The most posterior and largest are the 12 molars, which have several pointed cusps used to crush food so it is ready for swallowing. The third members of each set of three molars, top and bottom, are commonly referred to as the wisdom teeth, because their eruption is commonly delayed until early adulthood. It is not uncommon for wisdom teeth to fail to erupt; that is, they remain impacted. In these cases, the teeth are typically removed by orthodontic surgery.

Permanent and Deciduous Teeth

Figure 23.10 Permanent and Deciduous Teeth This figure of two human dentitions shows the arrangement of teeth in the maxilla and mandible, and the relationship between the deciduous and permanent teeth

This figure of two human dentitions shows the arrangement of teeth in the maxilla and mandible, and the relationship between the deciduous and permanent teeth.

Wisdom teeth: Overview

Introduction

Wisdom teeth come in at the very back of our mouth, with one at the end of each row of teeth. They usually do not develop until the ages of 17 to 24, and it is only then that they first break through, if they do at all. These teeth are commonly thought of as "trouble makers" because they usually do not fit well with the other teeth and can cause problems.

Wisdom teeth are thought to date back to our distant ancestors who had larger jaws and more teeth. Nowadays most people's jaws are too small to have enough room for these "extra" teeth. For a while they were routinely pulled, but because they do not always cause problems and there may be side effects if they are removed, dentists are now a bit more hesitant.

Effects

Often wisdom teeth will break through only partially or not at all, although they have stopped growing. This can cause pain, swelling or gum inflammation. The wisdom teeth may also damage nearby teeth and increase the likelihood of cavities. But usually wisdom teeth that do not break through do not cause any trouble.

Circumstances are similar if wisdom teeth break through: Sometimes they have no trouble fitting in at the back of the jaw. But they can push against other teeth, grow in crooked, and cause inflammation or other complications.

Diagnosis

If you are worried about your wisdom teeth it is best to talk to your dentist. They will first ask you about your symptoms and examine your mouth and jaw. An x-ray can be taken to see the position of the teeth. A thorough examination can help to find out whether the wisdom teeth will cause problems or will grow in normally.

Treatment

If one or more wisdom teeth start causing problems, they will usually need to be pulled. Depending on whether they have already broken out or are still deeper inside the jaw, surgery may be necessary.

Even wisdom teeth that were not causing any problems used to be pulled in most cases. But nowadays this is usually only recommended if problems are already occurring or are expected.

• Wisdom teeth are the last molars that usually come through during your late teens or early 20s.
• Not everyone has wisdom teeth, and not all wisdom teeth cause problems or need to be removed.
• Some wisdom teeth can cause dental problems including overcrowding, impaction (wisdom tooth pushes into gum or another tooth) and cause decay and infection, leading to pain, difficulty chewing and bad breath.
• If wisdom teeth are causing problems have them looked at by your oral health professional.

Wisdom teeth are the molars (back teeth) that come through last and furthest back in your mouth, usually in your late teens or early 20s. This is a normal part of mouth development. There are normally four wisdom teeth – two in the upper jaw and two in the lower jaw – but some people have more, fewer, or even none at all.

Some wisdom teeth come through without causing any issues, but others are problematic and may need removal or other treatment.

The teeth are secured in the alveolar processes (sockets) of the maxilla and the mandible. Gingivae (commonly called the gums) are soft tissues that line the alveolar processes and surround the necks of the teeth. Teeth are also held in their sockets by a connective tissue called the periodontal ligament.

The two main parts of a tooth are the crown, which is the portion projecting above the gum line, and the root, which is embedded within the maxilla and mandible. Both parts contain an inner pulp cavity, containing loose connective tissue through which run nerves and blood vessels. The region of the pulp cavity that runs through the root of the tooth is called the root canal. Surrounding the pulp cavity is dentin, a bone-like tissue. In the root of each tooth, the dentin is covered by an even harder bone-like layer called cementum. In the crown of each tooth, the dentin is covered by an outer layer of enamel, the hardest substance in the body (image).

