What are problematic wisdom teeth and how are they dealt with? – a brief summary:
Authored by Dr. Dominique Laatz, German Dental & Dermatology Centre
Wisdom teeth are the latest to appear in your mouth. In a majority of cases, they are misaligned or displaced due to a lack of space within your jaws. This can create multiple problems, from neighbor tooth damage to food impaction, typical gum infections (also called pericoronitis) and even severe abscesses in the cheek and surrounding areas.
Especially partially erupted wisdom teeth show a high rate of severe deterioration over time, because they attract food impaction and are almost impossible to reach with the toothbrush or other oral hygiene tools such as floss, interdental brushes or mouthwash dispensers. The high probability of complications with partially erupted wisdom teeth explains the widely accepted recommendation for surgical tooth extraction of the relevant professional organizations all around the world. In other case scenarios, such as fully impacted wisdom teeth, opinions differ and decisions will have to be made on a case-to-case basis after close examination by the treating medical professional.
Potentially problematic wisdom teeth usually display one or more of the following findings:
– partially covered by gum (mostly on the backside in the lower jaw)
– dental decay (“cavity”) on the wisdom tooth or the neighboring tooth
– bad breath
– food impaction
– swollen gums
– swollen cheek
– throbbing pain
– pain deterioration in the later hours of the day or in the night
The symptoms listed above, albeit commonly found with problematic wisdom teeth, can also stem from several other teeth and dental conditions, so a dental examination with a specialist must be advised, in case of occurrence.
What happens during wisdom teeth removal and what to expect after?
The personal experience from wisdom teeth removals can vary a lot, depending on the location (or dislocation), bone density, surgical skill level and – of course – the pain and pressure tolerance of the specific patient, as one of the most important factors.
Technically, some wisdom teeth demand a surgical methodology, which includes creating a gum flap, followed by a careful reduction of the directly surrounding bone and – if necessary – a separation of the wisdom tooth itself, in order to avoid creating too much pressure, by wrongfully trying to remove a large portion of the wisdom tooth at once, even if the necessary space is too small. It’s important for the patient to understand that a good oral or maxillofacial surgeon, will always try to limit the pressure at the time of removal, because, while the nerve fibers responsible for sharp pain sensation can be very effectively blocked by common local anesthesia, the pressure sensation unfortunately remains intact. Too much pressure during the removal is therefore something a proper surgical technique is meant to evade, by applying a tactical bone reduction and tooth separation.
Other, partially impacted or decayed wisdom teeth, sometimes don’t necessarily require surgical steps and can be tossed out of their bony socket by mild to moderate pressure with designated luxation tools. This situation is mostly found in the upper jaw due to the softer bone conditions when compared to the dense bone of the lower jaw.
It is for this reason, that swelling and post-operative discomfort mostly derive from the removal of impacted and partially impacted lower wisdom teeth. Even in the seldom scenario, where the situation demands the surgical removal of upper wisdom teeth, swelling, pain and post-operative discomfort are usually less, when compared to the lower jaw.
As in most scenarios of surgical healing, the peak of the post-operative swelling is usually reached after approximately three days and subsides significantly in the coming few days. Immediate, intermittent cooling with clothed ice-packs is routinely advised to lower the swelling.
While classical wound pain, isn’t a bigger issue in most cases, the swelling can lead to a severe restriction of the mouth opening. This can hinder the normal food intake and – together with the pressure of the swollen cheek – explains most of the post-surgical discomfort.
German Dental & Dermatology –
“German quality care you can trust!”