Oral surgery

All about wisdom teeth, pain and extraction

Wisdom teeth can be a problem for patients, especially for those who are at the age where they are erupting, usually between 17 and 24 years old.

The wisdom teeth may erupt in a nomal way without giving any symptoms. But in many cases they erupt in a malposition, usually due to a lack of space.

In these cases where the wisdom teeth erupt in a malposition they can cause problems such as Perioconaritis, which is an inflammation and/or infection of the gum covering the tooth, which can cause pain, bad breath, bad taste and in more advanced cases fever. These episodes can be treated with antibiotics but the infection may recur becoming chronic, being the treatment of choice extraction of wisdom teeth.

In other cases, malposition of the wisdom teeth can damage the neighboring teeth, producing them caries, shifts and even ending losing both teeth.

We recommend to early diagnose a possible problem with wisdom teeth, as their removal is easier and with less postoperative complications at early ages when wisdom teeth are not fully formed.

Wisdom teeth, also known as moral third, owe their name because they are the last teeth to appear.
Wisdom teeth can be a problem for patients, especially those who are at the age when they are erupting, usually between 17 and 24 years old.
Wisdom teeth can erupt normally without giving any symptoms. But in many cases these erupt in a malposition, generally due to a lack of space in the jaw.

A) What are wisdom teeth?

Wisdom teeth are the third molars that develop in the back of the mouth, and they usually grow between 17 and 24 years old. Wisdom teeth can erupt normally without giving any type of symptomatology. But in many cases they erupt in a bad position, generally due to a lack of space in the jaw, and can cause significant pain and complications.

A1) Does everyone get wisdom teeth?

No, there are people who have the 4 wisdom teeth in the mouth, others that have all 4 but did not come out and others that may have born some and others not, and there are even people who do not have any.

A2) What are they for or what were these teeth used for?

Wisdom teeth were perfectly functional in our ancestors who had wider jaws and a Paleolithic diet. As the human being evolved and with the change in diet, our jaws narrowed more and more, preventing in many cases that there is space in the mouth for their correct birth. There are even many people who do not even have any or no wisdom teeth.

B) Why do my wisdom teeth hurt?

As we said, the eruption of the wisdom teeth does not always cause problems, but when it does, they can be very painful. Here we expose the main causes of pain in the wisdom tooth.

B1) Impacted wisdom teeth

Due to a lack of space in the mouth, wisdom teeth are often unable to fully emerge or do not have enough space to grow properly. This can lead to impaction, which means they get trapped under the gum and bone and can grow at odd angles or against adjacent teeth. Impaction of wisdom teeth can cause pain, swelling, and discomfort in the mouth and jaw.
This can make chewing and speaking difficult.

B2) Pericoronitis - Infection caused by wisdom teeth

In certain cases in which the wisdom teeth erupt in a malposition, problems can occur such as pericoronitis, which is an inflammation and/or infection of the gum that covers the tooth, which can cause pain, bad breath, bad taste in the mouth and in more advanced cases fever. These episodes can subside with antibiotics, but this infection can reoccur becoming chronic, with wisdom teeth extraction being the treatment of choice.

B3) Tooth decay and gum problems

Wisdom teeth are difficult to reach and clean properly due to their location in the back of the mouth. This makes them more prone to accumulate food debris and bacterial plaque. The result can be the formation of dental cavities in the wisdom teeth and neighboring teeth, as well as an increased risk of periodontal disease, which affects the gums and tooth-supporting tissues.

B4) Can wisdom teeth move neighboring teeth?

There is a common belief that wisdom teeth can move neighboring teeth as they erupt or try to find space in the mouth. However, this idea is not supported by solid scientific evidence. Wisdom teeth, being the last teeth to appear, often encounter a jawbone that is already fully formed and full of teeth. Due to a lack of space, wisdom teeth can partially erupt or become impacted under the gums, which can lead to discomfort and dental problems.
However, the claim that wisdom teeth exert sufficient force to move neighboring teeth is questionable. Studies have shown that the pressure exerted by erupting wisdom teeth is minimal and unlikely to cause significant displacement of adjacent teeth. It is important to note that tooth displacement can be caused by other factors, such as a lack of space in the mouth, malocclusion, or prolonged use of ill-fitting dentures. These problems may require orthodontic treatment to correct the alignment of the teeth.

