Wisdom teeth generally cause problems when they erupt partially through the gum.

Below are the most common reasons for removing wisdom teeth.

1. Tooth decay

Saliva, bacteria and food particles can collect around an impacted wisdom tooth, causing it, or the next tooth to decay. It is very difficult to remove such decay. Pain and infection will usually follow.

2. Gum infection

When a wisdom tooth is partially erupted, food and bacteria collect under the gum causing a local infection. This may result in bad breath, pain, swelling and the inability to open your mouth fully. The infection can spread to involve the cheek and neck. Once the initial episode occurs, each subsequent attack becomes more frequent and more severe.

3. Pressure pain

Pain may also come from the pressure of the erupting wisdom tooth against other teeth. In some cases this pressure may cause the erosion of these teeth.

4. Orthodontic reasons

Many younger patients have had prolonged orthodontic treatment to straighten teeth. Wisdom teeth may cause movement of teeth particularly the front teeth when they try to erupt. This will compromise the orthodontic result.

5. Prosthetic reasons

Patients who are to have dentures constructed should have any wisdom tooth removed. If a wisdom tooth erupts beneath a denture it will cause severe irritation and if removed, the patient will need to have a new denture constructed as the shape of the gum will have changed.

6. Cyst formation

A cyst (fluid filled sac) can develop from the soft tissue around an impacted wisdom tooth. Cysts cause bone destruction, jaw expansion and displacement or damage to nearby teeth. The removal of the tooth and cyst is necessary to prevent further bone loss. Tumors may develop within these cysts or the jaw may fracture spontaneously if the cyst grows very large.

2. Why remove an impacted wisdom tooth if it hasn’t caused any trouble?

Impacted wisdom teeth are almost certain to cause problems if left in place. This is particularly true of the lower wisdom teeth. Such problems may occur suddenly and often at the most inconvenient times.

3. When is the best time to have my wisdom teeth removed?

It is now recommended by dentists that impacted wisdom teeth be removed between the ages of 14 and 22 years whether they are causing problems or not. Surgery is technically easier and patients recover much more quickly when they are younger. What is a relatively minor operation at 20 can become quiet difficult in patients over 40. Also the risk of complications increases with age and the healing process is slower.

4. Traveling to foreign places

It may be advisable to have them removed before traveling if you are going to an area where specialist dental services are not readily available and your wisdom teeth are impacted.

5. Should a wisdom tooth be removed when an acute infection is present?

Generally, no. Surgery in the presence of infection can cause infection to spread and become more serious. Firstly, the infection must be controlled by local oral hygiene, antibiotics and sometimes the extraction of the opposing wisdom tooth.

6. The ‘Pros & Cons’ of wisdom tooth removal

1. Some ‘Pros’ of removing a wisdom tooth.

• Wisdom teeth may be hard to access with your toothbrush or floss. Over time, the accumulation of bacteria, sugars and acids may cause a cavity to form in the tooth. If it is not restored with a filling, the cavity may spread and destroy more tooth structure causing severe consequences to the tooth and surrounding supportive structures.
• Due to the difficulty of keeping these teeth clean with your daily brushing and flossing, bacteria and food debris remaining on the wisdom teeth may present a foul smell causing bad breath.
• A wisdom tooth that is still under the gums in a horizontal position rather than a vertical position may exert pressure on surrounding teeth causing crowding and crooked teeth. This also may occur if there is not enough space in the mouth for the wisdom tooth. This may warrant braces to repair the damage.
• A wisdom tooth that is still under the gums may become irritated. The gum tissue that lay over the tooth may harbor food debris and bacteria that gets trapped under the gum resulting in an infection in the gums.
• There is the potential for more problems to occur the longer you wait and the older you get. This is because as you get older, the bone surrounding the tooth becomes increasingly dense making the tooth more difficult to remove. The healing process may also be slower.

2. Some ‘Cons’ of removing a wisdom tooth.

• Depending on the size shape and position of the tooth, removal can vary from a simple extraction to a more complex extraction. With a simple extraction, there is usually little swelling, bruising and bleeding. More complex extraction will require special treatment which may result in more bruising, swelling and bleeding. However, our participating dentists will provide you with post treatment instructions to minimise these side effects.
• Following an extraction, a condition called "dry socket" may occur. If the blood clot that formed in the extraction area becomes dislodged, it exposes the underlying bone. This condition is very painful but resolves after a few days. It is preventable by following the post treatment instructions provided by your dentist.

7. The operation

Surgery is often done at your dentist's practice rather than in a hospital. Your dentist will review the recommended procedure with you so that you will fully understand and be comfortable with the procedure before it is done. You will also be given information about eating, medication, rest, driving, and other considerations before surgery as well as after.

Many people have their wisdom teeth removed under local anesthesia by their dentist. This means that they are awake but the area around the wisdom teeth is completely numb. Sedative drugs can be given with local anesthesia to help people relax during the procedure.

The operation will not start until the anesthetic has taken effect. It is often necessary to make a small cut in the gum over the wisdom tooth, and to remove some bone so that the tooth can be lifted out. Stitches are usually put in to help the gum heal.

8. Post operative healing

The healing process begins immediately after surgery as your body sends blood to nourish the tooth socket. Simple pressure from a piece of gause is usually all that is needed to control the bleeding and to help a blood clot to form in the socket, which promotes healing. Within a day or two, soft tissue begins to fill in the socket, aided by the blood clot. Eventually, the bone surrounding the socket begins to grow, filling in the socket completely. This is illustrated below.