Wisdom Teeth Conspiracy

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Common questions and answers

Why do we have wisdom teeth?

The general consensus is that our ancestors needed these teeth because the ancestral food were harder to chew. This wore away their teeth and the new set let them keep eating this tough diet for longer. They did, however, have larger jaws that made it easier to accommodate all those gnashers.

Another theory is that tooth loss would have been much more common in the past, and the extra teeth were needed to replace those that had fallen out. Nowadays we have advanced dentistry techniques, including root canal treatment and dental crowns, which can save damaged teeth.

Overcrowding can lead to problems like impaction
Overcrowding can lead to problems like impaction

Where do wisdom teeth appear?

These teeth are known as ‘third molars‘ in the medical world since they are the third set of molars to appear (or ‘erupt’). They are located behind your second molars. If all goes well, they will end up extending the rows of teeth you already have.

How many wisdom teeth do we have?

Most people have four – one on the left and right of both the upper and lower jaw. However it’s possible for some people to have fewer than this or none at all. In some rare cases a person can have five, six or more – a condition known as hyperdontia. This often results in a double set of extractions – ouch!

Find out more about how many teeth adults have.

Is something wrong if I have no wisdom teeth?

No, and it could in fact mean that you are more evolved. People born without their third molars can still eat perfectly well but don’t have the risk of complications that the rest of us suffer.

Your dentist will be able to do an x-ray to check whether you have no wisdom teeth at all, or they just haven’t made an appearance yet.

When do wisdom teeth come in?

Originally called “teeth of wisdom”, they get their name from the fact that they typically appear much later than the rest of our teeth. Your second molars erupt around age 12. The average age for eruption of third molars is 17-25.

The idea is that by this age you are a little wiser, although many would argue this is not necessarily the case.

It’s quite possible for these teeth to stay hidden for decades and only erupt in a person’s 30s or 40s. Equally, they may never come through but also never cause any problems which require them to be extracted.

Third molars cause pain for many people
Third molars cause pain for many people

Do wisdom teeth hurt?

Even if your third molars have plenty of space to grow, it’s normal to experience some pain as they erupt. One of the most common symptoms of wisdom teeth coming through is pain from sore gums. Later on in this article we’ll share some tips for relieving any discomfort as well as spotting the signs of complications.

Do wisdom teeth have to be removed?

Until 1998, removing wisdom teeth was the default practice in UK dentistry. This changed after studies from the University of York and the Royal College of Physicians of Edinburgh showed that this was unnecessary.

The US and Australia are yet to adopt this stance and removal remains standard procedure. However, there is a growing amount of research to show that routine removal may be a waste of resources and could actually be putting the patient at risk of complications unnecessarily.

Some people naturally have enough enough space in their jaw and mouth to accommodate the extra teeth. They can remain in place and function normally for the lifetime of the patient.

Ask a dentist: Why should I have my wisdom teeth removed?

Your wisdom teeth are usually the last teeth in your mouth to erupt. If you have healthy gums, and the wisdom teeth come in properly aligned, there is often no need to remove them. However, this is not what happens for most people. It is necessary to remove wisdom teeth when: They grow in sideways, which can cause pressure against neighboring teeth and shift them Only partially emerge, which can cause bacteria and infection Don’t erupt at all and sit below the gums Having your wisdom teeth removed can help resolve all of these issues, especially when the procedure is done soon after the wisdom teeth show signs of erupting. Dr. Shane Porter, Premier Dentistry of Eagle

If you are experiencing any kind of tooth pain you should certainly see your dentist as complications will only worsen over time.

Does wisdom teeth removal hurt?

As with most extractions, dentists use a local anaesthetic to numb the area before proceeding. So although the process may be uncomfortable, it shouldn’t be painful. You’re likely to experience discomfort in the days following the extraction as your body recovers and adjusts.

Recovery might be painful if the extraction was complicated, but ibuprofen or paracetamol will usually be enough to suppress this pain. Your dentist will advise you on which medicines to take. There is more information below about managing discomfort and pain after a tooth extraction.

Video

Myth #2: Early Wisdom Tooth Extractionis Less Traumatic

The American Association of Oral and Maxillofacial Surgeons recommends the extraction of all 4 wisdom teeth by early adulthood before the roots are fully formed to minimize any chance of infection and pain.

The truth is that this early removal of wisdom teeth is actually much more traumatic than a wait and see approach which leaves asymptomatic wisdom teeth in place and only removes them if pathology develops in the future.

