Dr. Tony Wong: Wisdom Teeth Removal - Is It Always Necessary?

What Are Wisdom Teeth?

They are the “extra” third molars that grow in our upper and lower jaw.

When Do I Usually See Them?

The average age when you see them in the mouth (if they do erupt) is 18 to 20 years of age. They are typically the last tooth in the dental arch to erupt and hence results in poor positioning and impaction due to insufficient jaw space to accommodate them. 

There are two kinds of impacted wisdom teeth. 

If you see a little bit of the tooth in the mouth, they are considered partially erupted.

If you don't see or feel anything in the mouth, it does not mean that you don’t have wisdom teeth. They might be fully buried in the bone and can only be detected by dental X-rays or CT scans.

What Do I Feel If I Have Wisdom Tooth Issues?

It generally starts with a dull throb at the back of your mouth and pain on biting down on food in the affected area. You may also get a gum swelling (Pericoronitis) around the wisdom tooth. As this swelling gets bigger, you will get pus discharge and a foul smell if the gums get infected. There may also be swelling of the lymph nodes in the neck region under the jaw. If the tooth in front or the wisdom tooth is left there too long, you may even get a toothache if the dental decay is deep.

Why Must I Remove Them?

In general, you should remove your wisdom teeth when they are partially erupted and have recurrent gum swelling (Pericoronitis).  Pericoronitis is the inflammation of the gums around a partially erupted tooth due to food and bacteria being trapped. This can lead to swelling and pain and in some cases the swelling can be so bad it can spread to the throat and cause breathing difficulties.

You should also consider removing these partially erupted wisdom teeth when they cause food trap with the molar in front. The food trapped there can erode the surface of the tooth in front, causing decay. Decay in lower second molars related to an impacted wisdom tooth is common especially if the third molar is partially erupted. https://www.nice.org.uk/guidance/ta1/documents/wisdom-teeth-removal-review-proposal-appendix-b2 

According to this paper, https://www.ncbi.nlm.nih.gov/pubmed/30952374 the frequency of decay also increases the longer these wisdom teeth are left there.

When these impacted wisdom teeth try to erupt, they may also push unto the tooth in front and cause external root resorption. External root resorption of permanent teeth is believed to result from inflammation from force pressure. https://www.joms.org/article/S0278-2391(14)00336-X/pdf

Leaving decay and resorption on the tooth in front could lead to large cavities which trap food, lead to a bad smell and subsequent root canal issues for that tooth.

When Must I Remove My wisdom Teeth?

You should remove your wisdom teeth when you feel pain and the symptoms listed above; like swelling and swollen lymph nodes etc. However, it is also a good idea to remove these wisdom teeth prophylactically and early. BEFORE they cause damage and pain to the TEETH IN FRONT Otherwise you may sadly lose two teeth instead of one. https://www.joms.org/article/S0278-2391(14)00336-X/pdf

Do We Have To Remove Those Fully Submerged Wisdom Teeth That Are Not Connected To The Oral Cavity?

Wisdom teeth that are not removed have to be monitored as buried wisdom teeth form cysts according to a paper published in 2019. https://www.ncbi.nlm.nih.gov/pubmed/31005378

If your dental X-rays show that you have wisdom teeth but they are not causing any pain of swelling at the moment, you may leave them alone for now. But it will still be advisable to take Dental X-rays every 2 years to monitor for cystic changes or changes to the tooth in front of the wisdom teeth.

What Should I Do If I Think I Have Wisdom Tooth Issues?

Consult your dentist immediately. Your dentist will do an exam for you and take dental Xrays. He or she will address any acute infection with appropriate medication like antibiotics and painkillers, then schedule you for removal of the offending wisdom tooth/teeth.

What Is The Downtime For Removal Of Wisdom Teeth?

The usual downtime varies from a couple of days to a week.

What Is The Cost Of Wisdom Tooth Removal?

It depends on the difficulty of the tooth removal, but it general, it ranges from $250 to $400 if the wisdom tooth does not require surgical removal and can be extracted. 

If it is impacted and needs to be surgical , then it will usually cost between $1250 to $1500 per tooth and it is partially Medisave claimable, subject to government approval.

I'm Scared Though. Does Removing Wisdom Teeth Hurt?

Removing wisdom teeth is typically an in office day surgery procedure and you can choose to do it under local anaesthesia or sedation. 

There is a little bit of discomfort if you choose local anaesthesia when we numb you up before the procedure and you will not feel pain during the process of the tooth removal. Our surgical suite is also designed to calm the senses.

If however you still feel really nervous, please opt for a sedation experience with our Anesthetist as our clinic is sedation friendly. Just go to sleep and let us take care of everything else.

Dr. Tony Wong graduated from the Faculty of Dentistry, National University of Singapore with a Bachelor of Dental Surgery (BDS) in 1997. He has special interests in wisdom teeth removal, Dental Implantology and Restorative Dentistry.

References

1. Song, G., Yu, P., Huang, G., Zong, X., Du, L., Yang, X., Qi, Z., & Jin, X. (2020). Simultaneous surgery of mandibular reduction and impacted mandibular third molar extraction: A retrospective study of 65 cases. Medicine, 99(15), e19397. https://doi.org/10.1097/MD.0000000000019397
2. Low, S. H., Lu, S. L., & Lu, H. K. (2021). Evidence-based clinical decision making for the management of patients with periodontal osseous defect after impacted third molar extraction: A systematic review and meta-analysis. Journal of dental sciences, 16(1), 71–84. https://doi.org/10.1016/j.jds.2020.06.018
3. Pham, T., & Nguyen, N. H. (2019). Periodontal Status of the Adjacent Second Molar after Impacted Mandibular Third Molar Surgical Extraction. Contemporary clinical dentistry, 10(2), 311–318. https://doi.org/10.4103/ccd.ccd_634_18