Specialist surgeons Mr Fry and Mr Cascarini discuss the six things you need to know about impacted wisdom teeth
When it comes to maintaining good oral health, dealing with ‘impacted wisdom teeth’ can be a little challenging. Approximately 60% of the population are affected by the condition at some stage in their lives, which can lead to a host of undesirable symptoms including swollen, tender or bleeding gums, jaw pain, bad breath and, in more serious cases, infection.
People assume that impacted wisdom teeth will mean pain and inflammation however, this is not always the case. Many people live with impacted wisdom teeth without knowing it, making proper oral care difficult.
Here, Mr Alastair Fry and Mr Luke Cascarini, Oral & Maxillofacial Head and Neck Surgeons at London Bridge Hospital, part of HCA Healthcare UK, reveal six things everyone should know about impacted wisdom teeth – including the best treatment options and techniques available.
Might not cause pain and inflammation
Mr Fry begins: “Although formally known as third molars, the common name for our back set of teeth is ‘wisdom teeth’ because they appear so much later than our other teeth, at an age when we are presumably ‘wiser’.
“The majority of people will grow up to 32 teeth, however, some will have jaws too small to fit this many teeth in – meaning there is not enough space for the wisdom teeth when they finally erupt. When this happens, usually between 16 and 25 years of age, the tooth becomes ‘impacted’ and forced to come through at an angle.”
Mr Cascarini adds: “For some people, impacted wisdom teeth cause pain and inflammation. These people will often seek advice from their dentist or an expert. However, other people will feel no noticeable problems or symptoms – and the problem remains completely unnoticed.
“These impacted wisdom teeth still have the ability to cause future dental problems, so it’s important that they are identified and examined by a dentist or oral surgeon.”
Mr Fry: “Because impacted wisdom teeth have grown through at an angle, they can be difficult to reach when brushing your teeth. If they are not brushed properly or regularly, food and bacteria can get trapped around the edges causing a build-up of plaque – which can lead to tooth decay.
“Decay on an impacted wisdom tooth makes the surrounding molars more vulnerable to tooth decay or infection, so it’s important to brush them as thoroughly as you can. If you struggle with a normal toothbrush, try brushing your wisdom teeth with a narrow-headed toothbrush, and use mouthwash to rinse away any food or bacteria that your toothbrush can’t reach.”
Mr Cascarini: “In some more severe cases, this build-up of decay can lead to the loss of neighbouring teeth because the membrane around the crown of the neighbouring tooth can become cystic and weak, leading to the tooth falling out if not detected and treated quickly.
“If decay has spread from an impacted wisdom tooth to the adjoining molar, it may be necessary for a dentist or maxiofacial surgeon to extract the decayed wisdom tooth and then attempt to repair the second molar afterwards.”
Mr Fry: “Because impacted wisdom teeth are quite difficult to clean they are the perfect host for food and bacteria particles – often leading to bad breath.
The gums around impacted wisdom teeth are very sensitive and tend to get infected easily, so if they are not brushed properly food and bacteria residue can affect the gums and release smelly sulphur compounds.”
Mr Cascarini adds: “Such bad breath can be treated in the short-term through the use of antibiotics or by cleaning the gums around the wisdom teeth with hydrogen peroxide. However, some patients may need to consider having the wisdom teeth removed.”
Earlier the better
Mr Fry: “As we age the roots in our mouths form more fully and the bone around the teeth becomes harder meaning that teeth extraction can be a lot more uncomfortable. Because of this, we advise patients to have their impacted wisdom teeth extracted as soon as they become a problem.”
Mr Cascarini: “It’s important for people to regularly examine their teeth and know what they’re looking for. We advise our patients to check their wisdom teeth in the mirror and monitor them as they grow through the gums. If it looks like they are growing at an unusual angle, or if they are impacting nearby teeth, book an appointment with your dentist or a specialist surgeon to get them examined.”
Nerve damage need not be a problem
Mr Fry: “Previously the removal of impacted wisdom teeth has led to nerve damage in a small number of patients. This is because these nerves are very close to the roots of the wisdom teeth and might be easily obstructed during surgery.
“People might assume they are likely to experience nerve damage if they have impacted wisdom teeth removed – which dissuades them from going ahead with the surgery. However, maxillofacial surgeons have recently developed a new technique to deal with the problematic wisdom tooth without damaging the nerve.”
Mr Cascarini: “These surgeons are using new x-ray technology to assess how close the nerves are to the wisdom tooth root. If nerves appear close on the x-ray, the surgeons can use specialist scanning tools to accurately map out the position of the nerve, before commencing surgery.
“This allows them to reduce the incidence of nerve injury from around 20% in high risk cases to almost zero.”
You don’t have to wait for your dentist
Mr Fry adds: “In 2000, the National Institute for Health and Care Excellence (NICE) introduced new guidelines which stated that only wisdom teeth causing problems (e.g. severe pain, abscesses or cysts) should be removed.
“As a result, many people are living with impacted wisdom teeth and have subsequently developed dental issues. Instead having them removed in their late teens and 20s, they are seeking help in their 30s or 40s when the wisdom teeth have led to much greater dental problems and are more painful to remove.”
Mr Cascarini concludes: “People believe that only their dentist can provide or recommend treatment – however, this is not the case. If you think you may have impacted wisdom teeth, you can book an appointment with an oral and maxillofacial specialist to have them examined.
“Many people are also surprised to learn that impacted wisdom teeth removal can be covered by private medical insurance – so you may be eligible for treatment under your plan and not even realise it.”