Further, complications from wisdom tooth extraction which include dry socket, secondary infection, and paresthesia (numbness of the lip, tongue, and cheek) are less likely to occur in an older patient than an adolescent.

Anesthesia Options for Wisdom Tooth Surgery

For dental work, you typically have 3 levels of sedation to request: minimal, moderate, and deep sedation. There are multiple options at each level of sedation.

You and your oral surgeon can choose from various sedation options for wisdom tooth extraction:

  • Local anesthesia (MINIMAL): Local anesthetic is injected at the surgical site to fully numb the inside and outside of the area around the affected tooth. It’s the same as you’d get for a filling. It does not actually result in sedation, just numbing. All wisdom teeth extractions utilize local anesthesia.
  • Nitrous oxide (MINIMAL): This very safe, mild sedative helps you to feel calm and unconcerned during your dental procedure. It wears off quickly and you can expect to feel totally awake before going home. Nitrous oxide is only used for the extraction of non-impacted wisdom teeth.
  • Oral sedatives (MODERATE): Valium (diazepam) is the most common oral sedative for moderate sedation during dental work. You’ll generally take one dose 45-60 minutes before your procedure. You might be groggy enough to fall asleep, but your dentist can easily wake you up.
  • IV “conscious” sedation (MODERATE): You may opt for a similar sedative to Valium given intravenously. Similarly, you may sleep throughout some of the procedure but will wake easily.
  • General anesthesia (DEEP): General anesthesia will cause you to fall completely to “sleep” and not able to be easily awakened. If you receive general anesthesia for wisdom teeth removal, your oral must have additional two-year certification or use an in-house anesthesiologist.

Minimal sedation is used for wisdom teeth extractions when the tooth is not impacted. Moderate or deep sedation may be utilized for impacted wisdom teeth removal.

Can I drive home after wisdom teeth removal? With only minimal sedation, you can drive home after your wisdom teeth removal surgery. If you receive moderate or deep sedation, you’ll need to arrange for someone else to drive you home.

7. After tooth extraction

Your dentist places gauze over the wound, which you should bite down on for around 30-60 minutes. The gauze puts pressure on the wound area and helps reduce bleeding. A blood clot, which protects the wound, forms in the extraction socket.

The dentist who performed the procedure will give you instructions to follow after the extraction.

The extraction site heals relatively quickly, particularly in young adults.

POST-EXTRACTION INSTRUCTIONS

  • Avoid eating, drinking and smoking for at least two hours after extraction.
  • Eat and drink cold or cooled-down food and drinks that do not require chewing such as yogurt, thin soup, popsicles and ice cream.
  • Avoid strenuous physical activity at least for a couple of days.
  • Brush your teeth carefully. Avoid brushing the extraction site for at least a few days.
  • Take painkillers if needed. Painkillers containing acetylsalicylic acid (ASA), such as aspirin, are not recommended, as they can cause prolonged bleeding.
  • Use ice packs to reduce swelling and pain if needed.
  • The extraction socket may bleed for a few days. See your dentist if bleeding is heavy and doesn’t stop.
  • Most healthy people don’t need antibiotics after a regular tooth extraction.
You can use ice packs to reduce swelling after too
You can use ice packs to reduce swelling after tooth extraction. Hold the ice pack against your cheek near the extraction site for three hours, 20 minutes at a time.

After tooth extraction, you will feel pain for two days to one week. The pain is at its worst during the first one to two days after the extraction.

After more challenging tooth extractions, such as those for lower wisdom teeth, the pain may continue for several weeks. It takes around 6 months before the extraction site has properly healed and ossified.

If you have a fever or difficulty swallowing, contact your dentist or dental emergency service immediately.

CONTACT EMERGENCY SERVICE IF

  • bleeding continues for more than 24 hours after extraction
  • pain or swelling gets worse after 3-5 days
  • you have fever or difficulty breathing or swallowing
  • you have difficulty opening your mouth or feel severe pain in your jaw joint

Myth #4: The Risk of Problems with Wisdom Teeth Increases With Age

A study of 1756 people who kept their wisdom teeth for an average of 27 years found that less than 1% experienced any cyst formation.   There is zero evidence to support the unsubstantiated claim by the American Association of Oral and Maxillofacial Surgeons which states that problems with impacted wisdom teeth increase with age.

