Perhaps you feel that something is going on at the back of your mouth, you may have bad breath, pain, swelling, tenderness or redness behind the molars. These are the most common signs that your wisdom teeth are either coming out or that you are suffering from an infection.
While there are many horror stories about having wisdom teeth removed, we at Healthy Matters have asked dentist Dr. Jonathan Lui to demystify the procedure – and luckily it’s nowhere as bad as you might think it is.
Why do we have wisdom teeth?
Third molars (a.k.a. wisdom teeth) are the last remaining adult teeth to develop into the mouth. They are called “wisdom” teeth because they appear at a more mature age and presumably “the older you get, the wiser you are”. They usually begin to erupt when people are aged between 18 and 25, but sometimes they may remain dormant and never emerge. There are even cases of wisdom teeth erupting when they were over 50 years old!
Wisdom teeth are believed to be an evolutionary relic from our distant ancestors when they had diets with rougher foods such as raw meat and plants. In the past, when teeth wore down or fell off, wisdom teeth could be the substitution for grinding coarse foods.
Nowadays, we no longer need wisdom teeth as replacement teeth because we have better oral hygiene and softer foods. It is not uncommon to be missing one or more wisdom teeth and the most likely reason for this is evolutionary.
For our generations, wisdom teeth are 2 additional pairs of molars and for most do not provide any additional benefits to eating. Yet, they can be problematic when your mouth does not have enough space for them to erupt into. One of the causes of the lack of room for wisdom teeth is the lack of vitamin K2 in modern diets. Vitamin K2 is a nutrient that contributes to the development of the jaw, meaning that not getting sufficient vitamin K2 can lead to underdeveloped jaw and hence a limited space for wisdom teeth.
A study argues that “a mismatch between the size of the lower face and the dentition” is becoming more and more prevalent in modern populations. Essentially, our jaw can comfortably accommodate 28 teeth without any issue, but with wisdom teeth, we have as many as 32 teeth competing for space. Therefore, the removal of wisdom teeth is sometimes necessary.
How to know if wisdom teeth need to be removed?
Since wisdom teeth extraction can bring health risks and complications – as with all surgeries – it is unnecessary to have your wisdom teeth removed if they are:
- Erupted fully
- Positioned correctly
- Aligned with their opposing teeth
- Accessible for daily oral hygiene routine
Usually, by the time wisdom teeth start to emerge, the other 28 teeth are already in position. If there is insufficient space to accommodate an additional molar, this can lead to partial emergence, dormancy, or the wisdom tooth growing at a wrong angle. Wisdom teeth with such conditions are called “impacted”.
Problems can occur when you have impacted wisdom teeth because:
- If they appear partially within the gums, where it is hard to clean, it allows bacteria to grow, resulting in gum disease and dental decay.
- If they remain completely hidden or are unable to erupt normally and are trapped within the jaw, it can cause infections or cysts which may harm other teeth roots or bone support.
- If they do not have sufficient space to come out properly, they may crowd or damage the adjacent tooth.
The American Dental Association suggests having wisdom teeth removed if one of the following situations occur around or in the area of the teeth, for example:
- Pain or stiffness e.g. the jaw or the back of the mouth
- Infection of soft tissue e.g. the gums
- Damage to the adjacent teeth
Important: As a dental x-ray is required for a comprehensive understanding of the situation of your wisdom teeth, you should visit your dentist for a check-up to discuss the best solution for you.
How are wisdom teeth removed?
Some dentists suggest waiting and checking the emergence status of wisdom teeth before deciding whether they need to be removed. Others believe that it is better to extract the teeth before their roots and bone become fully formed so as to avoid any problems that may be caused.
Depending on individual cases, your regular dentists may be the ones to remove your wisdom teeth. However, you might also be referred to a specialist, otherwise known as an Oral Maxillofacial Surgeon if your case is particularly difficult. As wisdom teeth extraction is an outpatient procedure, meaning you can go home shortly after the treatment.
Prior to your extraction, you will be given information about the process as well as the potential benefits and risks. Most of the time, you will be also asked to sign a consent form.
During the procedure, doctors may need to make a small cut or incision into the gums in order to facilitate the extraction. If necessary, the tooth is sectioned into smaller pieces before being removed. After the surgery, doctors will then close the incision with stitches and pack the wound with gauze. The duration of the whole procedure can vary from a few minutes to 30 minutes, but in more difficult cases it might take even longer.
After your wisdom teeth have been removed, the most common post-operative discomfort will be swelling and bruising, which can sometimes give a classic chipmunk appearance! This can cause some difficulties during eating and talking. Some patients may feel pain, but the painkillers prescribed by your dentist should help. The first few days after the surgery will usually be the worst but the conditions will usually improve by the second week.
Recovery after wisdom teeth removal surgery
You should be able to return to your normal activities a few days after the procedure but note that it normally takes up to 6 weeks for a full recovery.
After the treatment, you may have trouble opening your mouth, pain, bleeding, and swelling. Doctors will give you advice on pain and discomfort management, such as eating soft foods, applying cold compression and taking painkillers.
You may also bleed excessively and/or develop a painful dry socket. A dry socket is a complication in which the socket has exposed bone that is inflamed. This can be quite painful and can delay healing. A dry socket develops when the blood clot is dislodged prematurely, often within the first three days. A dry socket is uncommon, however, factors such as smoking can significantly increase the risk of it developing.
Important: You must strictly follow the instructions provided by your dentist for a smooth recovery. Seek medical help from your dentist if you suspect that you have a dry socket.
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This article was reviewed by Dr. Jonathan Lui 雷威鴻醫生. Dr. Jonathan Lui is a specialist periodontist practicing at the Gum and Implant Dental Center. He is a Fellow of both the Hong Kong Academy of Medicine and the College of Dental Surgeons of HK. He obtained his university education from King's College (GKT) London and his specialist Periodontal training from Hong Kong University.
Does insurance cover wisdom teeth extraction?
According to health insurance experts at Alea, medical insurance plans cover the treatment and removal of wisdom teeth when medically indicated. Dental insurance may also cover some or all the costs of such dental procedures. It is impossible to only get dental insurance. Dental cover can only be added to a medical inpatient-only plan or inpatient & outpatient plan.
While dental treatment is not always covered, most companies provide some dental cover to their employees. Employee dental cover is normally limited to a selected network of dental providers or capped under an annual limit.
As for individual health insurance plans, the dental cover is usually an optional benefit with sub-limits and co-pay. The dental coverage may be divided into two categories with different sub-limits: Routine Dental and Major Dental. The dental benefits may also have a waiting period between 3 to 6 months.
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This article was independently written by Healthy Matters and is not sponsored. It is informative only and not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be relied upon for specific medical advice.