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Wisdom Teeth | Your questions answered

Wisdom teeth are the third and final set of molars that most people get in their late teens or early twenties. It is possible for them to erupt and become useful, healthy teeth, but usually they become impacted and need to be removed.

Wisdom teeth that have fully come through can function like any other teeth in your mouth. They have the same purpose as your other molar teeth, and have a large, flat surface that is used for chewing food.

Not everyone will get the usual number of four wisdom teeth. Some people will develop only a few, and some will get none at all. In rare cases, people can get many more than the usual number of wisdom teeth.

 

How do I take care of my Wisdom Teeth?

Wisdom teeth that have erupted or are erupting, require the same care and attention that the rest of your teeth need. Daily flossing and brushing is essential to preventing the teeth from getting decay and gum disease.

Wisdom teeth are right at the back of your mouth, and can be difficult to reach with normal brushing and flossing. Partially closing your mouth makes it easier to reach their outer surfaces and gives you a better ability to clean them.

Floss holders can help with trying to floss around your wisdom teeth. If you are finding it difficult to keep them clean, then we would recommend seeking advice from your dentist.

The assessment of your wisdom teeth should be part of a regular dental check-up.  An OPG X-ray will show the position of your wisdom teeth, and help to assess whether they are going to erupt normally or not.

Your dentist will recommend removal of your wisdom teeth if they are impacted or decayed, or have any disease associated with them such as a cyst, or are compromising the health of adjacent teeth. 

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What are impacted Wisdom Teeth?

The term "impacted wisdom teeth" refers to when the wisdom teeth are unable to fully erupt into the mouth. The cause of this are:

  1. Inadequate space due to the length of the mandible not being sufficient to accommodate all of the teeth
  2. The wisdom tooth growing on an angle which prevents it from erupting.  This is most often seen as a mesial  impaction where the wisdom tooth is leaning towards the tooth in front.  However the wisdom teeth can lean in any direction.

An impacted tooth can stay painless for a long time. You may not even realize it's present, therefore an assessment of wisdom teeth is an important part of any general check up. Pathology associated with wisdom teeth does not always cause symptoms.

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What symptoms can Wisdom Teeth cause?

Wisdom teeth when erupting can cause "teething" symptoms just like those experienced as a baby. The area can feel achy, and cause a pressure like sensation. You may experience some discomfort in the region of the erupting wisdom teeth, or externally in the region of your ear. Partially erupted wisdom teeth have a little flap of gum over them called an operculum.

As the wisdom teeth are erupting they become exposed to the same food and bacteria (plaque) that the rest of the teeth are exposed to. This means that they are just as susceptible (even more so if you are having difficulty reaching them) to decay as the rest of the teeth, even if you can't see them. There only needs to be a small gap in the gum behind the back tooth to expose the wisdom teeth to food and bacteria.

If the wisdom teeth become decayed you can develop toothache, however the decay may become quite large before this happens. The decayed wisdom teeth if left will eventually become abscessed and cause further pain and swelling.  The resulting infection can cause bad breath, difficulty opening your jaw, a bad taste in your mouth, and swollen lymph nodes. It may then progress to facial swelling and fever.

The presence of plaque causes gum disease. If you haven't brushed your teeth you will notice that the gums between your teeth become red and inflamed. The gums bleed easily. When the plaque gets into the small opening of an erupting wisdom tooth the surrounding gum also becomes inflamed. The operculum (gum flap) can become so inflamed that when you bite your teeth together the upper teeth bite into the operculum. This condition is called pericoronitis.

Once plaque and food gets under the operculum it is difficult to remove. Tooth brushing won't do it.  We recommend the use of a curved plastic syringe which when filled with warm salty water will irrigate under the operculum to flush out the debris.

Impacted wisdom teeth can cause decay of the adjacent teeth.  As discussed, plaque, food and bacteria can get down the back of the last visible tooth in your mouth and under the gum which can be open due to the erupting wisdom tooth. The plaque is difficult to remove and eventually causes decay, resulting in the loss of this tooth, and often the wisdom tooth as well.

Unerupted or partially erupted wisdom teeth can develop cysts (a fluid filled sac). A cyst will usually not cause symptoms and may only be detected with a full mouth x-ray (OPG). The cyst if left will erode the jawbone, potentially damaging nerves and adjacent teeth.

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Possible symptoms from impacted wisdom include but are not limited to ...

  1. Pain/discomfort

  2. Swollen and bleeding gums in the area of the wisdom teeth

  3. Bad breath or unpleasant taste

  4. Headache or jaw tenderness

  5. Stiffness of the neck

  6. Swollen lymph glands

We recommend seeking professional help if symptoms develop from your wisdom teeth. The appropriate treatment options can then be prescribed.

