Wisdom teeth or third molars are the last teeth to erupt in the oral cavity. Sometimes they might be missing (agenesis) because they are never developed on the maxillary bones. This might be happening because of the evolution of the human scull over the centuries. Wisdom tooth anatomy can be different from one person to another, or even in the same person. Very often they are cause of trouble and pain. That’s because of their eruption path that is longer and more difficult than for the other teeth. First we are going to explain why their eruption is more difficult.
- Wisdom teeth take longer time to develop. Generally wisdom tooth start their calcification from 7-8 until 18-25 years old
- The maxillary bones take develop faster and they grow with direction down and forward. This means that while the maxilla or mandible develops they drag the molar with them creating a curved form of the root, increasing the difficulties of its eruption
- The bones become denser during the development of the child, so the strength that the wisdom tooth needs to erupt is bigger.
- Space deficiency of the maxillary bones. Being the last molars to erupt, sometimes the space isn’t enough causing a change in the eruption direction like an impact on the second molar causing him important damage like periodontal pocket, profound caries, resorption of his root. This can cause serious pain and the only treatment is the extraction of the wisdom teeth and the repair of the damaged second molar with proper therapy.
Since there are so many difficulties in the eruption path of wisdom teeth they sometimes stay inside the bone causing no pain and they are diagnosed casually. Sometimes they erupt partially with two possibilities:
- With perforation of the gingiva- In this case the wisdom tooth is visible in the oral cavity and it associated with accumulation of dental plaque on the tooth surface for the difficulty to clean the area. This causes gum inflammation on the area, the gingiva appears swollen, with deep red color and bleeding. This kind of inflammation can lead to a more serious condition called pericoronaritis which is the infection of the gingival tissue surrounding the partially erupted wisdom tooth. The pain is strong and cheek swelling can happen. This condition can be solved by the dentist using antibiotics, surgery to remove the gengiva that covers the coronal part of the tooth and a more accurate oral hygiene. The accumulation of the dental plaque on the surface of the partially erupted wisdom tooth can also cause tooth decay for the tooth itself or for the second molar next to it.
Not only the accumulation of the dental plaque causes gum disease, it can also cause tooth decay to the wisdom tooth that can be difficult to see by the patient. It can led to these symptoms from the earlier to the older one: toothache when using sugar, sensitivity to cold food or drinks, sensitivity to hot and then pulp inflammation called pulpitis. These situations need professional treatment.
- With no perforation of the gingiva – In this case the wisdom tooth t’s not visible in the oral cavity but is it is covered only by the gengiva which may appear red and have hard consistency, it can be associated with a little pain more like a discomfort. In this case is needed a little more time for the tooth to erupt and no treatment. Just taking care of the oral hygiene can help you prevent the conditions mentioned earlier.
As we said when there is enough space the wisdom tooth can change eruption direction. This change might not cause any problems, but sometimes the tooth erupts toward the mucosa of the cheeks and leaves a lesion in it called decubitus lesion, that causes bacterial accumulation and inflammation associated with pain. Sometimes during the mastication the abnormal erupted tooth injures the muscular tissue causing a lockjaw. The patient can’t open the mouth more then 2 cm and a professional treatment is needed because it a very serious situation.
The treatment of the wisdom teeth problems sometimes is very difficult due to the profound position of the teeth on the oral cavity, lack of visibility for the dentist to treat properly so is better to extract but this is something that your dentist needs to decide based on his diagnosis. To have some temporary relief from pain until you see your dentist you can use pain killers, some kind of over the Counter pain medicine (OTC) like Tylenol, Advil or Ibuprofen. You can use Oral numbing medicine usually in gel form which you place around the tooth area that you’re having the ache from. It will numb the area for 30-45 min. And very important as soon as you see your wisdom tooth erupt you have to brush it carefully to prevent dental plaque deposition.
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