Wisdom Tooth Problems

Topic Overview

What are wisdom teeth?

Wisdom teeth are the upper and lower third molars, located at the very back of the mouth. They are called wisdom teeth because usually they come in between ages 17 and 21-when a person is old enough to have gained some wisdom.

What causes problems with wisdom teeth?

Wisdom teeth that are healthy and in the right position usually don't cause problems. You may have a problem if any of the following occur:

• Your wisdom teeth break through your gums only partway because of a lack of space. This can cause a flap of gum tissue to grow over them. The flap can trap food and lead to a gum infection.
• They come in crooked or facing the wrong direction.
• Your jaw isn't large enough to give them room. Your wisdom teeth may get stuck (impacted) in your jaw and not be able to break through your gums.
• They are so far back in your mouth or crowded that you have trouble cleaning around them.
• A cyst forms. This can damage the bone or roots.

What are the symptoms?

If your wisdom teeth are causing problems, you may have symptoms such as:

• Pain or jaw stiffness near an impacted tooth.
• Pain or irritation from a tooth coming in at an awkward angle and rubbing against your cheek, tongue, or top or bottom of your mouth.
• An infected swelling in the flap of gum tissue that has formed on top of an impacted tooth that has broken partway through the gum.
• Crowding of other teeth.
• Tooth decay or gum disease if there isn't enough room to properly clean your wisdom tooth and nearby teeth.

Most problems with wisdom teeth affect people between the ages of 15 and 25. People older than 30 usually don't have problems that require their wisdom teeth to be removed.

How are problems with wisdom teeth diagnosed?

Your dentist will check for signs of a wisdom tooth coming through your gum or crowding other teeth. You will have X-rays to find out if your wisdom teeth are causing problems now or are likely to cause problems in the future.

How are they treated?

Wisdom teeth that cause problems should be removed, or extracted. This can be done by a dentist or an oral surgeon.

The dentist or surgeon will open the gum tissue over the tooth if needed and remove the tooth. Sometimes a tooth will be cut into smaller pieces to make it easier to take out. After the tooth is removed, you may need stitches.

If you have an infection, you may need to wait until it is gone before you have your wisdom teeth removed. The dentist or surgeon may prescribe antibiotics to help clear up the infection.

While you wait to have the teeth removed, you can take steps to reduce pain and swelling.

• Put an ice pack on your cheek for 15 to 20 minutes at a time. Do not use heat.
• Rinse your mouth gently with warm salt water every 2 to 3 hours. To make your own salt water, mix 1 tsp (5 g) of salt in a cup [8 fl oz (240 mL)] of warm water.
• Try an over-the-counter pain reliever such as ibuprofen or naproxen. Carefully read and follow the directions. Do not give aspirin to anyone younger than 20 because of the risk of Reye syndrome, a rare but serious disease.

Don't put an aspirin directly on your gums. Aspirin used in this way can damage your gums.

Should wisdom teeth be taken out if they aren't causing problems?

Have your dentist check your wisdom teeth if you're 16 to 19 years old. Experts don't agree about whether it's a good idea to routinely remove wisdom teeth that aren't causing problems.

• Some dentists and oral surgeons think it's best to remove wisdom teeth before a person is 20 years old. Removing them when you're older is harder to do and more likely to cause problems.
• Some think it's best to wait and remove wisdom teeth only if there is a problem, especially if you are older than 30.
• Studies have not clearly shown if it is better or worse to remove wisdom teeth that aren't causing problems.

Your dentist can help you decide what's right for you.