Do my Wisdom Teeth require extraction?

Not all Wisdom Teeth need to be taken out. If they have fully erupted into your mouth and you are able to take care of them, there is no reason they can't be a perfectly functional part of your mouth.  

Wisdom teeth should be assessed by your general dentist as a part of your routine check-up.  If you are unsure just ask them.  Your dentist will recommend extraction of the wisdom teeth if they are, or have the potential to:

  1. Cause damage to other teeth in your mouth
  2. Not going to erupt fully into the mouth
  3. Or if they have any pathology associated with them, for example they are decayed or have a cyst associated with them
  4. Create a point of weakness in the lower jaw, therefore putting those who play contact sport at greater risk of jaw fracture

Wisdom teeth do not need to be causing symptoms such as pain prior to a recommendation to have them removed.

Your wisdom teeth may not need to be removed if they are:

  1. Fully erupted, or going to fully erupt into your mouth
  2. Able to be kept clean and healthy
  3. A functional part of your bite
  4. Not causing damage to your other teeth

If your dentist has recommended extraction of your wisdom teeth the next stage is to see a Specialist Oral and Maxillofacial Surgeon for there removal. The cost of your initial wisdom teeth consultation with our Specialist is fully rebateable from Medicare as long as you have a referral from a GP or Dentist.

Why do we advise preventative Wisdom Teeth removal?

If you have wisdom teeth that are impacted, or look like they will become impacted, we recommend that these be removed as a preventative measure, and at the earliest possible time.

Your wisdom teeth are assessed using an OPG, a full mouth X-ray like those on this page. This should be part of your regular dental check-ups, and you should be advised to have your wisdom teeth removed if they are likely to...

  1. Not fully erupt into your mouth
  2. Cause damage to your other teeth
  3. Become pathology such as a cyst
  4. Increase the risk of jaw fracture

The earlier you have impacted wisdom teeth out, the better. If it looks like your wisdom teeth are going to cause trouble, then it is more or less likely they will eventually.

The ideal time to remove impacted wisdom teeth is in your mid to late teens. There are a number of reasons for this, which are...

  1. If wisdom teeth are removed before the roots start to develop, the size of the surgical site can be reduced as less bone is required to be removed.  This is then a more conservative operation and will result in a better healing experience for the patient
  2. The bone in a young person is less dense and therefore softer than that of someone older. Less bone needs to be removed to gain access to wisdom teeth, and the increased flexibility in the bone makes them easier to remove.
  3. The roots of impacted wisdom teeth tend to grow down, and then around the main sensory nerve running through the jaw. Removing the wisdom tooth before this occurs, minimises the risk of damage to this nerve.
  4. As a rule your wisdom teeth will get more difficult to remove the older you are.

If you decide not to remove your wisdom teeth they will need monitoring regularly.  This can be done by your general dentist when you are having a regular check-up.  An OPG x-ray (like the ones shown) will be required so the area around the wisdom tooth is able to be viewed adequately to exclude the presence of pathology.

This X-Ray shows Impacted Wisdom Teeth in an 18 year old girl, with tooth roots that have only just started to grow. Removing the teeth now is ideal, before they can cause damage, and while the risk of complication is low.

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Do I need Bone Grafting when I get my Wisdom Teeth out?

Wisdom teeth that are impacted can cause resorption (loss) of the bone around the back of the molar tooth in front.  The molar would often be lost prematurely due to this loss of bone, which may result in periodontal disease, sensitivity and decay. 

Traditionally, nothing was done to address this bone loss. In 2003 we started performing bone grafts to the back of second molar tooth. These were highly successful, and we continue to offer bone grafting to this day. 

Many surgeons are now offering this procedure, but not all. If you are seeking an opinion for the removal of your wisdom teeth, make sure you ask your surgeon if bone grafting is necessary for your individual circumstances.  If impacted wisdom teeth have damaged the bone around the next molars, bone grafting will give these teeth the best chance of long-term survival. 

Bone grafting is offered to people who meet certain criteria.  We offer it to those that are at risk of loosing the teeth in front if bone grafting is not offered, however there are some circumstances in which a bone graft will not "take".   A consultation including medical history will indicate whether a bone graft is suitable.

The bone grafting material is a natural bone substitute derived from the hard, mineral portion of bovine bone. It is produced by purifying and sterilising the bone to remove all the organic elements from it.  The crystals form a fine lattice mesh that encourage the cells that form new bone to grow in and around it.  With time they will solidify into natural healthy bone and it will look, act and feel like any other bone in your body.

Medicare rebates are available if the bone grafting procedure is performed by a specialist oral and maxillofacial surgeon.

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Why are wisdom teeth more difficult to take out?

