Parents shouldn’t wait until their children’s wisdom teeth (third molars) have erupted or are causing pain to bring them to the dentist. Generally, wisdom teeth are developed enough in a person’s late teen years to assess whether there is enough room for eruption into the mouth.
If there is adequate room for the wisdom teeth to erupt and push up through the gums, and those teeth are hygienic and functional (in the bite plane), then they can be maintained just as other teeth in the mouth.
However, wisdom teeth, which develop behind the second molars in the posterior aspect of the upper and lower jaws, are the most frequently impacted teeth and often need treatment to prevent further complications.
An impacted tooth is one that has developed, but cannot erupt into a hygienic and functional position. If the tooth is impacted, the smooth shiny enamel surface of the tooth’s crown does not allow the surrounding tissue to “seal the crown,” which can potentially create a space for bacteria to reside.
All impacted teeth have the potential to develop problems, especially periodontal (gum) disease. For many patients, periodontal disease develops around the wisdom teeth and moves forward.
Other problems with impacted wisdom teeth include decay of the tooth or adjacent tooth, infection, contribution to crowding, pain and, in rare instances, cysts and tumors that can develop around impacted teeth.
Have your general dentist evaluate the position of your child’s wisdom teeth and determine if there is adequate room for eruption into the mouth. If there is not enough room for proper eruption, it is preferable to intervene and remove the teeth before the roots are fully formed.
The most thorough assessment is best done by an oral surgeon. An examination includes a panoramic type X-ray and, in some cases, a CBCT (Cone Beam CT scan) is used to further define and study the relationship of the wisdom teeth to other structures, such as the sensory nerve in the lower jaw or the sinus in the upper jaw.
Although some general dentists remove wisdom teeth, oral surgeons are considered the experts in the management of these teeth.
When wisdom teeth are identified as impacted, it is recommended to treat the teeth before disease develops. While other strategies are available, extraction is the most common management of impacted wisdom teeth.
The extraction is generally performed in the oral surgeon’s office with local anesthesia and IV sedation or general anesthesia. Oral surgeons are trained in anesthesia and board-certified to provide in-office sedation.
Recovery generally requires 3- 4 days off from full activities and about 10 – 14 days before a completely normal diet can be resumed. Side effects from surgery, including discomfort, swelling, limitation of opening, infection and, in some instances, bony splinters (sequestrum) can be expected and are usually easy to treat. Additionally, numbness to the lower lip and, rarely, the tongue can occur.
As summer approaches and kids are out of school, now is the best time to have your child’s wisdom teeth checked and, if necessary, scheduled to be removed.
Dr. David W. Todd, DMD, MD, has been active in his profession. He has authored 18 articles in various publications and made numerous presentations at state, regional, and national meetings. For Dr. Todd’s full bio click here.