The Wisdom Tooth

By George Bitar, MD

Often we will see patients in our office for problems associated with “Wisdom Teeth”, or who have been told that they needed their wisdom teeth removed. Frequently asked questions are “why do I need my wisdom teeth extracted when they dont bother me,” or “Why do we have wisdom teeth”.
“Wisdom Teeth” are just the last of the molar teeth to develop. They are also called the third molars. (Most of us have three upper and three lower molars on each side.) Long ago, when humans had poor oral hygiene and ate a very rough, unrefined diet, the teeth wore down and shifted toward the front of the mouth. This left room for the third molars to erupt, usually around 17-18 years old. Today, we take much better care of our teeth, have a more refined diet, and have much less wear. Few people now have room for the third molars. As a result, they become impacted (prevented from erupting fully into the mouth), or crowded against the soft gum tissue in the back of our mouths.
An impacted third molar often has some exposure to the oral cavity, allowing the food and bacteria in the mouth to get under the surrounding gum tissue where you cannot brush or clean. Over time this can lead to decay of the wisdom teeth, destruction of the roots of adjacent teeth, infection of the gum tissue and bone loss around the wisdom teeth and the teeth in front of the wisdom teeth. An impacted wisdom tooth that has no direct opening to the mouth still is surrounded by a layer of cells. This sac surrounding the tooth can fill with fluid and become a cyst which can lead to serious problems and the need for extensive possibly reconstructive surgery.
Sometimes these problems are heralded by pain and swelling, but not always. Often there will be developing complications that the person may not notice until the damage is extensive. Recent studies sponsored by the American Association of Oral and Maxillofacial Surgeons have found that even third molars which have broken through the tissue and erupted into the mouth in a normal, upright position may be as prone to disease as those third molars that remain impacted, especially an increased incidence of periodontitis. Ongoing studies have linked periodontitis to general health problems including heart disease, stroke and problems during pregnancy. Periodontitis is a serious chronic infection of the gum and bone surrounding the teeth.
As wisdom teeth grow, their roots become longer, the teeth become more difficult to remove and complications become more likely. In addition, partially or totally impacted wisdom teeth are more likely to cause problems as patients age.
No one can predict when third molar complications will occur, but when they do, the circumstances can be much more painful and the teeth more difficult to treat the older the patient is. It is estimated that about 85% of third molars will eventually need to be removed.