Trouble with wisdom teeth is one of the commoner problems dentists deal with. By some estimates around 90% of adults meet it at least once.
Wisdom teeth are the third molars, the eighth teeth in the jaw and the last to come through. They usually erupt in the third decade of life, though it is not unusual at fifteen or seventeen. They are called wisdom teeth because they arrive at an age when a person is expected to have acquired some.
The eighth teeth are in fact a legacy of evolution, evidence that people before us had considerably larger jaws with more teeth. They are thought to have served for chewing and grinding hard food. As our diet changed over the centuries these teeth lost that primary role. They still matter, because they prevent bone loss at the ends of the jaw.
Unfortunately, the arrival of a wisdom tooth can be very uncomfortable. It can cause severe pain for a number of reasons, which is why regular check-ups, and dealing with problems in time, matter.
Pain as a wisdom tooth comes through
For most people the arrival of a wisdom tooth is painful. Inflammation of the gum often follows as the tooth breaks through. Pockets can form as it erupts, and they are more than fertile ground for bacteria, so they need dealing with promptly.
If the wisdom tooth is coming through correctly and without affecting the neighbouring teeth, removing part of the gum with a laser may be suggested. That makes room for the tooth to come through properly, clears any infected pockets and prevents complications.
Problems with wisdom teeth that have not come through
Problems during eruption often come from a lack of room in the jaw. Since wisdom teeth are the last to arrive, they are the ones that suffer most.
An unerupted wisdom tooth does not necessarily cause complications. Statistically, though, about one in six leads to trouble and severe pain. Problems can arise from decay and from a periodontal pocket forming around the neighbouring teeth, and an orthodontic irregularity can develop from constant pressure on the other teeth.
A cyst on the tooth is another common possibility, and it can even cause pericoronitis — an infection of the soft tissue with severe pain, swelling and difficulty swallowing. At its worst the lymph nodes under the jaw become inflamed.
Dentists advise that an unerupted wisdom tooth should be removed before it causes more serious consequences. It is best done early, in your twenties, when the root is not yet fully developed.
Why wisdom teeth can be a problem
There are several reasons a wisdom tooth may cause pain that have nothing to do with the eruption itself:
- Decay: wisdom teeth are very hard to clean and can decay quickly. Repairing them is also difficult because of how far back they sit.
- Damage to the neighbouring tooth: because of where a wisdom tooth sits, decay can easily develop on the second molar too, or the root of that molar can resorb. It is not uncommon for the neighbouring molar to have to come out along with the wisdom tooth.
- Infection: soft tissue lies over the crown of a wisdom tooth with a space between. Food collects there, which suits bacteria very well. That part of the gum is easily damaged and can discharge pus. The swelling can spread to the cheek and to the nearby lymph nodes.
- Pushing the other teeth forward: wisdom teeth can shift the other teeth and disturb their position across the whole jaw.
- Cysts: cysts can form around affected teeth and deform the bone. They rarely require surgery.
- Fracture of the lower jaw: a wisdom tooth can sit in a way that raises the risk of a fractured lower jaw in people who play contact sports.
Should wisdom teeth be removed?
Dentists recommend that anyone in their twenties with impacted wisdom teeth has them removed. For all the reasons above, it is better to take them out before they cause trouble.
For someone around thirty with impacted wisdom teeth lying deep in the bone, it is usually better to leave them and check them periodically. If they have partly appeared in the mouth, however, it is better to remove them, as with younger patients. Before any procedure the dentist assesses whether intervening will actually improve matters.
People sometimes ask why impacted wisdom teeth should be removed at all if they are causing no trouble. The point is that, left in place, they will almost certainly cause trouble sooner or later. That is most often the case with impacted lower wisdom teeth.
Complications tend to come suddenly, at any age, and they almost always arrive alongside some other long-standing condition that makes the procedure more complicated.
A wisdom tooth is best removed once any acute infection has settled. Dentists recommend removing impacted wisdom teeth between the ages of fourteen and twenty-five, whether or not they are causing trouble. The procedure is considerably easier in younger patients and recovery is much faster; the same extraction in an older patient can be harder, more demanding and more painful.
Frequently asked questions
- What are wisdom teeth and why can they be a problem?
- Wisdom teeth are the third molars, which usually come through in the late teens or early twenties. Problems arise from a lack of room in the jaw, which can lead to pain, infection, damage to neighbouring teeth and other complications.
- Is pain normal when a wisdom tooth comes through?
- Yes. Pain is a common symptom as a wisdom tooth erupts, and it can come with inflamed gums and swelling.
- When does a wisdom tooth need to be removed?
- Removal is recommended for impacted wisdom teeth, particularly in younger patients, to avoid later complications. Where a wisdom tooth is coming through correctly and causing no trouble, extraction may not be necessary.
- What can happen if wisdom teeth are not removed?
- Possible complications include infection, decay, damage to neighbouring teeth, orthodontic problems, cysts and even a fracture of the lower jaw.
- How painful is recovery after a wisdom tooth is removed?
- Recovery varies, but is generally faster in younger patients. Pain and discomfort after the extraction can be managed with painkillers and good oral hygiene.
Book an examination
A first examination is not charged for. You choose an appointment online, in a few steps, or call us.