Wisdom teeth

Wisdom teeth are the molars (back teeth) that come through last and furthest back in your mouth, usually in your late teens or early 20s. This is a normal part of mouth development. There are normally four wisdom teeth – two in the upper jaw and two in the lower jaw – but some people have more, fewer, or even none at all.

Some wisdom teeth come through without causing any issues, but others are problematic and may need removal or other treatment.

Problems with wisdom teeth

Some wisdom teeth erupt (emerge through the gum) without causing any problems, but sometimes, wisdom teeth come through at an angle and push into the gum or the tooth beside them. This is called impaction.

Impaction of a wisdom tooth can be painful and sometimes causes infection. Brushing these teeth can be difficult. Food and bacteria can get stuck between the wisdom tooth and the tooth next to it, leading to tooth decay and gum infections called pericoronitis.

Crowded wisdom teeth often lean sideways and rub against the cheek. This may cause ulcers on the cheek and chewing problems.

Your oral health professional may recommend that your wisdom teeth be removed if:

• there is not enough room in your mouth for your wisdom teeth to come through properly – removing a tooth early may help prevent a future problem
• you are experiencing:
  • pain
  • infection
  • damage to other teeth.

They may also recommend keeping a watch on the tooth in case it looks like causing problems later.

Symptoms of wisdom teeth infection

Signs of gum infection caused by wisdom teeth include:

• red, inflamed gum near the wisdom tooth
• facial swelling
• pain and sensitivity
• pus coming from the gum
• swollen and sore lymph nodes underneath the jaw
• difficulty opening the mouth and swallowing
• fever
• food getting stuck and difficult to clean out.
• bad breath.

Treatment for wisdom teeth infection

Infections caused by wisdom teeth can be treated:

• by improving the cleaning and oral hygiene in the area
• by having the area cleaned by a dentist
• sometimes, by the prescription of antibiotics.
• removal of the wisdom teeth

However, the infection may keep coming back if problem teeth are not removed. People who have other health problems, especially people with lower immunity, may have complications from these infections.

Removal of wisdom teeth

X-rays will help to tell if wisdom teeth might cause problems. Some wisdom teeth do not cause problems and do not need to be taken out.

If your wisdom teeth need to be taken out, all you may need is a local anaesthetic so you won’t feel it. If your wisdom teeth are deeply impacted (blocked from coming through) and difficult to remove, or for other medical reasons, you may be offered a general anaesthetic. Sometimes this can be done with nitrous oxide (also known as happy gas) to make it more comfortable.

Once the wisdom tooth is removed, the area where the tooth was may be stitched to help it heal. It is normal for your jaw and gum to be sore, swollen and bleed a little for a few days after having a wisdom tooth out.

One possible complication of wisdom teeth removal is a dry socket (alveolar osteitis), when the area where the tooth came from doesn’t heal properly causing severe pain and a bad smell from the area. This happens more often in people who smoke or have difficulty in healing. Dry socket can be successfully treated by your oral health professional.

Problem wisdom teeth are best removed early

The longer you wait or delay, the more problems that can happen and damage that might result to the nearby teeth. Your oral health professional can help identify any problems early. Wisdom teeth can be removed by a dentist, but may also need to be referred to an oral maxillofacial surgeon who has done additional training and study in surgery or the teeth, bones, jaws and face.

The roots of wisdom teeth are still forming when you are a teenager, so it is easier to take them out at this age. It may be more complicated if you wait until later in life, when the roots are fully formed. Wisdom teeth can also be easier to remove when your bone is younger; heals and recovers faster.

Care after surgery for removal of wisdom teeth

Your oral health professional will talk with you about how to care for your mouth after having a wisdom tooth taken out. Some general suggestions include:

• Take pain-relieving medication if needed (and on advice from your oral health professional).
• Bite on the gauze to help stop bleeding, and other instructions that you may be given after the tooth is removed.
• Avoid excessive rinsing, sucking through a straw or spitting as that can cause the blot clot to not form, or come loose.
• Hold warm salty water in your mouth. Do this after meals and no earlier than 24 hours after surgery.
• Eat soft, easy-to-chew foods for the next few days to keep the area clean from food particles.
• Don’t smoke for 48 hours after the surgery.
• Avoid alcohol and excessive physical activity.

Where to get help

• Your dentist
• Dental Health Services Victoria provides public dental services through the Royal Dental Hospital Melbourne and community dental clinics, for eligible people. For more information about public dental services Tel. (03) 9341 1000, or 1800 833 039 outside Melbourne metro
• Australian Dental Association ‘Find a Dentist’ search function or Tel. (03) 8825 4600