The Dentist Visits You - 2015

Wisdom Teeth

By Vatsal Suthar

With the holiday season upon us and the kids at home for winter break, many Indian parents I know will use this time to get their children to the dentist for their cleaning and exam so as not lose any precious days away from school or college. As kids turn into teenagers and enter their early twenties, the development and associated symptoms of wisdom teeth begin to appear. Last month, I wrote on the merits of diagnosing a bad bite early so as to fix that malocclusion with braces. The wisdom teeth are in a similar situation in which bigger problems down the road can be avoided altogether by addressing them at this stage of life.

There are commonly four wisdom teeth that develop. Third molars, or wisdom teeth, begin to emerge in the mouth from 17-21 years of age. Wisdom teeth are considered “vestigial" because as humans have evolved, the need for them has been made obsolete. The common postulation is that the skulls of human ancestors had larger jaws with more teeth, which possibly were used to help chew down foliage to compensate for a lack of ability to efficiently digest the cellulose that makes up a plant cell wall. As human diets changed, smaller jaws gradually evolved, yet the third molars, or “wisdom teeth" still commonly develop in human mouths. If the wisdom teeth grow properly, they are no different than any other tooth in the mouth and can be kept without problems. However, only 2% of adults over 65 maintain their wisdom teeth without cavities or gum infection.

Because the jaws became smaller with evolution, there's less room for the third molars to position properly and more than likely become “impacted." An impaction can cause gum infection, decay on adjacent teeth, cysts, tumors, or pushing of other teeth leading to misalignment. Often times, the pain from the gum tissue over a wisdom tooth or decay into the nerve will cause a patient to seek treatment for extraction of the tooth.

A panoramic x-ray is taken at certain intervals to monitor the growth of the 3rd molars in a dental office in order to predict how the teeth will be positioned in the patient's jaw. If an impaction is likely, your dentist will suggest removing them. A common misconception for all patients is that if it does not hurt, why mess with it? Especially true for a vast majority of the Indian mentality is to wait only until you are on the brink of death to seek any treatment. If your physician can accurately predict you having a heart attack based on your blood pressure, cholesterol, imaging, and other testing, would you still wait until the “pain" to seek treatment?

Whenever I discuss an impacted wisdom tooth with patients, the most common question I receive is whether to remove one, two or all of them at a time. Having a tooth taken out can be an intimidating and scary circumstance. Patients sometimes need a pair of wisdom teeth out but, most often, all four will be removed at one time to eliminate all impaction risk areas. Furthermore, by extracting all four wisdom teeth at one time, you take care of all treatment needs at one time, take time away from work or school once, and your healing period is for only that single time frame. The procedure is performed in an outpatient setting with your dentist or an oral surgeon's office. While you will always receive local anesthetic to numb the areas and teeth, having sedation is optional dependent on your anxiety levels.

Because the 3rd molars present in a complex and wide variety of positions and conditions compared to other teeth, most general dentists will refer you to an oral surgeon for their safe removal. An oral surgeon is a dental specialist who has undergone an additional 4-6 years of training after dental school. Some even have dual dental and medical degrees which confirms their expertise to handle the diagnosis, surgery and treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and facial region. Furthermore, because surgeons have additional expertise in anesthesia, patients can be “put to sleep" safely with IV, oral, or inhalation sedation so that a patient has reduced anxiety and can forget the intimidating aspects during the procedure.

The most common complication following wisdom teeth removal is “dry socket." This is a condition in which the blood clot in the surgical site is not formed properly or has been dislodged prematurely. The clot contains many nutrients and natural components to allow your tissue to repair and recover. With dry socket, this important healing phase gets delayed while causing extreme discomfort. People that smoke, patients that do not follow home hygiene instructions, and females on oral contraceptives have an increased risk to developing dry socket. Not keeping the area clean with water rinses or a prescription mouth wash after surgery could lead to infection but is not as common. When wisdom teeth are taken out in the younger years, a person has a better chance of an uneventful outcome after surgery compared to if a person waited decades later to remove them.

The main objection to most patients in extracting the 3rd molars is they do not hurt. I believe our community would appreciate the idiom, “an ounce of prevention is worth a pound of cure" because taking care of something while it is small and manageable is not only cheaper, it saves you time and, most importantly, pain which keep you from performing at work, school or business. When you make an emergency appointment to see your dentist for a pain from your wisdom teeth, who then refers you to an oral surgeon for a separate visit and fee, you have wasted your time and money for a condition that was forecast well in advance. Since the chances of maintaining 3rd molars in perfect position without the risk for decay or gum infection is less than 10% for all adults, I urge those with wisdom teeth to seek timely treatment as suggested by your dentist.