Should I Always Remove My Wisdom Teeth

Some people think that the removal of wisdom teeth is a complete waste of time and money. Others believe that all wisdom teeth are a source of trouble and they must be removed. So, who is right? The simple answer is that not all wisdom teeth require removal; only those wisdom teeth which may cause problems in the future should be extracted.

When to Get a Wisdom Tooth Removed?

Now, we come to the next question. In what situations should wisdom teeth be removed? According to the National Health Service (NHS), wisdom teeth should be removed in case of the following clinical situations.

• Impacted Wisdom Teeth – a tooth is said to have become impacted if it is unable to erupt completely into the oral cavity. Wisdom teeth are among the most commonly impacted permanent teeth. When a wisdom tooth becomes impacted, oral hygiene maintenance in the region becomes difficult and there are higher chances of development of cavities and gum infection problems.
• Tooth Decay – Poor position of the wisdom tooth can cause food to get stuck between the wisdom tooth and the tooth adjacent to it. Over time, this causes gum pain and bleeding gums, as well as tooth decay that affects the adjacent tooth. As tooth decay happens and progresses without any pain, the dental decay is not easily detected. If it progresses into the dental nerve of the tooth, it will require a root canal or even tooth extraction of the previously healthy and functional tooth.
• Tooth Crowding – in some cases, there is insufficient space in the jaws to ensure optimal alignment of all teeth in a jaw. As a result, when the wisdom teeth erupt, they may exert pressure on the existing teeth, resulting in teeth movement and local crowding. In these cases, wisdom teeth should be removed. Removal of the wisdom tooth can in some cases create space for the re-alignment of the remaining teeth with orthodontic treatment.
• Pericoronitis – this is a condition in which the soft tissues surrounding a partially impacted wisdom tooth become inflamed. This condition is characterized by the presence of severe pain and swelling of the affected tooth, which can persist for a few days. In severe cases, this follows with limited mouth opening and foul odour. Pericoronitis can resolve by itself, and recur over and over again. The permanent solution for this condition is to remove the impacted wisdom tooth.
• Cysts – cysts are fluid-filled cavities which can sometimes form around the teeth and can damage the crowns or roots. Similarly, if a cyst develops around a wisdom tooth, it must be removed to prevent damage to the bone as well as the adjacent teeth.
• Cellulitis – this is a potentially serious and life-threatening condition in which infection from an impacted wisdom tooth can travel into the soft tissues of the cheeks, throat or the tongue. It can cause blockage of the airways. If you have any sign of breathing difficulty while experiencing a swollen gum associated with the wisdom tooth, do contact your dentist or doctor immediately as it can be life-threatening.
  
  

When a Wisdom Tooth Extraction May not be Necessary?

Removal of a wisdom tooth is not necessary, if:

• It is not impacted and not causing food to get stuck around it,
• Is properly aligned and is incomplete occlusion with the opposing tooth
• Can be easily cleaned
  
  

What are the Possible Risks of Removing a Wisdom Tooth?

The vast majority of patients who undergo wisdom tooth removal recover fully without any problems. In rare cases, there are some complications that may also arise, as with any surgical procedure.

• Bleeding – generally, bleeding stops almost immediately after the procedure have been completed. If you feel that the bleeding has started again when you come home, you must put pressure at the site by pressing a clean cloth or a dampened tea bag over it with pressure for about 30 minutes. If the bleeding still appears as gushing blood, you must contact your dentist immediately.
• Altered Sensation – two nerves which provide sensation to the tongue and the lower lips and the chin, respectively, and they lie very close to the wisdom teeth. In very rare cases, these nerves may get damaged during wisdom tooth removal. This can result in paraesthesia, which is the altered or complete absence of feeling in the region which they innervate. Chewing, speech and function is not affected. However, this paraesthesia is usually temporary, and can last
• Dry Socket – this is one of the most common complications of wisdom tooth removal. A dry socket is a condition where a blood clot gets dislodged from the socket, after wisdom tooth removal. This usually happens because of vigorous and/or frequent rinsing. Smoking can also increase the risk of this as the healing is affected. Onset of dry socket is approximately 3-5 days after the procedure. Symptoms include severe pain that can radiate up from jaw or head, and an unpleasant smell from the affected region. 