When to Call Your Dentist

Call your dentist right away if you have any of these symptoms after wisdom teeth removal:

  • Excessive bleeding past 4 hours after your surgery
  • Throbbing pain that won’t go away
  • Oozing pus
  • Swelling that increases rather than going down
  • Fever/chills
  • Pain that spikes 48 hours after the extraction
  • Nausea or vomiting after 10 hours post-op
  • Vomiting significant amounts of blood (a little blood is normal)
  • Coughing
  • Chest pain
  • Shortness of breath
  • Difficulty swallowing or breathing
  • Blood or pus from your nose

What about the cavemen?

So what would have happened back in the day of the caveman? Well they would have eventually died from the infection, though this wouldn’t have happened as much back then as it would do now if we didn’t have dentists – and we can thank evolution for that.

We have evolved to have smaller mouths than early man. The genes that control teeth and jaw size are on different chromosomes so they have not shrunk over time proportionately.

What to Expect on the Day of Surgery

Arrive on time for your appointment at the oral surgeon’s office. Your healthcare provider may perform dental X-rays again on the day of surgery if necessary.

During the Surgery

The surgery should take about 45 minutes. With anesthesia, you shouldn’t feel any pain or discomfort. Depending on what type of sedation is used, you may be asleep or conscious during the surgery.

These are the steps for a typical procedure:

  • Sedation: If you are receiving nitrous oxide (laughing gas), you will be fitted with a small mask to fit over your nose to inhale the sedative, allowing you to be awake but remain relaxed. If intravenous (IV) sedation is chosen, the assistant will place a needle in the vein in your arm to administer a sedative throughout the surgery. This is generally considered the most comfortable option since you drift in an out of consciousness and are unlikely to remember the procedure afterward.
  • Numbing: After sedation, your surgeon starts by numbing the wisdom teeth and their surrounding tissues with a local anesthetic.
  • Tissue removal: The surgeon removes any gum tissue covering the area where the wisdom tooth is located to access the tooth.
  • Bone removal: An impacted wisdom tooth could be fully or partially covered with bone. If this is the case, a high-speed handpiece is used to drill through and remove the bone covering the tooth.
  • Loosening and sectioning of the tooth: When the impacted wisdom teeth are visible to the dentist, various surgical instruments are used to gently loosen them from any connective tissue in the tooth's socket. The surgeon may also cut the tooth into sections to allow for easier removal.
  • Tooth removal: Once the wisdom tooth is loose or has been completely sectioned, it is ready to be removed. The surgeon will use surgical instruments specially designed to fully remove the tooth.
  • Stitches: Now that the wisdom teeth are gone, the surgeon may add stitches to close up the area. This is sometimes necessary when impacted wisdom teeth are removed or when the healthcare provider feels the patient will better heal with stitches in place.

After the Surgery

After the procedure is complete, the nitrous oxide gas or IV drip is stopped and you'll be brought slowly out of sedation.

The dentist will provide gauze for you to bite down on to help blood clot in the area. Immediately after surgery, you may feel mild effects of the anesthesia, including nausea, dizziness, and shivering.

You'll be brought to a recovery room where you will be monitored. Once a specialist has determined that you are stable and breathing normally, you'll be cleared to go home. Usually you'll spend less than an hour in the recovery room.

After surgery, you will feel groggy and swollen. You may not feel much pain immediately, but it will probably increase as the local anesthetic wears off in the hours after surgery.

2. Alternatives to tooth extraction

If a tooth’s pulp or root is infected, the dentist may perform tooth extraction or root canal treatment. The patient can also refuse treatment or postpone it and leave the infection untreated.

It is assumed that the infection can be treated with root canal treatment.

No treatment

  • Free of charge

Risk of infection in the head and neck area Infection doesn’t go away without treatment Easier and cheaper to treat when done on time

Tooth extraction

  • Quick treatment
  • Good prognosis

Tooth is lost Teeth other than wisdom teeth may need to be replaced with dental implants, which is expensive

Root canal treatment

  • Usually good prognosis
  • Better than dental implants if performed properly

Requires multiple visits

Treating infected teeth with root canal treatment is not always possible—for example, in cases of root fraction or advanced infection.

Moreover, root canal treatment is not recommended when a tooth is so severely damaged that it cannot be patched. Teeth extraction can then be the best treatment option.

Root canal treatment is a better treatment option
Root canal treatment is a better treatment option than tooth extraction when the prognosis is good and the damaged part of the tooth can be fixed, for example, using a ceramic filling or crown.

