Wisdom Teeth – Do they need to be removed?

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Wisdom Teeth – Do they need to be removed?

St Lawrence Dentistry carefully assesses wisdom teeth with respect to your individual situation.

Wisdom teeth are the final set of molars which to form. They are called wisdom teeth because if there is enough room for them they poke thru the gum (erupt) around 16-20 years old. At that age, the old adage is one is has lived enough to be ‘wise’. You can decide for yourself if you find this to be true!

Wisdom teeth are considered ‘vestigial’ structures. That is, they are evolutionary ‘left-overs’ which are no longer of great function. They are they are expected to be phased out of human gene pool over the next several millennia (hopefully we last that long!). Other examples of vestigial structures are human appendix and a whale’s thigh bone. Anthropology has shown us that long ago human’s jaws used to be bigger and our diet was different. Wisdom teeth were much more functional at that time as they erupted fully into the mouth and were used to chew (masticate) tougher foods than we typically have in our diet today. In modern times however our jaws are not often big enough to accommodate wisdom teeth and can lead to several different issues.

Some wisdom teeth may never need to be removed. If the wisdom tooth is completely housed in bone (fully impacted tooth) and has no sign of pathology either clinically or radiographically then there is good chance this tooth will be fine in the long run. Similarly, a wisdom tooth may never need to be removed if it has fully broken through the gum, has no decay, and is being cleaned properly.

Sometimes wisdom teeth need can be problematic due to dental decay. Even if our jaws are big enough to accommodate them they can have a higher decay rate due to there being more difficulty in accessing them when brushing. If the dentist does spot softening of these erupted teeth at an early stage he/ she can inform the patient and discuss ways of preventing further decay. This may involve altering your oral hygiene regimen. In addition, if warranted, the existing decay could be removed and filled with modern filling materials such as composite resin.

One common reason for pain or swelling around wisdom teeth is pericornitis. This is inflammation and infection of the gum around the wisdom teeth. This usually happens when a wisdom tooth has grown in halfway and the gum only partially covers the area. In this situation, debris can get trapped between the gum and the tooth causing pain and inflammation. Dr.Hawryluk will assess whether the tooth should be extracted or not. If the dentist feels there is significant chance this tooth may one day erupt more and be a viable tooth Dr. Hawryluk may opt to clean the area with ultrasonic instruments, flush the area with saline, or remove the piece of inflamed gum (operculum). If the dentist feels that none of these treatments will work in the long run then the best solution may be a removal of the tooth.

In some cases, wisdom teeth are removed at the young age (16-22 years) even if they are not causing an issue. This is practice seems to be more common in North America compared to Europe. The rationale here is that some teeth have a high probability of having complications later on in life and are much simpler to remove at a young age. Youth and a simpler surgery also mean fewer complications in the post surgical period. At a young age (16-22 years) wisdom teeth are much more easily removed because a dental follicle is around the tooth which makes more room for the clinician to remove it. In addition, the ligaments holding the tooth to the bone can be larger allowing for much more ‘give’ to the tooth when the clinician applies removal pressure. Another major consideration for removing wisdom teeth in young adults is the position of the tooth relative to the nerve canal (inferior alveolar nerve). At a young age, the wisdom tooth root may not be fully formed and sit well above the nerve canal. However, over time the root will form and often times transect the nerve canal. This could mean removing at a young age may greatly lessen the chance of any nerve damage (paresthesia).

In rare cases, cysts or tumors can form around wisdom teeth. Sometimes patients have no symptoms at all and they can grow undetected if the appropriate routine radiographic screenings are not done. If the cyst grows large they can lead to jaw fracture due to the cyst causing jaw resorption. St. Lawrence Dentistry always advise patients to have the appropriate screenings to prevent these situations and will deal with scenarios like this in an urgent fashion.

Finally, wisdom teeth should be removed if they are causing dental decay in the adjacent second molars. Wisdom teeth which are in a ‘meso-angular’ orientation can push on the roots of the second molars and cause bone loss in the area. If saliva seeps into the area of the bone loss and it cannot be cleaned this often leads to decay. Since the decay happens on the root of the second molar (and not on the crown) it can be difficult to fix by a simple filling alone and often times a root canal and crown could be indicated. However, if the decay is caught at an early stage and the wisdom tooth is removed promptly, the decay can sometimes be treated by a simple filling.

As you can see there are many factors to consider when assessing wisdom teeth. St Lawrence Dentistry will make an accurate diagnosis of your specific situation and you will be fully informed of your options. We offer awake and asleep options to remove wisdom teeth. Sedation at our facility is offered by a Board Certified Medical Anesthesiologist and we are fully certified by the Royal College of Dental Surgeons to provide Dentistry Asleep (Dental Sedation).

If you have any questions about your wisdom teeth and you live in the Mississauga, Oakville, or Toronto area please call us.

80 Port St East Suite H

Mississauga, Ontario
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(905) 278-1649

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