Wisdom teeth

Wisdom teeth can cause many issues. They are normally to last teeth to come through into your mouth and, if they become infected, they can cause a lot of pain, swelling and upset. During this time when dentists all over the world are closed due to the Corona Virus Pandemic, Dr Andrew Wilson has produced the following video to help you if you are suffering with issues caused by wisdom teeth.

Wisdom teeth are the very last teeth to come through into your mouth. They come through, right at the back, behind all of the other teeth. This usually happens between the ages of 18 years old and your mid twenties.

Lots of people don’t have wisdom teeth. Lots of people may have them but they may never come through. I have top wisdom teeth but not bottom wisdom teeth. The issue with wisdom teeth is that most people won’t have enough room in their mouths for their wisdom teeth to come through. They are essentially the same as any other tooth but wisdom teeth get their own article because they cause lots of people lots of problems.

A dental history lesson

Wisdom teeth used to be much more useful when we lived in caves. Before we invented cooking and smoothie makers, our diet was much tougher. Raw, uncooked food was much harder work for our teeth and so our teeth used to wear much more. If you know any cave men, you may have noticed that their teeth are short and flat. Because of all the raw dinosaur (this has not been fact checked) they used to eat, the teeth wore down, making little spaces between the teeth. The teeth all drifted forwards to fill these gaps, making space at the back. So when it was time for the wisdom teeth to shine, they were welcomed through as reinforcements, gladly ready to help chew that diplodocus.

Now that we turn all of out food into slop by cooking it, we don’t wear our teeth nearly as much and so these extra teeth are a right pain in the gum.

Wisdom teeth infections

When they only come through half way, the gum will still cover them a bit and this provides a great area to trap food and bacteria. When bugs get stuck under this flap of gum, the gum is infected and will swell up.

When this happens, you may experience several things. It may be painful. You may feel the swelling and you may also feel swelling under your chin or elsewhere around your jaw. You may find that you cannot open your mouth as much as normal. You may find that it hurts to bite because the swollen gum is getting in the way. People tend to have more problems with their lower wisdom teeth rather than their top ones.

Symptoms that could mean it’s your wisdom tooth:

• Swelling at the back of you mouth and in your cheek

• Swelling under your chin

• Not being able to open your mouth very much

Treatment

If this is the first time that you have had pain with your wisdom teeth, then it could just be a one off. If that’s the case, treating the infection with antibiotics may be all you really need. Your dentist may want to flush under the infected gum to get rid of as much gunk or trapped food as possible. Then you need to keep it really clean and see how it recovers.

If this type of problem is becoming a regular thing then you may need some further treatment. Often this will involve the extraction of one or more wisdom teeth.

Sometimes the issue can be caused by the upper wisdom tooth bashing into the gum over the lower wisdom tooth. If the top one is hitting the lower gum, the simplest option is often to remove the top wisdom tooth. If you get rid of the tooth which is causing the trauma, it will free up a bit of space for the lower wisdom tooth to come through more. If this happens and the lower wisdom tooth has more space, it may stop being an issue and you may avoid taking that one out. Be aware that this doesn’t always work. The reason I discuss removing the top wisdom tooth with my patients first is because it is usually much easier to remove than the lower one and will often solve the problem.

Lower wisdom teeth can sometimes be tipped over at all sorts of angles. If your lower wisdom tooth is tipped forward and digging into the back of the tooth in front, it can start to cause issues with that tooth. If the wisdom tooth is at a funny angle, it may make it impossible to keep that area clean. If food and plaque hangs around there, it is likely to cause decay in the tooth in front.

So if your wisdom tooth is making it impossible to keep that part of your mouth clean, you should seek advice from your dentist. It may be that your dentist advises just to keep an eye on it for now but if there is a hole starting, you want it sorting sooner rather than later.

If you are advised that you need the lower wisdom tooth out, you may be referred to a more specialised dentist. Lower wisdom teeth are often a bit trickier than the top ones. They are often bigger teeth and can be at very awkward angles as I mentioned above. Removal of a lower wisdom tooth may require the dentist to make a little nick in your gum to make space for it to come out.

Risks

If the dentist has had to make a nick in the gum to remove your wisdom tooth, there will probably be some pain and swelling for a few days after. There is guidance about what to do after having a tooth out in the ‘Tooth Extraction’ article.

Be aware that lower wisdom teeth can be quite close to a nerve in your jaw that goes to your lower lip. When taking out a lower wisdom tooth, this nerve can be bruised. If this happens, you may be left with some tingling on one side of your lower lip. This normally gets better with time but it can (rarely) be permanent. Your dentist will take x-rays and will be able to advise you on whether this is likely for you or not.

Wisdom teeth can be troublesome. While they are coming through, they can be uncomfortable. If they are becoming a persistent pain, get help from your dentist.

The National Institute for Health and Care Excellence set guidelines for dentists regarding the extraction of wisdom teeth. Guidelines followed by dentists can be found here.