Wisdom Teeth

As you may know, all our primary teeth are replaced with permanent teeth between the ages of 5 and a half and thirteen years of ago. The exception to this rule is the wisdom teeth which erupt at age 17 or later IF they have the room. The important word, of course, is “IF”.

Contrary to popular belief, wisdom teeth are not “extra teeth”. We are born with three sets of permanent molars. The 1st molars erupt at approximately age 6-7, the 2nd molars erupt at approximately age 12-13 and the 3rd set of molars erupt late in our teen years if they have the room.

Most of us have all four wisdom teeth, whether they have room to erupt or not. As the jaw grows some of us do, in fact, have the room for the eruption of these teeth. However, 95% of the population does not have the room for proper eruption, have subsequent discomfort, pain or infection and require that these teeth be extracted by an oral surgeon.

Because most of us have 28 normal, functioning teeth the loss of 4 wisdom teeth is not significant. The extraction of these teeth, however, may be quite significant depending on their position in the jaw bone. Some of these teeth will remain in proper position while some, mostly as a function of little room, may develop horizontally or even upside down. In order to evaluate the position of these wisdom teeth, a panoramic x-ray is taken of the jaw to see all teeth, their position and the size of the jaw bone.

Sometimes, the wisdom teeth appear to erupt into the mouth only to find that they have limited room and can only partially erupt. This may actually be worse since once the gum tissue has been perforated by the tooth, there is access for food, plaque and bacteria to enter the tissue and cause inflammation and possible infection. Furthermore, as the tissue swells, we tend to “bite” our gum as we eat thereby inflaming the tissue even more and resulting in significant discomfort.

Although we try to predict whether wisdom teeth will eventually erupt or require extraction before there is a problem sometimes it is a close call and despite our best efforts, some of our patients will become symptomatic.

In general, aside from contacting us or being referred to an oral surgeon for evaluation, the following palliative treatment is recommended:

  1. The use of an anti inflammatory analgesic such as Advil.
  2. Rinsing with warm salt water to reduce the inflammation of the tissue and make it less susceptible to trauma while eating.
  3. Soft diet.
  4. Good oral hygiene around the area to reduce the amount of bacteria causing the inflammation.

The use of antibiotic may be necessary if significant infection develops. That is evaluated on a one to one basis by the dentist or oral surgeon.

If we suspect that the wisdom teeth will not have the required room to erupt, we will recommend a consultation with an oral surgeon. It is best to go for the consultation even if extraction isn’t indicated right away. This way, if a problem does arise, x-rays and consultation have been completed and confusion can be eliminated when the patient requires treatment and is most uncomfortable.

What happens if you do nothing at all? Some of the possible consequences of not having wisdom teeth extracted are:

  1. Pain and infection particularly when teeth partially erupt but never fully erupt into the mouth.
  2. Future cyst formation. The body may encapsulate the tooth in a fluid filled sack (cyst) and over time the cyst will grow destroying jaw bone in the process. While not a malignant process, it can lead to eventual jaw fracture.
  3. Gum and bone problems behind the 12 yr molars as the wisdom tooth erupt against these molars and not allow normal bone and gum to develop.
  4. If wisdom teeth need to be extracted later in life, the roots of these teeth may have wrapped themselves around the large nerve that runs through the lower jaw resulting in damage to that nerve during extraction and possibly resulting in permanent numbness of part of the face.

Clearly, if wisdom teeth need to be extracted, the earlier it is done, the better and easier for the patient.

If necessary and as a general rule, extraction of wisdom teeth should be done the summer between the patients senior year of high school and college to eliminate any problems during the first year of college.




Dentistry For Children, P.A. proudly serves Essex County, New Jersey including the Nutley, Clifton and Bloomfield, New Jersey communities.