WISDOM TEETH AND TOOTH REMOVAL

Removing a Tooth

At Melbourne Dentistry we only advise removal of a tooth if there is no suitable alternative treatment.

Tooth Removal

Wisdom teeth and sometimes other teeth may be removed if there is:

• extensive destruction from dental decay which cannot be restored,
• excessive mobility as a result of advanced gum disease,
• irreversible pulp disease and a patient does not wish to proceed with the alternative option of root canal treatment,
• a request from a patient’s Orthodontist to remove specific teeth as part of an overall orthodontic treatment plan,
• an unrestorable fracture resulting from deep cracks or traumatic events,
• a supernumerary tooth (unexpected extra tooth),
• associated pathology such as cysts or tumours, or
• a problematic impacted third molar often called a wisdom tooth/teeth.

Problems With Wisdom Teeth

Wisdom teeth should be regularly monitored by your dentist to determined if or when intervention is required. Early removal of impacted wisdom teeth is often recommended to avoid future problems and decrease the surgical risks associated with third molar extraction procedures, as patients become older. Recovery from surgery is also easier if wisdom teeth are removed in earlier life.

Eruption And Impaction Of Wisdom Teeth
Wisdom teeth are the last teeth to erupt into the mouth, usually pushing through the gums in late teenage years or early twenties. Most people have 4 (or up to 4) wisdom teeth. Approximately 10 percent of people however, are fortunate enough not to develop any. 

If wisdom teeth are able to erupt completely and can be well maintained, they are a valuable adjunct to chewing function. Often, however, there is little space available at the back of the mouth for wisdom teeth to erupt fully. Hence, they frequently become wedged in or impacted. Wisdom teeth may grow sideways, partially emerge from the gums or remain trapped under the bone. When this occurs, problems may arise.

Difficulties With Cleaning Wisdom Teeth
Impacted wisdom teeth are commonly associated with intermittent issues. Over time, these may lead to more serious complications. The most common problems are painful infections of the gums around partially erupted wisdom teeth (bacteria on the partially exposed tooth can trap and stagnate under the gapping gum and lead to gum inflammation termed pericoronitis). Infections of this nature are at risk of becoming facial swellings, causing jaw pain and restricting jaw movement. Treatment usually requires antibiotic therapy.

Difficulties in reaching wisdom teeth to clean and maintain them can also lead to gum disease around adjacent molars. Decay of wisdom teeth or adjacent second molar teeth, may result with food trapping on, or in between these poorly aligned and hard to clean teeth. Also, root resorption (significant erosive damage) of an adjacent molar may result from the pressures of an erupting wisdom tooth against it. For these reasons, wisdom teeth are often found to contribute to the loss of second molar teeth.

Other Issues With Wisdom Teeth
Pressures from emerging wisdom teeth may move other teeth and disrupt the orthodontic or natural alignment of teeth. An upper wisdom tooth may grow out toward the cheek and lead to an ulcer or frequent cheek biting.

For those who play sport, fractures of the jaw will often occur at the site of impacted wisdom teeth as their presence creates a point of weakness in the jawbone. Preventive removal of wisdom teeth for some athletes to minimize these risks should be considered.

Occasionally, wisdom teeth may remain submerged in the jaw and cause no apparent issues. Regular dental review and radiographs of symptom free teeth are still required to exclude rare complications such as cysts and tumours, which can grow from the tissues around impacted wisdom teeth.

Wisdom Tooth Removal

Removal of wisdom teeth is a common procedure. At Melbourne Dentistry, assessing a tooth’s shape and position in the jaws radiographically is essential prior to establishing a tooth removal treatment plan.

Some wisdom teeth may be removed comfortably in the dental chair with local anaesthesia. If the removal of a wisdom tooth is likely to be difficult or particularly complicated or if multiple teeth are recommended for removal, referral to a specialist Oral and Maxillofacial Surgeon may be advised for treatment to be undertaken in the hospital with the benefits of IV sedation or general anaesthesia.