Impacted Wisdom Teeth - Risks of Keeping Them In

It is important to understand that not more than 12% of impacted wisdom teeth have associated pathology.

1. Gum Disease (Periodontal Disease)

Your wisdom teeth may break partway through your gums, causing a flap of gum tissue to grow over them. Food can become trapped under the flap and cause your gums to become red, swollen, and painful. These are signs that germs growing under the flap are causing infection.

Gum disease (periodontal disease) may be initially mild known as gingivitis or progress to periodontitis. Infection occurs in fewer than 10% of wisdom teeth (3rd molars), most of which can be cured with antibiotics, oral rinsing, or removal of excess tissue (the hyperculum) around the tooth, without requiring removal of the tooth itself.

Periodontal disease can harm the gums and the surrounding bone of the tooth. Even the neighboring tooth can be affected. Because of this, oral surgeons often recommend removal of the infected wisdom teeth to prevent damage or loss of an adjacent 2nd molar.

2. Cavity in a Tooth Next to a Wisdom Tooth

If a wisdom tooth that is aligned poorly creates a trap for plaque and debris between the wisdom tooth and the adjacent 2nd molar cavities can occur just like gum disease mentioned above.

Both teeth can decay and develop a cavity and both may need to be extracted if the cavities become severe. The image to your right shows an example of this scenario.

3. Cavity in a Wisdom Tooth

If a wisdom tooth is hard to clean due to positioning, dental plauque can remain after and form a cavity after a while.

A cavity in a wisdom tooth can be repaired by placing a filling as is normally done with other teeth. Some dentists will not fill a cavity in a wisdom tooth period or only in certain circumstances. This is because the decay found on the tooth might be in an awkward location.

If a wisdom tooth with a cavity is filled, another cavity can form adjacent to an existing filling, especially if the tooth is hard to clean.

4. Cysts/Tumor Development (Pericoronitis)

A fluid sac may form around an impacted tooth, and the sac may grow into a cyst, which can cause permanent damage to healthy teeth, jawbone, and bones. Rarely a tumor may develop, which can require removal of tissue and bone.

When a wisdom tooth does not come out fully emerege through the gums and into its proper position (meaning partially erupted) this can create an extension of gum called an operculum. This operculum can be irritated and infected leading to pericoronitis which means that the bacteria in the dental plauge has an active infection.

The signs of pericoronitis are tenderness and swelling in the gum tissue surrounding a wisdom tooth.

There can also be an unpleasant mouth odor, severe pain, and a bad taste coming from the infected area. Usually a dentist will show you how to flush out the space between the tooth and gum, where the infection is, and give you antibitoics.

If the wisdom tooth is impacted, pericoronitis will often come back after it has cleared up. Under the right conditions when an operculum is present and if the wisdom tooth has already erupted, it is possible to make an operculectomy, which is the removal of the extension of the gum without extracting the tooth.

5. Additional Considerations

One or more of your wisdom teeth may come in at an awkward angle, with the top of the tooth facing forward, backward, or to either side. A wisdom tooth may even remain trapped beneath the gum and bone. .

If you need orthodontic treatment and need to get braces, keeping your wisdom teeth may affect the treatment

If your jaw is not not wide enough your wisdom teeth may erupt in an alignment that can cause problems with the way you chew food.

References
1. MayoClinic. Impacted Wisdom Teeth. Accessed July, 2008.
http://www.mayoclinic.com/health/wisdom-teeth/DS00679/DSECTION=treatments-and-drugs
2. Friedman JW. The prophylactic extraction of third molars: a public health hazard. Am J. Public Health 2007;97:1554-1559.
3. Jeannette Curtis, Healthwise. Written September, 2007.
http://www.webmd.com/oral-health/wisdom-tooth-extraction
4. American Association of Oral and Maxillofacial Surgeons. White Paper on Third Molar Data.
Written March 2007. http://www.aaoms.org/docs/third_molar_white_paper.pdf
5. WMDS, Inc. Impacted Wisdom Teeth. Accessed July 31, 2008.
http://www.animated-teeth.com/wisdom_teeth/t2_wisdom_tooth_extraction.htm
6. Flickr.com. Image by samfeinstein. http://www.flickr.com/photos/samfeinstein/1349509551/
7. Dr. Anto Youssef, Studio Dentaire http://www.studiodentaire.com/en/treatments/wisdom_teeth.php#expression