Wisdom teeth Ngā niho kōhari tuatoru
Most people have 32 teeth by the time they are 18. At around age 18 to 20 the third molars (wisdom teeth) are the last 4 teeth to come in. Wisdom teeth may have to be removed to correct a problem or to prevent future problems.
About wisdom teeth
Most people only have enough space in their mouth for 28 teeth. Because the wisdom teeth are the last to come through, they often do not have enough space. Because of this they may:
- be crooked
- only come through partly
- remain completely embedded within the jaw.
If your wisdom teeth are aligned properly, have come through completely, and you can reach them to clean them, they will probably not have to come out.
Possible problems with wisdom teeth
- Your jaw may not be large enough to fit them and they may become impacted. This means they cannot break through your gums. More serious problems can happen when impacted wisdom teeth cause a cyst to form or damage the roots of neighbouring teeth. If this happens, you may lose those teeth.
- Your wisdom teeth may break only part way through your gums, causing a flap of gum tissue to grow over them. This can trap food and germs, causing an extremely painful infection. It might also cause an abscess.
- One or more of your wisdom teeth may come through at an awkward angle. The top of the tooth may face forward, backward or to either side.
- Your wisdom teeth may put pressure on the surrounding tissues as they grown, causing pain and discomfort.
Deciding whether to have your wisdom teeth removed
If your wisdom teeth are not causing problems, it may be difficult to decide whether to have them removed to prevent problems in the future. There are several things to consider.
- You may never have any problems with your wisdom teeth.
- It is rarely harmful to your health to have your wisdom teeth removed, but there are minor risks with any surgery.
- In rangatahi (young people in their late teens and early twenties), the roots of wisdom teeth are not fully developed, and the jawbone is not as dense. This means it is easier to take the teeth out than it is later in life. The easier it is to remove the teeth, the more straightforward your recovery is likely to be.
- Most problems with wisdom teeth develop between the ages of 15 and 25.
- If you have a medical condition that may get worse over time and your teeth may cause problems, consider having your wisdom teeth removed while you are healthy.
Removing wisdom teeth
How easy it is to remove your wisdom teeth depends on whether they have come through or not.
A wisdom tooth that has fully come through your gum can be taken out the same way as any other tooth. But a wisdom tooth can be underneath your gum and within your jawbone. To remove this:
your gum will have to be lifted
part of the bone lying over the tooth will have to be removed
the tooth may have to be taken out in small sections.
Sometimes this can be done with a local anaesthetic in your local dental clinic. More complicated wisdom teeth can be removed in hospital or a dental clinic. You will probably need a general anaesthetic (where you are asleep for the procedure) or lighter 'conscious sedation' for this. Your oral and maxillofacial surgeon or dentist will let you know which is best for you.
Complications of removing wisdom teeth
You may have some complications after your wisdom teeth are removed.
Your face may swell around the area where the tooth was removed. To minimise the swelling, place an ice pack (or a small bag of frozen peas) wrapped in a clean cloth on the side of your face. Keep it there for 10 to 15 minutes every hour for the first 24 hours.
The socket (the space where your tooth was) may bleed. To control the bleeding, put a piece of clean, moist gauze over the empty tooth socket and bite down firmly. Keep doing this for about 45 minutes. Repeat this if you continue to have light bleeding.
If you have heavy bleeding that will not stop, contact your dentist or oral surgeon.
Dry socket is common. It happens when either:
- a blood clot has failed to form in the socket
- the blood clot that does form is dislodged.
This delays healing.
Dry socket typically happens 3 or 4 days after the extraction. It causes pain (ranging from dull to severe) and a foul mouth smell. Your oral surgeon or dentist will treat this by placing a medicated dressing in the socket. You will need to replace the dressing every 24 hours until the symptoms go away.
Numbness is less common. Wisdom teeth impacted in the jaw may be close to nerves. Sometimes these nerves can be bruised or damaged when the tooth is removed. This causes numbness (called a paraesthesia) of the tongue, lip or chin that can last a few days, weeks or months. Very rarely, it may be permanent.
Self care after wisdom tooth removal
- Take the pain relief prescribed by your oral surgeon or dentist for the first 48 hours. It is better to prevent pain by taking it according to instructions, rather than waiting for pain to develop and taking it then.
- Chew food on the other side of your mouth. If you have had a difficult extraction, only consume soft foods and liquids for the first 24 hours.
- Try not to rinse or spit for 24 hours after your teeth come out.
- Avoid hot liquids, hard food, alcohol, vigorous exercise and touching the wound. These things can dislodge the clot which helps you to heal.
- While your mouth is numb, be careful not to bite your tongue, lip or the inside of your cheek.
- Avoid smoking because it decreases the blood supply and can bring germs and contaminants into your mouth.
- After 24 hours, rinse your mouth with an antiseptic mouth rinse or warm salt water (half a teaspoon of salt in a cup of warm water) after meals and before bed.
- Keep your mouth clean. Brush your teeth with a soft toothbrush twice a day.