Wisdom Tooth Problems

Topic Overview

What are wisdom teeth?

Wisdom teeth are the upper and lower third molars, located at the very back of the mouth. They are called wisdom teeth because usually they come in when a person is between age 17 and 21 or older-old enough to have gained some "wisdom." Wisdom teeth that are healthy and properly positioned do not cause problems.

What causes problems with wisdom teeth?

Wisdom teeth may break partway through your gums, causing a flap of gum tissue to grow over them where food can become trapped and a gum infection can develop. Wisdom teeth can also come in crooked or facing the wrong direction. Or, if your jaw is not large enough to give them room, wisdom teeth may become impacted and unable to break through your gums. You may have trouble properly cleaning around wisdom teeth because they are so far in the back of your mouth and may be crowded.

What are the symptoms of wisdom tooth problems?

Wisdom teeth often cause no symptoms. Symptoms that may mean your wisdom teeth need to be removed include:

• Pain or jaw stiffness near an impacted tooth.
• Pain or irritation from a tooth coming in at an awkward angle and rubbing against your cheek, tongue, or top or bottom of the mouth.
• An infected swelling in the flap of gum tissue that has formed on top of an impacted tooth that has partially broken through the gum.
• Crowding of other teeth.
• Tooth decay or gum disease if there's not enough room to properly care for the wisdom tooth and surrounding teeth.

Most problems with wisdom teeth develop in people between the ages of 15 and 25. Few people older than 30 develop problems that require removal of their wisdom teeth.

How are problems with wisdom teeth diagnosed?

Your dentist will examine your teeth and gums for signs of a wisdom tooth coming through your gum or crowding other teeth. You will have X-rays to find out whether your wisdom teeth are causing problems now or are likely to cause problems in the future.

How are wisdom tooth problems treated?

The most common treatment for wisdom tooth problems is removal (extraction) of the tooth. Experts disagree about whether to remove a wisdom tooth that is not causing symptoms or problems. Oral surgeons generally agree that removing a wisdom tooth is easier in younger people (usually in their early 20s), when the tooth's roots and the jawbone are not completely developed. In the late 20s and older, the jawbone tends to get harder, and healing generally takes longer.

Frequently Asked Questions

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	Should I have a wisdom tooth removed?

Symptoms

Wisdom teeth, whether they are impacted or have broken through the gums, often cause no symptoms. Symptoms that may mean your wisdom teeth are causing problems and need to be removed include:

• Pain or jaw stiffness near an impacted tooth.
• Pain or irritation from a tooth coming in at an awkward angle and rubbing against your cheek, tongue, or top or bottom of the mouth.
• An infected swelling in the flap of gum tissue that has formed on top of an impacted tooth that has partially broken through the gum. When wisdom teeth only partially break through, the skin next to the tooth opens up. Germs can get in around the tooth and gum, causing infection.
• Crowding of other teeth.
• Tooth decay or gum disease if there's not enough room to properly care for the wisdom tooth and surrounding teeth.

Exams and Tests

Your dentist will examine your teeth and gums for signs of a wisdom tooth coming through your gum or crowding other teeth. You will have X-rays to determine whether you have problems with your wisdom teeth now or whether they are likely to cause problems in the future.

Treatment Overview

The most common treatment for wisdom tooth problems is removing the tooth (extraction). This involves opening the gum over the tooth, removing the tooth, and closing the gum with stitches if necessary. Recovery usually takes just a few days.

Experts disagree about whether to remove a wisdom tooth that is not causing obvious symptoms or problems.

• Some oral surgeons believe that it is best to remove a wisdom tooth, especially if it is impacted, before a person is 20 years old, to prevent future problems. Removing a wisdom tooth later in life is associated with more complications.^{1, 2}
• Some dentists think it is best to wait and remove a wisdom tooth only if there is a problem, especially if you are older than 30.
• Studies have not clearly shown what happens when an impacted wisdom tooth that is not diseased or causing problems is left in place.³
• Experts also disagree about whether disease-free wisdom teeth should be removed during orthodontic treatment.^{4, 5}

Wisdom teeth that are causing problems usually should be extracted. An oral or maxillofacial surgeon or your dentist can remove wisdom teeth.

Should I have a wisdom tooth removed?

What To Think About

Wisdom teeth are as useful as any other teeth if they come in properly and there is plenty of room in your mouth for good dental care.

Talk to your dentist about whether to have your wisdom teeth removed. You and your dentist may consider several factors, including:

• Whether your wisdom tooth is impacted and whether it is causing any problems for you.
• Your age and other medical conditions.
• Whether you are able to take good care of your wisdom tooth and the surrounding teeth every day with proper brushing or cleaning.

