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Impacted Wisdom Teeth – Symptoms, Causes, Treatment and Prevention

Definition

Impacted wisdom teeth is a tooth that gets blocked aWs it pushes through the gum into your mouth. Wisdom teeth (also called “third molars”) usually do not push through the gums until people are in their late teens, twenties or even older. Wisdom teeth are usually the last teeth to come through the gums. Most people have four wisdom teeth. Some people have none. Often, there is little space at the rear of the jaws for wisdom teeth to come easily through the gums. If the jaw does not have enough room for the wisdom tooth to come through, the tooth will become wedged in or “impacted”. Some impacted wisdom teeth remain buried and cause no trouble. However, other impacted wisdom teeth may cause severe problems. If one or more of your wisdom teeth become troublesome, your oral surgeon may recommend that they be removed.

History

Wisdom teeth have been described in the ancient texts of Plato and Hippocrates. “Teeth of wisdom” being from the Latin, dentes sapientiæ, which in turn is derived from the Hippocratic term, sophronisteres, from the Greek sophron, meaning prudent.

Charles Darwin believed the wisdom teeth to be in decline with evolution which his contemporary, Paolo Mantegazza, later proved to be false when he discovered Darwin was not opening the jawbones of specimens to find the impacted tooth stuck in the jaw.

In the late 19th and early 20th centuries, the collision of sterile technique, anaesthesia and radiology made routine surgery on the wisdom teeth possible. John Tomes’s 1873 text A System of Dental Surgery describes techniques for removal of “third molars, or dentes sapientiæ” including descriptions of inferior alveolar nerve injury, jaw fracture and pupil dilation after opium is placed in the socket. Other texts from about this time speculate on their deevolution, that they are prone to decay and discussion on whether or not they lead to crowding of the other teeth.

Impacted wisdom teeth

Epidemiology

Few studies have looked at the percentage of the time wisdom teeth are present or the rate of wisdom teeth eruption. The lack of up to five teeth (excluding third molars, i.e. wisdom teeth) is termed hypodontia. Missing third molars occur in 9-30% of studied populations.

One large scale study on a group of young adults in New Zealand showed 95.6% had at least 1 wisdom tooth with an eruption rate of 15% in the maxilla and 20% in the mandible. Another study on 5000 army recruits found 10,767 impacted wisdom teeth. The frequency of impacted lower third molars has been found to be 72% and the frequency of retained impacted wisdom teeth that are free of disease and symptoms is estimated at 11.6% to 29% which drops with age.

The incidence of wisdom tooth removal was estimated to be 4 per 1000 person years in England and Wales prior to the 2000 NICE guidelines.

Types of impactions

Dentists use a number of terms, in combination, to describe the positioning of impacted teeth. They are mesial, distal, horizontal, vertical, soft-tissue and bony

a) Mesial, vertical, horizontal and distal

These terms are used to refer to the general angulation (positioning) of the tooth.

The other types of impactions, in order of frequency of occurrence, are the vertical, horizontal, and distal types.

b) Soft-tissue and bony wisdom tooth impactions

In combination with the classifications above, wisdom teeth are also categorized as soft tissue or bony impactions.

Causes of Impacted wisdom teeth

Impacted wisdom teeth symptoms

Complications caused by Impacted wisdom teeth

Infection

When an impacted tooth starts to push through the gum, an infection can start around the top of the tooth. Infection and inflammation (swollen, red gums) can cause pain, swelling, and jaw stiffness. Swallowing may be painful. The patient may feel generally unwell. The infection can cause bad breath and an unpleasant taste.

 Pain

Pressure from the wisdom tooth may cause pain in the tooth next to it. Pain can also be caused by infection around the wisdom tooth, as shown above.

Ulcer

An upper wisdom tooth may push sideways out of the gum. It may cause an ulcer where it rubs against the inside of the cheek.

A food trap

Food becomes trapped between the wisdom tooth and the molar next to it. This can cause cavities in both teeth.

Cysts

In rare cases, a sac of fluid called a cyst can form around the wisdom tooth. The cyst can dissolve bone and damage other teeth and the gums.

Diagnosis and test

Your dentist or oral surgeon can evaluate your teeth and mouth to determine if you have impacted wisdom teeth or if another condition is causing your problems. Such evaluations typically include:

Treatment and medications

You may be advised to rinse your mouth often with a warm saltwater mouthwash. Use one teaspoon of salt in a glass of warm water. The water should be warm as possible, but not too hot. Your surgeon may also suggest an antiseptic mouthwash and a pain killer. Your surgeon may prescribe antibiotics. Tell your surgeon if you have ever had an allergic reaction to any antibiotics or other drugs. Take the complete course of antibiotics.

The Decision To Remove Teeth

After inspecting your mouth, jaws and X-Ray films, your surgeon can discuss the diagnosis with you. Your surgeon may recommend removal of one or more wisdom teeth, or other options. If the area around the tooth has been infected, your surgeon may decide to delay surgery while the infection is treated. Even though a wisdom tooth may cause problems, it may “settle down” after it pushes through the gum. While impacted wisdom teeth may cause problems, some never cause trouble and may not need to be removed. The decision to have wisdom teeth removed is always yours. If you are uncertain about your surgeon’s advice or diagnosis, you may wish to seek the opinion of another surgeon.

Early Removal of Wisdom Teeth

It is best to have troublesome wisdom teeth removed while the person is young. In young people, a tooth‘s roots have not formed totally, and the bone surrounding the tooth is softer. This allows easier removal of the tooth, and there is less risk of damage to nerves, bone or other teeth. Your surgeon may recommend early removal of one or more wisdom teeth for the following reasons:

Medicines

Give your surgeon a list of all medicines you are taking now or have been taking recently. This includes the “Pill”, blood thinners such as warfarin, and any over-the-counter medicines, such as aspirin or cough medicines. Tell your surgeon if you have ever had any type of allergic or bad reaction to antibiotics or any other medicine.

Pregnancy

Tell your surgeon if you are or may be pregnant. This could affect your treatment including:

Prevention of Impacted wisdom teeth

You can’t keep an impaction from occurring, but keeping regular six-month dental appointments for cleaning and checkups enables your dentist to monitor the growth and emergence of your wisdom teeth. Regularly updated dental X-rays may indicate impacted wisdom teeth before any symptoms develop.

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