We probably get in the region of 20 to 30 patients every month asking if they need to have their wisdom teeth removed.
Wisdom teeth usually come through from the age of 18 up to about 21 or 22 years of age, they are the last permanent molars at the back of your mouth to come through. We all know somebody who has had their wisdom teeth out, or is going to have their wisdom teeth out, and there’s plenty of horror stories. On a lighter note I suppose you can have the day of school, or you can have a few days off work and stay in bed eating ice cream while you nurse yourself better; but there are also plenty of horror stories such as an infection, oh it was a horrible procedure, and so on.
So really the question is if you need to have your wisdom teeth removed at all. Obviously it’s better if you don’t have your wisdom teeth removed as long as they’re not causing any damage to your mouth your gums or the other teeth as well. Dentists, whether on the high street in general practice or in hospital, have to follow something called the NICE guidelines. The NICE guideline stands for National Institute for Health and Clinical Excellence, so it is part of the NHS, and involves a team of experts who do the research on for example wisdom teeth in this, and they come up with guidelines that dentists should then have to follow as an example.
Before the days of NICE a lot of people had their wisdom teeth taken out even if they didn’t have any problems with them at the time. This used to be called prophylactic removal, so in other words they thought by removing a wisdom tooth it would prevent any problem occurring. But when research was done for with patients over a long time it was noticed that many wisdom teeth were not producing any symptoms, or any pain, or any swelling, and in the past they probably would have been removed; but by not removing them didn’t cause the patient any problem so why have the wisdom tooth out in the first place?
So now there are strict NICE guidelines as I said, which stands for the National Institute for Health and Clinical Excellence, so the first part of this is that the dentist has to assess your wisdom teeth and take a history from you; for example are you getting any pain and swelling. X-rays might show decay, so the lady looking at is looking for any pathology around the wisdom tooth or other reason to causing any pathology – pathology means a deviation from health – so if there is pathology, that is usually an indication that wisdom teeth needs to be taken out. But not all pathology means that you just immediately barge in, for example if it is the first time you have a gum infection around the wisdom teeth also called pericarditis, it is best to let that episode settle down and then wait and see to see if it happens again and how frequently it happens. If it does happen again and it starts to reoccur frequently within short time periods then that is usually an indication that you should go to have your wisdom tooth or teeth taken out. So pathology can include things like decay in the wisdom tooth, decay in the adjacent tooth, gum flap problems, gum disease, infections, cysts, so really there are a lot of reasons why the tooth might need to be taken out because of pathology.
You’ve all heard of impacted wisdom tooth but what does impaction really mean? They are the last permanent molars to come through, usually at the age of eighteen to about 21 years of age, and because they’re usually the last teeth molars to come out they usually become impacted, which means that they haven’t fully come through unlike your other teeth. The usual reason for impaction is lack of space within the jaw bone, and also there may be an obstruction for example the adjacent teeth which is preventing it from coming through.
This impaction by itself is not a reason or indication to have your wisdom tooth out, but if the impaction is causing symptoms or causing disease, then it is coming back to the question of if you need to have your wisdom teeth removed or not. The answer really is that your dentist will assess your symptoms when you tell them and also they will look at x-rays and examine everything before coming to some decision.
If the wisdom tooth does need to be taken out, then the next decision will be if you have it removed in the surgery or Hospital. This really boils down to how difficult it might be, or on the expertise of the individual dentist. In addition the other decision you may have to make is whether you want the tooth out under a local anesthetic just like when you have a filling done where the tooth is numbed up or do you like have a done while you’re asleep.
Usually the indications for having it done while you’re asleep up in hospital will be if it is particularly difficult or if there’s multiple wisdom teeth that need to be taken out all in one go, or you may be especially nervous, which means that a general anaesthetic might be the way forward. You do have to balance the risks of having yourself put to sleep against the risks of having it done while you’re awake, so going back to the question do you need your wisdom teeth removed?
Each case is obviously different and individual, but many wisdom teeth do need to be taken out and just because you have to have a wisdom tooth out is not reason to start panicking because many wisdom teeth come out very easily, sometimes even more easily than you can imagine. But there are some which are more difficult as well, and some are actually very difficult, and there are also complications afterwards as well that you need to be aware of.