The wisdom tooth, popularly known as “judgment teeth,” are the last dental arch. They are the last teeth to erupt, usually around the age of 18-21, the age at which they reach their most incredible age and hence the popular name.

They are characterized by being large and special teeth due to their unique anatomy. These teeth and their molar neighbors were needed in our ancestors to help chew more complex foods. Thus, with the evolution of times and food, these teeth were disappearing in the human species. Some people don’t have any wisdom teeth; others only have one or two. Due to the phenomenon “of function,” that is, nowadays, and considering the type of diet in society, these teeth are no longer needed, so their natural tendency is to disappear.

Can I live with a wisdom tooth?

The decision to extract or not must be made with clinical criteria and individually. The ones that cause the most problems are the badly erupted either by genetic factors or lack of space. Thus, there are some situations in which this tooth must undoubtedly be extracted.

Reasons for wisdom tooth extraction

INSUFFICIENT ARCADE SPACE

Food impaction can occur when there is no room for the wisdom to erupt correctly, with consequent tooth decay.

Another scenario is pericoronitis, an inflammation of all the tissues surrounding the wisdom area and which is quite painful. When wisdom cannot complete its eruption, food debris accumulates around it, and bacteria proliferate, producing a purulent infection (pericoronitis). This can result in bad breath (halitosis), pain that radiates to the ear or temporomandibular joint, swelling, purulent discharge, and, often, limited opening of the mouth (trismus). 

This inflammatory process can spread through the soft tissues of the face and neck, which can translate into a difficult situation that requires hospitalization and urgent care. It is essential to realize that it works as an alarm once the first episode has occurred, as the following ones will be more frequent and severe.

PAIN

The pain caused by wisdom can be more local or radiate to the ear or temporomandibular joint; most of the time, it is associated with swelling, purulent discharges, and, many times, limitation in the opening of the mouth (trismus). This inflammatory process can spread through the soft tissues of the face and neck, which can translate into a difficult situation that requires hospitalization and urgent care.

TOOTH WITHOUT OCCLUSION

When the tooth has no occlusion. Wisdom without occlusion/without an antagonist, in addition to not stopping erupting, has no function, being responsible for the accumulation of dental plaque and, sometimes, for biting the cheek (with greater or lesser severity)

INTERFERENCE IN OCCLUSION (bite)

As it is often verified by the lack of space in the dental arch, they are poorly positioned, creating interference when we close the mouth and function (chewing) and may, therefore, be responsible for joint disorders.

ASSOCIATED DENTAL CHIST

They usually form from the epithelial tissue of the unerupted wisdom tooth. They are mostly asymptomatic, which is why it is essential to assess the state of the wisdom teeth at your dentist through examinations. In most cases, it is possible to restore total oral health after extracting and removing the cyst.

In short, we argue that wisdom teeth should be kept in the mouth whenever possible. However, in cases with insufficient space for it, resulting in complications, and when they compromise the patient’s balance and oral health, they should be removed.

How is the surgery? And the Post-Operative?

We can divide it into upper and lower wisdom surgery. Typically upper wisdom teeth surgery has no complications. As a medical procedure, the postoperative period varies significantly from patient to patient, but these teeth generally have a perfect postoperative period without significant complications.

On the other hand, lower wisdom teeth can be more problematic; due to their position close to a vital sensory nerve and its anatomy, they require specific precautions, care, and techniques. 3D complimentary exam to be safe where we can act. Usually, these teeth are worse positioned and, consequently, require more complex surgery. It also depends on the tooth, but there are two scenarios: simple surgery without opening a flap or surgery with a flap and slight bone enlargement.

POSTOPERATIVE

The postoperative period is done with medication, and often with antibiotics, edema or swelling in these 48 hours can occur, being normal. The patient should apply ice on the face several times a day and avoid hard or hot foods, alcohol intake, and smoking. After a week, he goes to the clinic to remove the suture and be re-evaluated. Exercise is not recommended for three days.

POSSIBLE COMPLICATIONS/RISKS?

Usually, in the extraction of the upper wisdom systems, there are no significant complications. However, there are more complex clinical cases.

On the other hand, lower wisdom entails some risks associated with its extraction. As explained, there is a sensory nerve in this area that varies its position in the space from patient to patient. Thus, this nerve may be closer to the wisdom tooth or less close to it. Precisely because of its proximity, the risk of nerve damage exists.

As a consequence, there may be loss of sensation on that side of the mandible/hemiface, usually temporary, but in more severe cases, it may, in the end, be definitive.

Thus, we are aware of this risk and, to prevent it, we have experienced professionals in constant training.

We always carry out a complimentary 3D exam that allows us to observe with great precision the path of the nerve and how the wisdom tooth is related to it.

Can I get more than one wisdom tooth out?

Can I go to work?

Yes, you can; in some instances, it is indicated to perform a surgery to extract the four wisdom teeth; we usually advise to complete the upper and lower surgery on the same side simultaneously. We are reducing antibiotics (if necessary) or other medication to one time only.

Unless otherwise indicated, we usually do not recommend extracting the four wisdom teeth in a single intervention for the sake of postoperative comfort for the patient, as they may have comorbidities and feeding difficulties.

Yes, you can usually go to work the next day, bearing in mind that it depends on the clinical case, and your prognosis varies accordingly, from person to person.

When should they be extracted? At what age?

From the moment they have a clinical indication for it. It varies a lot from clinical case to clinical case, and it is not possible to have a linear response.

However, many times in patients between 14 and 20 years of age, we have already been able to make this diagnosis through various complementary exams. In these cases, it is recommended to extract as soon as possible as it entails fewer complications. 

Surgery is technically more accessible because the bone is less dense, the apex is not fully formed, and patients recover faster. Thus, we consider it extremely important to have regular appointments with your dentist to control all these factors.