To Extract or Not to Extract – A Brief Guide to Impacted Wisdom Teeth

Impacted Wisdom Teeth

Wisdom teeth usually sprout from the gums between the ages of 17 and 25. They are the last of the large molars at the back of your mouth. Some people never develop these last teeth, but you can have as many as four: one in each corner of your mouth.

You usually can tell if your wisdom teeth are growing when you have some symptoms such as pain or inflammation in the area and even infection in some cases, but these symptoms do not always appear.

Typically, patients worry about Wisdom Teeth and associate these molars with the development of upcoming problems like infections, denture misalignments, and especially eventual discomfort and pain.

However, the development of Wisdom Teeth does not necessarily mean an imminent extraction. In fact, Wisdom teeth extraction highly depends on the space in the mouth for each of the teeth.

This article summarizes many of the significant worries patients have about Wisdom Teeth. Therefore, we conciliate an approach that starts from understanding when Wisdom Teeth become a problem (impacted Wisdom Teeth).

Next, consider Wisdom Teeth as the cause of a problem and how to address it, including their extraction. Finally, we pinpoint the specifics of Wisdom Teeth and Orthodontics.

What are Impacted Wisdom Teeth? 

Wisdom Teeth can sprout in different forms. In some circumstances, there is enough space in the mouth, and Wisdom Teeth erupts straight. Sometimes, the mouth has little space, and teeth erupt partially above the gums. 

However, and most radical, there are cases where there is no space for Wisdom Teeth to sprout and remain below the surface of the gums. To summarize, teeth that do not erupt or do so partially are called “impacted teeth.”

Impacted teeth tend to develop at an angle, shifting from their normal position. Accordingly, there are three different angles at which impacted teeth can develop:

  • Towards the front in an angled position: With the occlusal area, which is where the tooth normally touches the tooth in the opposite arch, but directed at an angle towards the second molar in the same arch;
  • Towards no other tooth: With the occlusal area facing the back of the mouth and;
  • Grow straight or angled: Staying trapped within the jawbone.

Impacted Wisdom Teeth are not functional; this means they don’t help in the food chewing and biting process. Sometimes, they become a problem for patients and require extraction. 

What Are the Problems of Impacted Wisdom Teeth?

In many cases, Impacted Wisdom Teeth cause no discomfort or pain. Yet, patients might not even know they have impacted teeth until they get a panoramic X-ray of their mouths. Regrettably, impacted teeth might remain unnoticeable, bringing no problems for a long time and eventually causing lots of trouble. 

Patients’ worries increase when they start feeling pain produced by an infected gum, a deep cavity infecting the nerve, or the occlusal area of the impacted teeth touching the second molar and eroding it. All of these cases are undoubtedly worrying and require extracting intervention.

Consequently, patients knowing they have impacted teeth, worry about the surprising pain that can appear spontaneously and decide to get their Wisdom Teeth extracted preventively. However, there are also circumstances where Wisdom Teeth can produce no problems throughout the entire lifespan. Also, the removal of Wisdom Teeth might require surgery. So, without doubt, Wisdom Teeth extraction has generated debate among dentists. 

Here we include a list of agreed circumstances that undoubtedly require professional intervention and eventual extraction of an impacted tooth:

Preventive Extraction Case

  • A partially sprout impacted tooth form irregularly shaped catchment areas in which debris and food residues stuck, creating a breeding environment for bacteria to grow. Dentists might recommend preventive extraction in this case.

Imminent Extraction Cases

  • Partially erupted Wisdom Teeth are challenging to clean, increasing the risk of a gum condition named pericoronitis which is an infectious process affecting the soft tissue that partially covers the crown of the tooth and affects the immune system;
  • Difficulty cleaning Wisdom Teeth might also cause caries (cavities) that account for 15% of Wisdom Teeth extractions;
  • Both pericoronitis and caries might result in a pulp infection, which is a mass of connective tissue. A tooth’s survival rests on the pulp. Infection of the pulp (necrosis) could spread to the fascial space perforating the cortical plate, causing a severe problem; 
  • Impacted Wisdom Tooth’s malposition exerts strain on a functional second molar leading to erosion of the roots, damaging a fully functional tooth to the point that can end in tooth loss;
  • A fluid sac named dentigerous cyst forms in the soft tissue and jaw bone on top of an impacted Wisdom Tooth, which can eventually cause pain and stresses other teeth provoking misalignments. These cysts can develop producing infections;
  • An impacted tooth might erupt ectopically. This means it can grow in the maxillary sinus producing chronic sinusitis and;
  • Even though the incidence of Wisdom Teeth in Orthodontic treatment is minimal, the second molar movement complicates when a wisdom tooth obstructs its displacement. Also, some scientific authors support the opinion that lower third molars cause teeth crowding.