Home Treatment

If a wisdom tooth is impacted or is emerging and causing problems, you should schedule an appointment with your dentist. While you are waiting for treatment, you can relieve pain and swelling with home treatment.

• Use an ice pack on the outside of your cheek. Apply it for 20 minutes, then remove it for 20 minutes. Repeat as needed.
• Gently rinse your mouth with warm salt water every 2 to 3 hours.
• Try an over-the-counter medicine to help relieve your face or jaw pain. Carefully read and follow all labels on the medicine bottle and box. Medicines that might help include:
  • Acetaminophen, such as Tylenol or Panadol.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs). These include ibuprofen (such as Advil or Motrin), naproxen (such as Aleve or Naprosyn), or aspirin (such as Bayer or Bufferin). Do not give aspirin to anyone younger than 20 because of the risk of Reye's syndrome, a rare but serious disease.
• Do not use heat or put an aspirin directly on your gums. Aspirin used in this way can damage your gums.

Your dentist or surgeon may prescribe antibiotics if an infection has developed. Be sure to take them for the entire time prescribed. Healing the infection before the tooth is removed makes the extraction procedure easier and will reduce the risk of problems after surgery.

After you have had a wisdom tooth extracted, the recovery period in most cases is only a few days. Take painkillers as needed, using the recommended dose. To help speed recovery and prevent complications, such as a dry socket, take the following steps:

• Change cotton gauzes before they become soaked with blood. If it doesn't cause any pain, bite down gently on the cotton gauze. Call your dentist if you still have enough bleeding to need a gauze pad after 24 hours.
• While your mouth is numb, be careful not to bite the inside of your cheek or lip or your tongue.
• Do not rinse your mouth on the day you had your surgery, because it may wash away clots and delay the healing process. On the day after surgery, very gently rinse your mouth with warm salt water-½ to 1 teaspoon of salt in 8 ounces of warm water-every 2 to 3 hours. This will reduce swelling, relieve pain, and clean the area.
• Relax and get plenty of rest after surgery. Strenuous physical activity may increase bleeding.
• Do not smoke cigarettes or drink through a straw. Dragging on a cigarette or sucking on a straw could dislodge the clot and delay healing. Smoking also decreases the blood flow, so healing takes longer. And smoking can bring germs and other contaminants to the surgery site.
• Apply an ice pack to the outside of your cheek for 20 minutes to reduce pain and swelling. Then remove it for 20 minutes. Repeat as necessary. Some swelling after tooth removal is normal.
• Do not lie flat. This may cause you to bleed longer. Prop up your head with pillows.
• Avoid rubbing the area with your tongue or fingers.
• After the numbness is gone, drink only clear liquids and eat soft foods such as gelatin, pudding, or thin soup. Avoid hot liquids, alcoholic beverages, and hard, sticky foods. Gradually add more solid foods to your diet as healing progresses. Try not to chew in the areas where your tooth was extracted.
• Gentle rinsing with warm salt water after meals will help keep food particles out of the area where your tooth was removed.
• Continue to brush your other teeth and your tongue carefully with a soft-bristled brush. Avoid brushing around the extraction area until your dentist says you may brush there.

Other Places To Get Help

Organizations

Related Information

• Basic Dental Care
• Gum Disease
• Tooth Decay

References

Citations

1. Curran TJ (2004). Clinical decision-making for the patient with third molars. Texas Dental Journal, 121(11): 1062-1066.

2. Bui CH, et al. (2003). Types, frequencies, and risk factors for complications after third molar extraction. Journal of Oral and Maxillofacial Surgery, 61(12): 1379-1389.

3. Esposito M (2006). Impacted wisdom teeth, search date August 2005. Online version of Clinical Evidence (15).

4. Hicks E (1999). Third molar management: A case against routine removal in adolescent and young adult orthodontic patients. Journal of Oral Maxillofacial Surgery, 57(7): 831-836.

5. Beeman C (1999). Third molar management: A case for routine removal in adolescent and young adult orthodontic patients. Journal of Oral and Maxillofacial Surgery, 57(7): 824-830.

Other Works Consulted

• Academy of General Dentistry (2005). What Are Wisdom Teeth? Available online: http://www.agd.org/consumer/topics/wisdom/main.asp.

• Kaminishi RM, Kaminishi KS (2004). New considerations in the treatment of compromised third molars. Journal of the California Dental Association, 32(10): 823-825.

• Slade GD, et al., (2004). The impact of third molar symptoms, pain, and swelling on oral health-related quality of life. Journal of Oral and Maxillofacial Surgery, 62(9):1118-1124.

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