Although enamel protects the underlying dentin and pulp cavity, it is still nonetheless susceptible to mechanical and chemical erosion, or what is known as tooth decay. The most common form, dental caries (cavities) develops when colonies of bacteria feeding on sugars in the mouth release acids that cause soft tissue inflammation and degradation of the calcium crystals of the enamel. The digestive functions of the mouth are summarized in image.

A tooth that is prevented from erupting by a physical barrier, usually other teeth. Impaction may also result from orientation of the tooth in an other than vertical position in the periodontal structures.

Some wisdom teeth erupt (emerge through the gum) without causing any problems, but sometimes, wisdom teeth come through at an angle and push into the gum or the tooth beside them. This is called impaction.

Impaction of a wisdom tooth can be painful and sometimes causes infection. Brushing these teeth can be difficult. Food and bacteria can get stuck between the wisdom tooth and the tooth next to it, leading to tooth decay and gum infections called pericoronitis.

Crowded wisdom teeth often lean sideways and rub against the cheek. This may cause ulcers on the cheek and chewing problems.

Your oral health professional may recommend that your wisdom teeth be removed if:

• there is not enough room in your mouth for your wisdom teeth to come through properly – removing a tooth early may help prevent a future problem
• you are experiencing:
  • pain
  • infection
  • damage to other teeth.

They may also recommend keeping a watch on the tooth in case it looks like causing problems later.

Signs of gum infection caused by wisdom teeth include:

• red, inflamed gum near the wisdom tooth
• facial swelling
• pain and sensitivity
• pus coming from the gum
• swollen and sore lymph nodes underneath the jaw
• difficulty opening the mouth and swallowing
• fever
• food getting stuck and difficult to clean out.
• bad breath.

Infections caused by wisdom teeth can be treated:

• by improving the cleaning and oral hygiene in the area
• by having the area cleaned by a dentist
• sometimes, by the prescription of antibiotics.
• removal of the wisdom teeth

However, the infection may keep coming back if problem teeth are not removed. People who have other health problems, especially people with lower immunity, may have complications from these infections.

X-rays will help to tell if wisdom teeth might cause problems. Some wisdom teeth do not cause problems and do not need to be taken out.

If your wisdom teeth need to be taken out, all you may need is a local anaesthetic so you won’t feel it. If your wisdom teeth are deeply impacted (blocked from coming through) and difficult to remove, or for other medical reasons, you may be offered a general anaesthetic. Sometimes this can be done with nitrous oxide (also known as happy gas) to make it more comfortable.

Once the wisdom tooth is removed, the area where the tooth was may be stitched to help it heal. It is normal for your jaw and gum to be sore, swollen and bleed a little for a few days after having a wisdom tooth out.

One possible complication of wisdom teeth removal is a dry socket (alveolar osteitis), when the area where the tooth came from doesn’t heal properly causing severe pain and a bad smell from the area. This happens more often in people who smoke or have difficulty in healing. Dry socket can be successfully treated by your oral health professional.

The longer you wait or delay, the more problems that can happen and damage that might result to the nearby teeth. Your oral health professional can help identify any problems early. Wisdom teeth can be removed by a dentist, but may also need to be referred to an oral maxillofacial surgeon who has done additional training and study in surgery or the teeth, bones, jaws and face.

The roots of wisdom teeth are still forming when you are a teenager, so it is easier to take them out at this age. It may be more complicated if you wait until later in life, when the roots are fully formed. Wisdom teeth can also be easier to remove when your bone is younger; heals and recovers faster.

