Wisdom teeth

Wisdom teeth are third molars that usually appear between the ages of 18 and 20 (although they may appear when older, younger, or may not appear at all). Often they need to be removed when they impact against other teeth—colloquially known as "coming in sideways."

Wisdom teeth are sometimes described as an example of a "vestigial" trait. Some argue that recent changes to softer diets which cause less wear on the teeth may be causing the third molars to be less useful, and, in fact, problematic in many humans. Alternately, it is possible that wisdom teeth were useful when it was common for humans to lose several teeth to decay by the age when they appear.

Although most people have four wisdom teeth, it is possible to have more or fewer. Absence of one or more wisdom teeth is an example of hypodontia. Any extra teeth are referred to as Supernumerary teeth. [http://www.wsoctv.com/health/3034496/detail.html

Etymology

They are generally thought to be called "wisdom teeth" because they appear so late—much later than the other teeth, at an age where people are supposedly wiser than as a child, when the other teeth erupt.

Alternatively it may be that the term derives from a mistranslation of the corresponding term in Dutch in which language they are called 'verstandskiezen', literally 'far-standing-molars' referring to the fact that they are located at the back of the mouth. In Dutch such compound words are contracted (written without the spaces) leaving the first part of the word as 'verstand' which can correctly be translated as 'wisdom' in English. It is interesting to note that, although the origin of the word is well known, among Dutch speaking layman it has become common to derive the word from verstand (as wisdom), similar to the common English derivation, apparently under infuence from the English language and in modern Belgian (Dutch and French) they are sometimes called wijsheidstand (dents de sagesse) which seems to be a literal translation of the English term.

Impactions

Impacted wisdom teeth fall into one of several categories. Mesioangular impaction is the most common form, and means the tooth is angled forward, towards the front of the mouth. Vertical impaction occurs when the formed tooth does not erupt fully through the gumline. Horizontal impaction occurs when the tooth is angled fully ninety degrees forward, growing into the roots of the second molar. Finally, distoangular impaction is the least common form, and means the tooth is angled backward, towards the rear of the mouth. Typically distoangular and vertical impactions are the most difficult types of wisdom teeth to extract.

Impacted wisdom teeth may also be categorized on whether they are still completely encased in the jawbone. If it is completely encased in the jawbone, it is a bony impaction. If the wisdom tooth has erupted out of the jawbone but not through the gumline, it is called a soft tissue impaction.

Sometimes the wisdom tooth has failed to erupt completely through the gum bed and the gum at the back of the wisdom tooth extends over the biting surface, forming a soft tissue flap or lid around the tooth called an operculum. Teeth covered by an operculum can be difficult to clean with a toothbrush. Additional cleaning techniques can include using a needle-less plastic syringe to vigorously wash the tooth with moderately pressured water or to softly wash it with hydrogen peroxide.

However, debris and bacteria can easily accumulate under an operculum, which may cause pericoronitis, a common infection problem in young adults with partial impactions that is often exacerbated by occlusion with opposing 3rd or 2nd molars. Common symptoms include a swelling and redness of the gum around the eruption site, difficulty opening the mouth, bad odor and/or taste in the mouth and pain in the general area which may also run down the entire lower jaw and/or neck. Untreated pericoronitis can progress to a much more severe infection.

If the operculum does not disappear, it may be necessary to trim the soft tissue in a procedure called an operculectomy. If it reoccurs along with pericoronitis, it may be necessary to extract the wisdom tooth.

Extraction

Wisdom teeth are extracted for two general reasons: either the wisdom teeth have already become impacted, or the wisdom teeth could potentially become problematic if not extracted. Potential problems caused by the presence of properly grown-in wisdom teeth include infections caused by food particles easily trapped in the jaw area behind the wisdom teeth where regular brushing and flossing is difficult and not effective. Such infections may be frequent, and cause considerable pain and medical danger. The extraction of wisdom teeth can be a difficult surgical procedure, and should only be performed by dental professionals with proper training and experience performing such extractions.

