A FEW days ago, a 32-year-old man e-mailed me asking a series of questions about wisdom teeth. My reply to him could benefit countless others.
Why do we have wisdom teeth? Adults can have a maximum of 32 teeth. The wisdom teeth are the last to come through, right at the back. They usually appear between the ages of 17 and 25, although sometimes they appear many years later. People often have jaws that are too small for all 32 teeth. Sometimes we get ‘riders’ for this very reason. In fact, 28 teeth are often the most we have room for. So, if all the other teeth are present and healthy, there may not be enough space for the wisdom teeth to come through properly.
Do they always cause problems? No. If there is room, they will usually erupt into their right positions and cause no more problems than any other tooth. Often, there will be some slight discomfort as they come through the gum, but this is only temporary, and will disappear once the tooth is fully in position.
What is an impacted wisdom tooth? If there is not enough room, the wisdom tooth may try to erupt, but will get stuck against the tooth in front of it. The wisdom tooth will be at an angle, and will be described by the dentist as ‘impacted’. If part of the wisdom tooth has appeared through the gum and part of it is still covered, the gum may become sore, and perhaps swollen. Food particles and bacteria can collect under the gum’s edge, and it will be difficult to clean effectively. This can sometimes be very painful, and the person can hardly open their mouth without pain.
Your dentist will advise you whether this is a  temporary problem that can be dealt with by using mouthwashes and special cleaning methods (and possibly antibiotics), or whether it is better to have the tooth removed, or even a minor surgery to cut away a piece of the gum which may be causing the problem.
What can I do to help myself? A mouthwash of medium hot water with a teaspoonful of salt will help to reduce gum soreness and inflammation (Check that it is not too hot before using it). Swish the solution around the tooth, trying to get it into the areas your toothbrush cannot reach. An antibacterial mouthwash such as corsodyl can also be useful to reduce the inflammation. Pain-relieving tablets such as paracetamol or aspirin can also be useful for short-term use, but consult your dentist if the pain continues.
But if it does not help? If the pain does not go away, or if you find it difficult to open your mouth, you should see a dentist. They will be able to see the cause of the problem, and advise you accordingly. It may be useful to clean around the tooth very thoroughly, and an antibiotic may be prescribed.
Are x-rays needed? The dentist will usually take x-rays to see the position of the root, and to assess whether there is room for the tooth to come through into a useful position.
What are the main reasons for taking wisdom teeth out?
1. When it is clear that the wisdom teeth will be able to come through into a useful position because there is not enough room, and when they are also causing some pain or discomfort.
2. If they have only partially come through and are decayed — such teeth will often be susceptible to decay, as it will be difficult to clean them as thoroughly as your other teeth.
3. If the wisdom tooth is causing a cleaning problem and has no real use.
4. If a wisdom tooth starts to ‘over-grow’. This often happens if the lower one has already been removed or is impacted and cannot come through. The upper one will come down too far, looking for a tooth to make contact with, and the upper one has no tooth to bite against.
5. If they are painful.
Are wisdom teeth difficult to take out? It all depends on the position and the shape of the roots. Your dentist will advise you as to how easy or difficult each tooth will be to remove after looking at the x-rays. Obviously, the surgical competence of your dentist is important.
Upper wisdom teeth are often more straightforward to remove than the lower ones, which are more likely to be impacted. Your dentist will advise you whether the tooth should be taken out at a dental practice, or whether you should be referred to a specialist (oral surgeon) at a hospital.
Occasionally, there is a possibility of some numbness of the lip after the removal of a lower tooth. Your dentist will tell you if it is possible in your case.