C) Treatment and management of wisdom teeth

When wisdom teeth are causing significant problems, treatment is likely to be required. Here we list some of the most common treatments.

C1) Wisdom teeth extraction

Surgical removal of wisdom teeth is the most common approach to address problems associated with them. A dentist or oral surgeon will perform the procedure, usually under local anesthesia or conscious sedation. Extraction may involve cutting through the surrounding gum and bone to access the wisdom tooth and then removing it completely.

C1.a) What care should be taken after the extraction of wisdom teeth?

It is important during the first hours to apply local cold in the external area intermittently.

  • During the first hours you should not drink drinks or hot food, to avoid bleeding. After a few hours you will be able to eat liquid and soft food but never hot during the first day.
  • In the following days you can take any food that is not excessively hard so as not to damage the area.
  • Avoid smoking and intense physical exercise for a few days.
  • Avoid vigorous rinsing during the first hours, so as not to damage the formed clot and cause bleeding.
  • You may experience postoperative pain that usually subsides with the prescribed medication.
  • In case of bleeding, you can take a compact dry gauze and apply it to the area, pressing with your mouth closed for about 20 minutes.

It is advisable to diagnose a possible problem in the wisdom teeth early, since their extraction is easier and with fewer postoperative complications at an early age in which the wisdom teeth are not fully formed.

C1.b) Does it hurt to have your wisdom teeth removed?

All extractions are performed under local anesthesia, with which the patient will not feel pain. In cases of very fearful patients there is also the possibility of conscious sedation with intravenous drugs administered by an Anesthetist.

C1.c) Do you always have to extract wisdom teeth?

No, some wisdom teeth that do not have any pathology and do not interfere with the shape of the bite will not need to be extracted. In other cases in which the malposition of the wisdom teeth can damage the neighboring teeth,producing caries, displacements even being able to lose both teeth, their extraction would be indicated.

C1.d) Do we have to extract all four wisdom teeth or only the ones that cause problems?

Depending on the case, only those that present a problem or also for prevention can be extracted. When two wisdom teeth on the same side are erupted, that is, in the mouth, and one of them needs to be extracted, it is advisable to also extract the opposite one, to prevent it from being extruded, occupying the space left by the extracted one.

C1.e) How long does a wisdom tooth extraction intervention last?

It depends a lot on the position of the tooth and the complexity of the extraction. There are wisdom teeth that can be removed in 30 seconds and others that can take up to 1 hour.

C1.f) Can you get all four in the same intervention?

Yes, in many cases it is possible to extract all four wisdom teeth in a single surgical procedure. This depends on the evaluation of the dentist and the complexity of each case.

C1.g) How long is the postoperative period after wisdom teeth extraction?

It will depend a lot on the complexity of the extraction, the time it takes to perform it, the individual conditions of each one (some people are more prone to swelling and bruising than others) and the follow-up of postoperative rules, including medication prescribed. Discomfort and swelling will usually be experienced for a few days, and full recovery may take one to two weeks.

C1.h) What happens if the wisdom teeth are not extracted?

If problematic wisdom teeth are not removed, a number of oral complications and problems can arise, such as Increased risk of tooth decay and periodontal disease, recurrent infections, cyst and tumor formation, pain and discomfort etc.

C2) Control of pain caused by wisdom teeth

Before and after the extraction, pain relievers or anti-inflammatories may be prescribed to relieve pain and swelling. Applying cold compresses to the affected area can also help reduce inflammation.

C3) Antibiotics

In cases of infections associated with wisdom teeth, antibiotics may be prescribed to fight the infection and prevent further complications.

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