The wisdom teeth or third molars are the last teeth to erupt. Their function is complementary to that of the rest of the molars and due to their position, they are the molars with the greatest variability in shape and position.
Classically it has been said that they are useless, but if they erupt in a good position, completely and occluding the upper molar, they are logically useful. The problem is that in many cases, due to their bad position, they do not erupt completely or they are impacted or they do it in a bad position and the only thing they generate are problems. We are going to detail all these cases and try to elucidate in which occasions surgery is indicated.
We could classify the situations in large groups
- Clinical wisdom teeth
These are those that, when they erupt, can cause symptoms such as pain. In the same way that presents any dental piece, they can suffer local inflammation for example (what we call pericoronaritis), infection or caries that generates pain. It is a localized pain at the tip of the finger in the exact place of the wisdom tooth.
It is also possible that, if they erupt in an anomalous position, these symptoms such as pain or caries may appear in the anterior molars due to impaction.
- Asymptomatic wisdom teeth
We can find cases in which the molars are completely included and do not show any symptoms at all.
In this case we must always evaluate the risk ratio (of surgery) and the benefit (of extraction).
In many cases, we apply the precautionary principle. Completely included wisdom teeth, asymptomatic and with a low risk of caries due to impact on the anterior tooth, should not be extracted, since the risks of surgery (injury to the dental nerve, inflammation or subsequent infection) outweigh the benefits.
In asymptomatic wisdom teeth, but which present a cyst or cause resorption in the roots of the preceding tooth or caries, surgery would be indicated.
When is it necessary to remove them?
Defining exactly the indications for their extraction is still a matter of controversy today. It is established that they must be extracted.
By way of summary, and at the risk of oversimplifying, we could say that surgery is necessary for symptomatic wisdom teeth or those that due to their poor position can cause lesions in the front teeth.
Other times, the orthodontist may recommend your exodontia so that the entire dentition can be moved back to align the teeth. This should be done and not the other way around. There is a belief, a very old myth, that the wisdom teeth move the teeth, this is not true, and in the 60’s it was demonstrated that they had no strength.
So, if we can say that if you have had orthodontics and your teeth move, it is not because of the wisdom teeth, but because of your wisdom teeth.
What procedure is followed to remove wisdom teeth?
The procedure in the case that the tooth is included in the jaw bone is to remove part of the bone that surrounds it and extract it, whole or in parts depending on each case. It is a procedure that is performed under local anesthesia, although sometimes when we perform extractions of 2, 3 or 4 wisdom teeth it can be performed under sedation in the presence of an anesthesiologist.
Risks of the surgery
Unfortunately most of the time the risks are determined by the anatomical position of the molar.
In the maxilla the most important risk of surgery of upper wisdom teeth is that the mouth and nose are connected, this risk is low, and if it happens it usually closes by itself, if it does not close, there are procedures to solve it.
Anatomically in the jaw there is a channel through which passes the nerve that gives sensitivity to the lip and inside the jaw passes the nerve that gives sensitivity to the tongue. The more included, generally the greater the risk and, depending on the location of the nerve canal of each patient, also the greater or lesser the risk. It is important to understand that risk 0 does not exist.
What happens if the nerve is injured?
Normally the risk is low, and if it happens it is temporary in most cases (weeks to months). Lack of sensitivity in the tongue, chin or lip. Eye, sensitivity, aesthetically mobility is not affected.
After surgery, the face may become inflamed, a hematoma may appear or we may not be able to open our mouth properly for a few weeks. These are the most normal risks of wisdom tooth surgery, especially if we have to remove a lot of bone.
The medication that is sent after surgery usually includes antibiotics and anti-inflammatory medication that will help us to cope better with the postoperative period, together with a soft and fresh diet for the first few days, will help us to recover sooner than we think.
And is it better to remove them as soon as possible?
Extracting them early when people are in their teens, what we call dental germs simply leads to a more invasive surgical procedure, which increases the likelihood of complications and also commits them to extractions when we do not know if it would cause any problems or if they could have erupted favorably in the future.