Wisdom Teeth

95 percent of Singaporeans need to have their wisdom teeth removed.

Wisdom teeth are known to dentists as the third molars, which appear in the mouth at about 18 years of age.  They are called Wisdom Teeth in common parlance because they erupt at a time when the person has started to come of age, and is wiser.  Well, we all know people who are none-the-wiser for their wisdom teeth, but the name has stuck with these teeth.

Wisdom teeth are usually impacted, or 'jammed' behind the second molars of the mouth because there isn't enough space in jawbone to accommodate them.  This isn't so much a result of smaller jaws or bigger teeth, but a reduced amount of wear from the diet; the contact surfaces between the teeth do not wear down as much because the diet is softer and more processed, and the teeth remain 'wide' and occupy more space, such that there isn't room for the third molar to erupt.

In most Asians who want to have straighter teeth with braces, an additional four teeth other than the four wisdom teeth are removed to make the space for the teeth to be aligned.

The impaction of the wisdom teeth can come in many forms, and the difficulty of the surgery depends on many factors, such as the depth of the tooth, the angle, the number and shape of the tooth roots, the proximity to important structures (that we want preserved, such as nerves,) the ease of access to the area, the personality of the patient, the training of the surgeon, and so on.

Historically, some dentists have advised patients with deep impactions not to remove the wisdom teeth, because they lacked the skills to do so.  Nowadays, there are trained specialists in wisdom tooth removal.  Just as there are people who excel in certain types of work, there are dentists who excel in removing wisdom teeth.

Leaving an impacted wisdom tooth in place has a few risks, depending on the type of impaction.  The most common problem is recurrent pericoronitis, which is a swelling of the gum 'tent' covering the partially-erupted tooth; this is caused by an infection, and is commonly misdiagnosed by laymen as 'erupting wisdom tooth pain' and dismissed.  This pericoronitis usually recurs, and gets worse with every episode – in the long run, it may cause life-threatening swellings that interfere with breathing.

Sometimes, the impacted tooth causes food to collect in the crevice between the tooth and the tooth in front, and decay forms deep down the back edge of the tooth in front, that is difficult or impossible to fill, and both teeth are lost instead of just the third molar.  We all love discounts, but 'two for the price of one' in this situation is not a good deal.

Less likely, there is a possibility of deeply-impacted teeth to develop a cyst around the tooth, which grows in size and disfigures the jaw, and requires more extensive surgery.

Most wisdom teeth are removed routinely under local anaesthesia in the dental office, but in some people, removal under general anaesthesia is required.  Usually, all the wisdom teeth are removed, whether singly, in pairs (one side at at time) or all at one visit.  This depends on the skill of the surgeon and the situation.