Your dentist will explain the treatment, discuss potential risks and answer any questions.
Most wisdom teeth can be removed using local anaesthetic, which numbs the area so you should not feel discomfort during the procedure, although you may feel pressure or movement.
During the procedure
Depending on the position of the tooth, your dentist may need to:
Make a small incision in the gum to access the tooth.
Remove a small amount of surrounding bone if necessary.
Remove the tooth in one piece or divide it into smaller sections.
Clean the area and place dissolvable sutures if required.
Some extractions take only a few minutes, while more complicated procedures may take longer.
Where specialist treatment is appropriate, your dentist may recommend a referral to an oral surgeon or a hospital service.
What is recovery like after wisdom tooth removal?
Recovery varies from person to person and depends largely on how straightforward or complicated the extraction was.
After a simple extraction, you may feel well enough to return to normal activities the following day.
Following surgical extraction, you may need a few days of rest.
During recovery, it's normal to experience some discomfort, swelling, bruising or stiffness around the jaw.
Swelling can be most noticeable during the first two to three days and some symptoms may take up to two weeks to settle completely.
Your dentist will provide specific aftercare instructions, but the following advice is generally helpful.
What should you do?
Take suitable pain relief. Paracetamol or ibuprofen may help, provided they're safe for you to take and used according to the instructions.
Choose soft foods. Yoghurt, mashed potatoes, scrambled eggs and lukewarm soup can be easier to manage while your mouth is tender.
Keep your mouth clean. Continue brushing your other teeth carefully, taking care around the extraction site.
Start gentle salt-water rinses after the first 24 hours, if advised by your dentist.
Rest and allow time for healing, particularly after more complicated extractions.
What should you avoid?
Avoid vigorous rinsing, spitting or disturbing the extraction site during the first 24 hours.
Avoid smoking, as it can interfere with healing and increase the risk of complications such as a dry socket.
Avoid alcohol and very hot drinks during the initial recovery period.
Avoid hard, crunchy foods or small particles such as seeds that could become trapped in the wound.
Avoid strenuous exercise immediately after surgery and follow any instructions about returning to normal activities.
If you have had sedation or general anaesthesia, you must also follow the specific driving and supervision restrictions given by your treatment team.
One particularly important part of recovery is protecting the blood clot that forms in the empty socket. This clot plays an essential role in the healing process.
Are there any risks associated with wisdom tooth removal?
Wisdom tooth removal is a common dental procedure, and most patients recover without significant complications.
However, as with any surgical treatment, there are some risks.
These may include:
Dry socket
This happens when the protective blood clot is lost or breaks down before the socket has healed properly. It can cause significant pain a few days after the extraction and may require further treatment.
Infection
Occasionally, an infection can develop following removal. Symptoms may include increasing pain, swelling, fever or an unpleasant taste.
Nerve irritation or injury
The roots of lower wisdom teeth can sometimes lie close to important nerves.
In certain cases, removing the tooth may cause temporary numbness or tingling affecting the lip, chin or tongue. Permanent changes are uncommon but possible.
Other complications
Less common risks include damage to neighbouring teeth, retained root fragments or, with upper wisdom teeth, complications involving the nearby sinus.
Your dentist or surgeon will discuss the risks relevant to your particular tooth before treatment.
When should you seek urgent dental advice?
If you are experiencing severe pain or swelling around a wisdom tooth, it's important not to ignore it.
You should seek urgent dental advice if:
Your pain or swelling is severe, worsening or not responding to pain relief.
You have a high temperature, feel generally unwell or notice an unpleasant taste associated with pain.
You experience persistent bleeding following an extraction.
You develop signs of infection or increasing difficulty opening your mouth.
If you have significant swelling affecting your breathing or swallowing, seek emergency medical help immediately.
Worried about your wisdom teeth? We are here to help.
At Devon Dentists, we understand that the thought of wisdom tooth problems, particularly the possibility of extraction, can make some patients feel a little nervous.
But having wisdom teeth doesn't automatically mean you'll need surgery, and even an impacted tooth may never cause any problems.
Our approach is simple: we take the time to listen, assess your individual situation and explain your options clearly, so you can make an informed decision about your dental care.
Whether you are experiencing discomfort, concerned about a wisdom tooth growing at an unusual angle or simply looking for some reassurance, our friendly team will be happy to help.
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And remember, when it comes to wisdom teeth, sometimes the wisest decision is simply to get them checked and keep them under observation.
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