Post-extraction problems

There are several problems that can manifest themselves after the extraction(s) have been completed. Some of these problems are unavoidable and natural, while others are under the control of the patient. The suggestions contained in the sections below are general guidelines that a patient will be expected to abide by, but the patient should follow all directions that are given by the surgeon in addition to the following guidelines. Above all, the patient must not disregard the instructions given to them; doing so is extremely dangerous and could result in any number of problems ranging in severity from being merely inconvenient (dry socket) to potentially life-threatening (serious infection of the extraction sites).

Bleeding and oozing

Bleeding and oozing is inevitable and should be expected to last up to a day. Rinsing out one's mouth during this period is counter-productive, as the bleeding stops when the blood forms clots at the extraction sites, and rinsing out the mouth will most likely dislodge the clots. The end result will be a delay in healing time and a prolonged period of bleeding. Gauze pads should be placed at the extraction sites, and then should be bitten down on with firm and even pressure. This will help to stop the bleeding, but should not be overdone as it is possible to irritate the extraction sites and prolong the bleeding. The bleeding should decrease gradually and noticeably upon changing the gauze. If the bleeding lasts for more than a day without decreasing despite having followed the surgeon's directions, the surgeon should be contacted as soon as possible. This is not supposed to happen under normal circumstances and signals that a serious problem is present.

Due to the blood clots that form in the exposed sockets as well as the abundant bacterial flora in the mouth, an offensive smell may be noticeable a short time after surgery. This is to be expected and will diminish over an indefinite amount of time, although one to two weeks is normal. However, a persistent bad smell may be accompanied by an equally rancid-tasting fluid seeping from the wounds. While not a cause for great concern, a post-operative appointment with your surgeon seven to ten days after surgery is highly recommended to make sure that the healing process has no complications and that the wounds are relatively clean. A syringe (minus the hypodermic needle) full of salt water or antiseptic mouthrinse should be gently plunged into the sockets to remove any food or bacteria that may collect in the back of the mouth.

Dry socket

A dry socket is the event where the blood clot at an extraction site is dislodged or falls out prematurely or fails to form. In some cases, this is beyond the control of the patient. However, in other cases this happens because the patient has disregarded the instructions given to them by the surgeon. Smoking, spitting or drinking with a straw in disregard to the surgeon's instructions can cause this. The extraction site will become irritated and pain will manifest at one level or another. The patient should contact their surgeon if they suspect that they have a case of dry socket; the surgeon can prescribe medication in topical form to apply to the affected site. If this is done, dry socket becomes merely an annoyance, but without the medication dry socket can progress to an infection of the extraction site.

Swelling

Swelling should not be confused with dry socket; although painful, swelling should be expected and is a sign that the healing process is progressing normally. There is no general duration for this problem; the severity and duration of the swelling vary from case to case. The instructions the surgeon gives the patient will tell the patient for how long they should expect swelling to last, including when to expect the swelling to peak and when the swelling will start to subside. If the swelling does not begin to subside when it is supposed to, the patient should contact their surgeon immediately. While the swelling will generally not disappear completely for several days after it peaks, swelling that does not begin to subside or gets worse may be an indication of infection. Swelling that re-appears after a few weeks is an indication of infection caused by a bone or tooth fragment still in the wound and should be treated immediately.

Controversy

Preventative removal of the third molars is a common practice in developed countries despite the lack of scientific data to support this practice. In 2006, the Cochrane Collaboration published a review^* designed to evaluate the effect of preventative removal of asymptomatic wisdom teeth. The authors found no evidence to either support or refute this practice. However, there was reliable evidence showing that preventative removal did not reduce or prevent late incisor crowding. The authors of the review suggested that the number of surgical procedures could be reduced by 60 percent or more.

External links

Wisdom teeth informedhealthonline.org

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