It is not the size or shape of wisdom teeth that makes them difficult to remove, but the fact they are located right at the back of your mouth. Operating in such a tight space can prove challenging to those without specialist training.

If the wisdom teeth are impacted, than the difficulty of their removal increases even further. The lower wisdom teeth in particular, are the ones that are usually most challenging.

How challenging depends on the severity of their impaction, how far down they are in your jawbone, how close they are to the main sensory nerve that runs through your jaw, and if there is any pathology associated with them.

Age is also a factor because as you get older, your bone becomes more dense. More bone usually needs to be removed in order to gain access to the wisdom teeth, and this usually means a more delayed recovery period.

It is a good idea to have impacted wisdom teeth removed at an early age, when healing is usually faster and more comfortable, and before wisdom teeth have the opportunity to damage your other teeth.

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Will I need to go under a general anaesthetic?

Not all wisdom teeth extractions are complicated or extremely difficult. Many wisdom teeth can be removed in our dental surgery under local anaesthesia (LA). Other forms of sedation are available to relieve anxiety about the procedure.

If you feel that you are anxious about the procedure and would prefer not to remember it, you may choose to have your wisdom teeth removed under general anaesthesia (GA) in a private hospital setting.

It is important to remember that having a general anaesthetic is a medical procedure that has its own recovery period. Most people that undergo general anaesthesia will feel the after effects for a few days after surgery.

Ultimately the decision on how to have your wisdom teeth removed (either under LA or GA) is usually up to you and your personal circumstances.

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What's involved in the post-op care?

Our practice will recommend to you the best after care for wisdom teeth removal. Typically, you will be advised to: 

  1. Protect the area where the tooth has been removed and avoid touching it with your tongue or hands. 
  2. Avoid hot drinks or hot food for 24 hours, as this may cause the wound to bleed. 
  3. Avoid rinsing your mouth and swishing water or mouthwash for 24 hours as this may dislodge the blood clot in the tooth socket and cause further complications. 
  4. If you experience bleeding, apply gentle pressure on the site with a clean gauze pack. 
  5. Do not smoke for 2-3 days after the procedure and avoid drinking alcohol as this can cause serious complications and delay healing.
  6. Take prescription medication as directed

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What is the recovery period?

This is dependant on how difficult the extractions are and your individual situation. Some people are ready to go back to work the next day, some need several days.

A person who has a job that requires heavy manual labour will usually require longer time off work than someone who works at a desk all day.

What are the risks of taking out Wisdom Teeth?

Most people who have their wisdom teeth removed will not have complications.  The risk of experiencing a complication is influenced by;

  1. Medical history
  2. Social history (eg. smoker)
  3. Age
  4. Position of the wisdom teeth (how impacted they are)
  5. Root formation
  6. Pathology associated with the wisdom teeth (eg. decay or cyst)
  7. Proximity to IDN (inferior dental nerve)
  8. Experience of the clinician removing the wisdom teeth 
  9. Correctly following post op instructions and care

Unless the removal of your wisdom teeth is considered simple, we recommend seeking treatment by an oral & maxillofacial surgeon.

Generally speaking, the risks of removing impacted Wisdom Teeth are...

  1. Numbness or altered sensation | The nerve supplying sensation to your bottom teeth, gums and lips may be bruised or damaged from Wisdom Teeth removal. The proximity of the nerve to the Wisdom Teeth should be assessed at your consultation and if there is any risk to the nerve, you should be advised of this.
  2. Dry socket | After a tooth is extracted a blood clot forms in the socket and seals the area so that it can heal. A dry socket is uncommon, and may occur if the blood clot breaks down or is dislodged, exposing the bone underneath. We recommend no smoking, spitting or vigorous rinsing, and leaving the site alone with your tongue to minimise the risk of this. 
  3. Infection | Antibiotics are prescribed after surgery to eliminate the risk of infection. We also advise no dairy products are consumed until the sutures are removed, as plaque (food/bacteria) can adhere to stitches. 
  4. Excessive bleeding | Normally this isn't a problem, but certain medical conditions or medications may mean you have greater risk of bleeding after Wisdom Teeth removal. A full medical history will be taken at your initial consultation to assess whether this may be a risk.
  5. Difficulty in opening mouth | is common and usually goes away in a few days after the swelling goes down.

This is not a complete list of the risks relating to each person and their medical health. Specific complications should be discussed by your surgeon during your consultation with them. Bring a list of questions with you, so you won't forget the things you want to ask.

We are able to remove your wisdom teeth in our rooms in Surry Hills, Sydney or Newcastle under local anaesthetic, or under General Anaesthetic at a private hospital in either Sydney or Newcastle.  The cost of your initial wisdom teeth consultation is partially rebateable from Medicare if you have a referral from a GP or Dentist.

‘Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.’

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