Your oral health professional will talk with you about how to care for your mouth after having a wisdom tooth taken out. Some general suggestions include:

• Take pain-relieving medication if needed (and on advice from your oral health professional).
• Bite on the gauze to help stop bleeding, and other instructions that you may be given after the tooth is removed.
• Avoid excessive rinsing, sucking through a straw or spitting as that can cause the blot clot to not form, or come loose.
• Hold warm salty water in your mouth. Do this after meals and no earlier than 24 hours after surgery.
• Eat soft, easy-to-chew foods for the next few days to keep the area clean from food particles.
• Don’t smoke for 48 hours after the surgery.
• Avoid alcohol and excessive physical activity.

Do's and Don't's after after wisdom teeth removal

Having a tooth extracted can be a worrying experience. Yet, the recuperation process doesn’t need to be! There are some measures you can take (and a couple of things to keep away from) to make your recuperation process quicker and comfortable.

Simply take after these tips, and you'll be up and smiling again in the blink of an eye.

What's in store after surgery?

Comprehending what's in store can expel a ton of the uneasiness that accompanies one when they have after-surgery in mind. Commonly, a day after surgery, you may encounter some pain and some swelling around your eyes and cheeks. This swelling can last up to 72 hours after surgery.

To limit any #distress and #swelling, apply an ice pack to your jaw for 20 minutes; and then remove it for 20 minutes. You can rehash this a couple of times each day for the initial 48 hours. (Tip: you can use a zipped plastic bag with broken ice if you don't have an ice pack.) After 48 hours, treatment with ice won’t be very effective, so change it, to utilizing a warm pack to ease torment or swelling.

After wisdom teeth extraction, you can expect some bleeding for the initial couple of hours. Starting every 2 to 3 hours after your surgery, change the bandage at the surgery site every 30-60 minutes and control bleeding by firmly biting down on it. Proceed with this treatment until the point the #bleeding stops.

What to do to help the recuperating procedure?

Normally, it will take two weeks to a month for the surgical site to heal. To help this procedure, here are some things you can do:

• Keep your mouth clean – It's alright to brush your teeth the day of your surgery, yet hold up until the following day to rinse your #mouth. From that point on, utilize a container (8oz) of warm water blended with a teaspoon of salt to carefully wash your mouth no less than 5 to 6 times each day and particularly after dinners.
• Take medication – Use any pain killers prescribed by your specialist to control the pain. If your dentist prescribes anti-biotics, make a point to finish the dosage as apportioned.
• Use a tea bag – Tea has tannic corrosive, which contracts veins and decreases bleeding. Put a wet tea bag on the surgical site and bite down firmly for around 20 to 30 minutes.
• Get lots of rest – It's critical to shun any physical action for the initial 24 hours after surgery. Hoist your head up with some comfortable pads while resting and abstain from sleeping on the side as your extraction.
• Resume your typical cleanliness routine – After the initial 24 hours, you can come back to your ordinary brushing and flossing schedule. Simply make sure to avoid the surgical area. As of now you can continue wearing any orthodontic retainer you are utilizing. In the event that it causes distress, you can wait for seven days to start your orthodontic treatment again.
• Watch your diet – In the start, eat soft and cold foods like smoothies, dessert, yogurt, and pudding.

What not to do after wisdom tooth removal

Following are some tips to follow after wisdom tooth removal:

• Try not to use straws – It's essential not to dislodge the blood clot that has formed in the socket or you could encounter a condition known as dry attachment. Try not to rinse your mouth too rigorously, suck on a straw, or drink carbonated refreshments for the initial 24 hours.
• Try not to smoke or drink liquor – Do not smoke or consume alcohol for no less than 48 hours after surgery and ideally not for the whole week.
• Try not to clean out your nose – This can be a hard one in case you're encountering any nasal problems or stuffiness. For the initial 14 days, just delicately wipe your nose without really blowing.
• Try not to eat hard-to-chew foods– Foods, for example, oats, nuts, or popcorn can be exceptionally hard to eat after an extraction and may wound sensitive tissues. Sit tight for a week or so before you include them again into your menu.

By following these simple do's and don'ts after wisdom tooth extraction, you ought to be just fine in a short period of time.