What is the Process of Wisdom Teeth Removal?

Wisdom Teeth removal is an ambulatory process that a dentist can perform. However, deeply impacted teeth stuck in the bone or soft tissue might require a surgical approach to the problem and an oral surgeon’s intervention. 

Firstly, a dentist evaluates X-rays to determine the need to refer the patient to an Oral Surgeon. Otherwise, a dentist treats the case at the office and schedules an extraction. In any case, we have listed some pre-procedural recommendations, what to expect during an intervention and advice about post-intervention measures.   

Openly Discuss Health-Related Conditions

Open and sincere communication between a patient and an Oral Surgeon is critical. Before surgery, patients must describe any health conditions or related problems and list all currently prescribed medications.    

Planning In Advance

As previously discussed, a Wisdom Teeth extraction is an ambulatory procedure that lasts 45 minutes, and you can immediately reincorporate it into your routine activities. However, not all people respond similarly to pain and anesthesia. 

Consequently, you might need to plan a ride back home or work. Also, surgery might momentarily disrupt your daily routine, so take a preventive measure and look for assistance for grocery shopping or the like. 

What To Expect During a Wisdom Teeth Extraction Intervention?

Wisdom Teeth Extraction is a painless procedure. Your dentist or Oral Surgeon will explain in detail the type of anesthetics or sedatives administered before and during the extraction procedure. We include a list:

Local Anesthesia

Local anesthesia is the less invasive type of anesthesia injected directly into the mouth near the nerves surrounding Wisdom Teeth. Here is a list of local anesthetics::

  • Novocaine;
  • Lidocaine or; 
  • Mepivacaine. 

In addition, nitrous oxide, also known as laughing gas, helps a patient relax and reduce discomfort and the tension this type of procedure causes. 

Intravenous Sedation (IV sedation)

Like nitrous oxide, your dentist or oral surgeon might recommend intravenous sedation. Again, IV sedation produces drowsiness and relaxation.    

General Anesthetics

A general anesthetic acts on the central nervous system inhibiting neurotransmission and making a patient fall asleep. General anesthetics effects last between one hour and two.  

Surgical Procedure Details

The Oral Surgeon opens the gums making an incision to make the Wisdom Tooth visible and have manageable access. However, tooth manipulation is problematic in some cases and requires breaking the tooth into pieces to make extraction possible. 

A Dentist or Oral Surgeon performs a thorough cleaning to prevent leaving any residues that might cause future complications. After cleaning, the Oral Surgeon stitches de wound for a quick recovery.     

Post-Surgery Measures

After Teeth extraction, you might be a little drowsy and feel discomfort in your mouth. The good news is you can return to your regular activities with a little extra care. However, not everyone reacts similarly to anesthesia, so it’s a good idea to anticipate taking some measures to your daily routine on the day of the surgery.

The next three days after surgery are critical. It is normal for patients to feel discomfort that will recede with the passing of days. Full recovery from Wisdom Teeth extraction might take up to three weeks. During this time, it is imperious to follow any prescription and recommendation given by your Oral Surgeon. Here is a list of recommendations after a Wisdom Teeth removal surgery:

  • Pack some ice and gently press it against your cheek to reduce inflammation; 
  • Carefully try to open your mouth, making little effort;
  • Start brushing your teeth the next day after the surgery taking special care not to touch the extraction area;
  • Follow your Oral Surgeon’s recommendations and take any prescribed medication;
  • If pain or swollenness increases after the first three days, call your doctor;
  • Don’t use a straw for drinking. Sucking might force the stitched area muscles and tissue;
  • Try to constantly and gently gargle using salt water and; 
  • Avoid drinking alcohol and smoking for a few days.

Can An Orthodontist Remove Wisdom Teeth?

Orthodontists have the training to identify malocclusions that require tooth extractions. In addition, orthodontists work with specialists like Oral Surgeons and Periodontists that assist them in intervening in their specialty areas; in cases requiring specific procedures like denture extractions or receding gummy tissue.

Do I Need to Get my Teeth Extracted for Braces?

Generally, patients “do not need” to get a tooth extracted before or during braces treatment. In fact, young patients that have not yet developed their Wisdom Teeth are perfect candidates to start orthodontic treatment. 

Also, patients that already have their Wisdom Teeth sprout can wear braces or other orthodontic appliances. In some cases, Orthodontists cement braces on Wisdom Teeth.  An Orthodontist evaluates every patient and only recommends an extraction if it is fully needed to accomplish the goal of getting a beautiful smile.