Symptoms of wisdom teeth infection

Signs of gum infection caused by wisdom teeth include: 

  • red, inflamed gum near the wisdom tooth
  • swelling
  • pain
  • pus coming from the gum
  • swollen and sore lymph nodes underneath the jaw
  • difficulty opening the mouth and swallowing
  • fever
  • bad breath.

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Suffering from Wisdom Teeth Pain? Contact Rockcliffe Dental Today!

Any of the mentioned signs are good indications that it’s time to schedule a check-up with a dental clinic in Ottawa to see whether you require a wisdom tooth extraction. Practicing good oral hygiene and applying ice packs may temporarily relieve the pain, but ignoring the symptoms of wisdom teeth will only create serious potential health implications for you.

So give us a call at Rockcliffe Dental to set up your next appointment and receive proper treatment. Our team of dental professionals will be happy to provide proper oral health care for you

Damage to adjacent teeth

While never the dentist’s intention, it’s possible that damage to the tooth directly adjacent to a wisdom tooth (a 2nd molar) will be damaged during its extraction process.

Causes

In most cases, the damage is caused by pressure placed on them by the instruments used to remove the wisdom tooth (a dental elevator would be a common culprit How extraction instruments are used.).

That’s not the way extraction instruments are intended to be used. But in locations where access is difficult and visibility low (like the places in the mouth where 3rd molars are located), this complication is possible.

Incident rates

The teeth that will be most at risk are those that are already fragile due to having a large filling or cavity. The positioning of the wisdom tooth can play a role too. Studies suggest that the incidence of tooth damage during the extraction process runs on the order of 0.3% to 0.4% of cases. (Blondeau)

Section references – Blondeau

Wisdom Teeth Symptoms: First Signs Your Wisdom Teeth Are Coming In

When inspecting your mouth for signs of wisdom teeth comping in, pay attention to these dental health symptoms:

  • Bleeding or tender gums
  • Swelling of the gums or the jaw
  • Jaw pain
  • An unpleasant taste in the mouth or foul mouth odor
  • Difficulty opening your mouth

Tender and Swollen Gum Tissue

One of the first signs of your wisdom teeth coming in is when you experience any tenderness or discomfort around the back of your mouth. This can be on either side or just one. If you can imagine the sensation of adult teething, this would be an accurate idea of what you would feel. You may also notice swollen gums.

Triggered Headaches

If your wisdom tooth does become trapped under the gums, this can lead to a build-up of pressure, which can trigger headaches. This can be a difficult sign to detect if you already suffer from frequent headaches. So always ensure you continue to attend your regular check-ups with a skilled dentist so they can monitor the condition of your oral health.

Infection In The Gums

As a wisdom tooth begins to erupt, wisdom teeth roots can often be awkwardly positioned, which causes only part of the tooth to emerge. When this happens, it can leave the gum tissue very susceptible to active infections. Even with a minuscule opening, food can easily get lodged in there, making it very difficult to remove, even with thorough brushing and flossing. This can escalate into a potentially serious infection known as pericoronitis if not detected and corrected immediately. This is the most serious sign to look out for when your wisdom teeth are coming in, so always consult with your dentist as soon as possible.

Wisdom tooth displacement

This complication refers to the situation where control of the wisdom tooth being removed is lost and it enters an adjacent portion of the patient’s body. The entire tooth might be displaced or some fragment of it (like in the case of sectioned or broken teeth).

Causes

It’s easy enough to suggest that the tooth’s displacement is associated with using a level of force greater than its supporting tissues can withstand. But to the dentist’s defense, determining what amount of supporting tissues exist, and therefore what level of pressure is appropriate to use, can be exceedingly difficult to determine.

As an example, the thickness of bone that encases an upper wisdom tooth’s roots and also serves as the floor of the adjacent sinus may be just paper-thin.

Incidence rates

A paper by Blondeau states that the complication of wisdom tooth displacement is seldom reported in dental literature and as such gives no estimate of its occurrence.

Treatment

The displaced tooth or tooth fragment will need to be retrieved. But the exact process used will depend on the individual circumstances and as such lies beyond the scope of our page.

Section references – Blondeau

Wisdom teeth and pregnancy

Ideally we would like to reduce any dental treatment if you are pregnant which is why I always recommend a trip to your dentist if you are thinking about a family.

Otherwise there are always ways to treat a pregnant patient and the best time for this is in the second trimester, as it is often too uncomfortable for a patient in their third trimester to sit in the dental chair for a long period.

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