Wisdom teeth typically begin to erupt in the late teens or early twenties, a time when the other teeth have already established their positions in the dental arch. However, due to limited space in the mouth and various anatomical factors, wisdom teeth often do not erupt properly or may cause problems. The decision of whether to correct wisdom teeth is not a straightforward one and requires a comprehensive evaluation of multiple factors.
Position and Alignment of Wisdom Teeth
Impacted Wisdom Teeth
One of the most common issues with wisdom teeth is impaction. An impacted wisdom tooth is one that fails to fully emerge through the gum line. It can be partially impacted, where only a portion of the tooth is visible, or fully impacted, remaining completely beneath the gum and bone. Impacted wisdom teeth can cause a range of problems. They may push against adjacent teeth, leading to crowding and misalignment of the existing teeth. This can disrupt the overall alignment of the dental arch and may require orthodontic intervention to correct.
For example, if a lower wisdom tooth is angled sideways and pushing against the second molar, it can cause the second molar to shift out of its proper position. This can affect the bite and lead to difficulties in chewing and potential damage to the teeth over time.
Angled or Rotated Wisdom Teeth
Wisdom teeth that erupt at an incorrect angle or are rotated can also cause issues. They may not fit properly within the dental arch and can create spaces where food particles can get trapped. These trapped food particles are difficult to clean and can lead to an increased risk of tooth decay and gum disease. The abnormal position of the wisdom teeth can also irritate the surrounding gum tissue, causing inflammation and pain.
A wisdom tooth that is rotated 90 degrees, for instance, may have a large surface area in contact with the adjacent tooth, making it impossible to clean effectively. Bacteria can build up in this area, leading to cavities on both the wisdom tooth and the neighboring tooth.
Potential Impacts on Oral Health
Infection and Abscess Formation
When wisdom teeth are not properly aligned or erupted, they can create pockets between the tooth and the gum. These pockets are ideal breeding grounds for bacteria. The bacteria can cause an infection, known as pericoronitis, which is characterized by swelling, pain, and redness of the gum tissue around the wisdom tooth. If left untreated, the infection can spread and lead to the formation of an abscess. An abscess is a collection of pus that can cause severe pain and may even lead to systemic infections if the bacteria enter the bloodstream.
In cases where the wisdom tooth is partially erupted and the gum flap covers part of the tooth, food and bacteria can accumulate under the flap, triggering the infection.
Cavities and Gum Disease
As mentioned earlier, the difficult-to-clean areas around misaligned wisdom teeth increase the risk of cavities. The bacteria in the plaque that forms on the teeth can produce acids that erode the tooth enamel, leading to decay. Additionally, the inflammation of the gum tissue due to the presence of the wisdom tooth can progress to periodontal disease. This can cause the gums to recede, the bone around the tooth to deteriorate, and ultimately, the loss of the adjacent teeth if not managed.
If a wisdom tooth is in a position where it constantly rubs against the cheek or tongue, it can also cause irritation and potentially lead to the development of oral ulcers, which can further increase the risk of infection and affect oral health.
Symptoms Associated with Problematic Wisdom Teeth
Pain and Discomfort
One of the most obvious signs that a wisdom tooth may need correction is pain. This can range from a dull ache to sharp, throbbing pain. The pain may be constant or intermittent and can be exacerbated by chewing, biting, or even opening the mouth. The pressure exerted by an impacted or misaligned wisdom tooth on the surrounding tissues, nerves, and adjacent teeth can cause significant discomfort.
Some patients may also experience pain in the jaw joint (temporomandibular joint or TMJ) due to the altered bite caused by the wisdom tooth. This can lead to difficulties in opening and closing the mouth and may even cause clicking or popping sounds in the joint.
Swelling and Redness
Swelling and redness of the gum tissue around the wisdom tooth are common symptoms of inflammation. This can be a result of infection, as in the case of pericoronitis, or due to the constant irritation caused by the tooth’s position. The swelling can make it difficult to eat and speak and may also cause a feeling of fullness in the mouth. In severe cases, the swelling can extend to the cheek and even cause difficulty in swallowing if it becomes large enough.
Difficulty in Chewing and Biting
If a wisdom tooth is interfering with the normal occlusion (bite) of the teeth, it can lead to difficulties in chewing and biting. The patient may find it hard to properly grind food, which can affect digestion. Uneven pressure on the teeth during chewing can also cause excessive wear and tear on the teeth, leading to sensitivity and potential damage.
Treatment Options and Considerations
Extraction
In many cases, when wisdom teeth are causing problems, extraction is the recommended treatment. This is especially true for impacted wisdom teeth that are likely to cause ongoing issues or have already led to infections, pain, or damage to adjacent teeth. The extraction procedure can be relatively straightforward for fully erupted wisdom teeth but may be more complex for impacted ones, requiring surgical removal.
After extraction, patients need to follow proper post-operative care instructions, including avoiding certain foods, keeping the extraction site clean, and taking prescribed medications to manage pain and prevent infection.
Orthodontic Correction
In some instances, if the wisdom teeth are causing mild crowding or misalignment and the patient desires to avoid extraction, orthodontic correction may be considered. This may involve using braces or clear aligners to create space and guide the eruption of the wisdom teeth into a more favorable position. However, this option is not always feasible and depends on various factors such as the age of the patient, the degree of crowding, and the overall dental health.
Orthodontic treatment for wisdom teeth correction can be a long and complex process and requires careful planning and monitoring by an orthodontist.
Monitoring and Watchful Waiting
For some patients, wisdom teeth may not be causing any immediate symptoms or problems. In such cases, the dentist may recommend a policy of monitoring and watchful waiting. Regular dental check-ups and X-rays are used to assess the progress of the wisdom teeth’s eruption and any changes in their position or the surrounding tissues. If any issues develop over time, appropriate treatment can then be initiated.
This approach is suitable for patients whose wisdom teeth are in a relatively stable position and are not likely to cause significant problems in the near future.
Conclusion
The question of whether wisdom teeth need to be corrected depends on a variety of factors. The position and alignment of the wisdom teeth, their potential impacts on oral health, and the associated symptoms all play a crucial role in determining the appropriate course of action. While extraction is often the most common solution for problematic wisdom teeth, orthodontic correction or watchful waiting may be viable alternatives in certain situations. It is essential for patients to have a comprehensive evaluation by a dental professional to make an informed decision about the management of their wisdom teeth. By addressing wisdom teeth issues proactively, patients can maintain better oral health and avoid potential complications that could affect their quality of life and the integrity of their dentition.
