December 19, 2011
I have already given a detailed blog about various wisdom teeth and the pros and cons about their removal. Basically, a wisdom tooth is like any other tooth – if it erupts normally into the mouth it is fine but at risk of decay. If decay gets into the nerve area it causes pain, swelling and infection. It is often inaccesable to treat, so the wisdom tooth to be removed. If this risk appears high, or the teeth are not erupting normally and your dentist suspects future problems – he or she may recommend the tooths removal to reduce the risk to you of a serious infection or complications. The older you get, the more the wisdom teeth roots can grow towards the nerve in the jaw, and the harder your jawbone can get, increasing the risks of complications of surgery (such as permanent lip numbness or tingling – called paraesthesia). Your dentist is always trying to wiegh up the best alternative based on the information at hand.
I have taken some random photos of wisdom teeth we have seen in our practice. Some were fine, others were at risk, some were removed, and some required specilaist intervention. Don’t let anyone say you should or should not remove wisdom teeth without knowing your specific case – everybody is different.
To the right of each photo I have drawn and approximate line showing the roots of the teeth in black, the nerve in the jaw in blue, any obvious infection in the bone in yellow, and obvious decay in red.
June 23, 2011
Wisdom Teeth – Why do we need to remove wisdom teeth? Often we don’t, but because they are hard to reach, they are harder to clean and more likely to get decay. Some wisdom teeth may be growing in the wrong direction and get stuck (impacted) and this leads to problems as well.
This young patient has an impacted lower wisdom tooth causing no pain. It is under the gum and can’t be seen in the mouth. Sadly, the lower picture shows the decay highlighted in black – there is decay in the upper and lower wisdom tooth, but also the second back tooth has decayed almost to the nerve. This tooth may now need very expensive root canal therapy or extraction. The pink line shows that the lower wisdom tooth is touching the nerve in the jaw and will need specialist attention. This will require time and careful planning but unfortunately the decay has made the situation urgent.
Even older patients can have wisdom teeth problems. Not long ago one of our dentists removed a wisdom tooth from an 89 year old!
This picture shows how a cyst is damaging the jaw.
Many people have wisdom teeth come through perfectly just like any other molar. Thank goodness we are all different. If you have any queries see your dentist and get an Xray to check.
October 7, 2010
Wisdom teeth are so varied in how they present. Here is a patient I just saw and you can see the wisdom tooth on one side is fully impacted (impacted is when there is tooth or bone in the way stopping the tooth from erupting properly). The other side shows a partialy impacted wisdom tooth.
Unfortunately, the partial impacted tooth was visible in the mouth, so it had decayed. The tooth next to it had also decayed because food trapped between the teeth. We removed this partial impacted tooth today without incident.
See my other posts on wisdom teeth from February 2008 link.
December 8, 2009
Well, I have been a bit slack in writing new info. It takes time to get interesting photos and new ideas, although I see them every single day at work. I guess this post is to ask people for their dental problems, queries. I am here for free consultation – obviously I can’t look in your mouth, but I can give advice generally about dental questions you have. It will give me more info on what are the dental concerns people have that I can help with via the net. I mostly get wisdom tooth questions but thought this post might stimulate some others.
I’ll have a post coming soon on bleaching and full porcelain crowns for crowded front teeth based on an interesting patient I have just had the opportunity to help. Come and check it out in the next day or so.
June 6, 2008
A patient rang our practice recently querying some problems about their wisdom teeth but having heard that you shouldn’t see a dentist while you are pregnant. This is a common story for us so it’s time to bust the myth.
- When you are pregnant you shouldn’t see a dentist – wrong – overall health during pregnancy is essential – healthy mother healthy body. Your mouth is the first line of defense to infection in the body and the immune system hypes up during pregnancy. If your hygiene drops (not uncommon when you have a lot of issues going on while you are pregnant) your gums may become more red or bleed. Your dentist can continue regular cleans and hygiene and give advice on keeping things comfortable.
- My mother lost all her teeth because the baby took all her calcium. wrong – your body gets calcium from your diet and failing that from your bones. Your bones can be formed and reformed but your teeth grow once and then they are as hard as they will get. Usually what has happened is the person already had decay or problems not picked up before they found out they were pregnant. They then didn’t have dental care for the period of pregnancy and early childhood due to the business of motherhood. By the time they go to the dentist they are in pain, have multiple large cavities and may opt to extract some teeth.
So why should we go to a dentist if we don’t feel any problems?
The problem of dentistry and pregancy is related to risk assesment. Ideally, we would rather do nothing other than a check and clean during pregnancy and avoid X-rays (unfortunately X-rays may be the only way to detect some problems but usually we can leave for a few months). If a patient has some small cavities and we know about it we can try simple preventive measures to see that the teeth will last until the baby is born then fix them.
If decay is deep there is a chance of an abcess (an infected tooth). If you leave a tooth until it is abcessed then we have several concerns. Leaving the abcess means the mother carrying an infection and this can be a threat to the mother and child. Abscesses are treated by removing the tooth (an X-ray may be needed) or root canal treatment (many Xrays are needed) or antibiotics (what about the safety of the child?). By finding deep decay early we can dress the tooth and reduce the risk.
Basically waiting until you have problems puts you and your child at risk. If we know about the problems early we have less risk and more options. But that goes for everyone whether pregnant or not. I have one filling – but I go for a check and clean every 6 months, brush twice a day, floss every night.
Remember – there are no wrong choices in life – only consequences
February 4, 2008
I have a general philosophy on removal of wisdom teeth. Basically, do it if they have ever given the slightest trouble and you are under 25 and the risks seem minimal. Reasons for removal are varied:
Wsidom teeth are the hardest to clean and often decay early- filling them can be virtually impossible due to space and access. If they can’t be filled or cleaned, they will eventually decay to the point where they cause major pain and problems – this is not the best time to remove wisdom teeth. Bacteria impacts under the gum causing decay or nasty infections – this can be life threatening, but usually is just a pain. It also puts the adjacent teeth at risk – see the photo! The older you get, the harder the bone is and the more difficult to remove the teeth, and the worse result on healing. If you are likely to keep your wisdom teeth for life then that is fine – but I have had to remove wisdom teeth from a 90 year old and that is a serious risk. As you age you may be on medications or have health issues that complicate surgery. Some medications such as bisphosphonates for osteoporosis and bone diseases can be related to post surgery wounds that never heal and are acutely painful (see www.nundahdental.com or http://www.ada.org.au/newsroom/article,documentid,109063.aspx for more info. If your dentist suggests removal of wisdom teeth it is usually in your best interests in the long run.
What are the risks of wisdom teeth removal? – the nerve supplying sensation to the lower lip and tongue can be damaged resulting in permanent numbness of these areas. This risk is usually very small and your dentist can judge the risk better by looking at your X-ray -(usually an OPG X-ray). If the risks are great they may advise against removal – but if the tooth is decayed or infected you may have no choice – again, the earlier these teeth are removed, the less the risk of problems.
I am happy to supply more info if anyone is interested.