What Happens If You Avoid Wisdom Tooth Removal?

If your dentist has recommended the removal of one of your wisdom teeth, and you continue to avoid it, then there are higher chances of development of the following problems:

• Teeth Cavities – optimal teeth cleaning often becomes difficult around impacted or partially impacted teeth. As a result, there are higher chances of development of teeth cavities, not only around the impacted tooth but also in the neighbouring teeth as well, which can cause long term serious problems.
• Gum Problems – as a result of the difficulty in maintaining oral hygiene around wisdom teeth, there are higher chances of development of gum and periodontal problems. If the wisdom tooth is not removed in time, the infection can spread to the other teeth as well.
• Pericoronitis – if the extraction of a partially impacted is avoided for a prolonged duration, the soft tissue surrounding the tooth frequently gets inflamed, leading to severe pain and discomfort. When this happens, the affected tooth must be removed as soon as possible.
• Tooth Crowding – in some cases, the eruption of wisdom teeth exerts pressure on the existing teeth, leading to crowding and misalignment. This situation is corrected by removing wisdom teeth and creating space for re-alignment through orthodontic treatment.
  
  

How are Wisdom Teeth Removed?

First, your dentist will perform a detailed examination of the affected tooth. He or she will also look at the x-ray images of the tooth to assess the proximity to any structures such as the jaw nerve or nasal sinuses, as well as the anatomy of the tooth, so as to prepare a treatment plan.

Removal of wisdom teeth is performed under local anaesthesia, which takes away the pain during the procedure. In cases where the wisdom teeth have fully erupted, dentists are able to remove wisdom teeth by conventional extraction.

However, if they are impacted or partially covered by the gum, a more advanced surgical procedure needs to be performed. A small incision in the gum and the bone is uncovered and if necessary, partially removed to gain sufficient access to the wisdom tooth. With a skilled surgeon, the wisdom tooth can then be split into pieces and removed in order to minimize bone removal. Once the tooth has been removed, the socket is cleaned and stitches to close up the gum. A small hole can be seen afterwards if the tooth has partially erupted in the mouth initially.

Medication, including painkillers, antibacterial mouth rinse and antibiotics should be taken according to the dentist’s instructions. You may expect some swelling afterwards with the healing process and solid food can be consumed on the same day or the next day depending on your comfort level.

If you wish, the wisdom teeth surgery can be performed under sedation or general anaesthesia, where you will be unconscious for the duration of the surgery. It will be significantly more expensive as there will need to be an anesthesiologist present and hospital fees.

The Final Word

Not all wisdom teeth need to be removed. Instead, the decision to remove a wisdom tooth should be made after your dentist has examined the wisdom tooth position and X-rays. However, if your dentist has recommended that you remove one of your wisdom teeth, you should do so as soon as possible. Otherwise, it can lead to serious problems and complications.

Dental Designs Clinic is a Medisave Accredited Clinic approved by the Ministry of Health Singapore.

At Dental Designs Clinic, our dentists are trained in the latest techniques in dentistry to provide the best treatment available. Our clinic is equipped with high tech equipment from Germany, and we follow international European Sterilisation Standards to ensure a safe and clean environment for you and your family. Our dentists are friendly and gentle, as we understand any dental treatment and surgery is a stressful experience and we do our best to make it as painless and stress-free as possible.

You may use your Medisave to pay for the costs of your wisdom tooth surgery.

Click here for more information on wisdom tooth surgery in Singapore!

References:

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   Paul Coulthard-Edmund Bailey-Marco Esposito-Susan Furness-Tara Renton-Helen Worthington - (https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004345.pub2/abstract)
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   M. Ethunandan-D. Shanahan-M. Patel - (https://www.nature.com/articles/sj.bdj.2012.135)
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