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Wisdom Tooth Extraction

Third molars, commonly referred to as wisdom teeth, are the last teeth to erupt in the oral cavity, typically between the ages of 17 and 25. The decision to extract or retain wisdom teeth must be evaluated individually for each patient.

If a wisdom tooth has erupted in a proper position, does not damage adjacent structures, and can be adequately cleaned, it may be retained without concern. According to current approaches, healthy and well-positioned wisdom teeth may even be preserved due to their potential future value in stem cell research.

However, wisdom teeth may remain tilted, horizontally positioned, or impacted within the jawbone. When insufficient space exists in the dental arch, eruption may be incomplete, resulting in partially or fully impacted teeth that may pose future risks and require extraction.

Indications for Wisdom Tooth Extraction

Dental Caries:

Plaque and bacterial accumulation around partially erupted wisdom teeth increases the risk of caries and infection in both the third molar and the adjacent second molar. Detection and treatment of caries in this region are challenging, and pain, abscess formation, or swelling may occur.

Pericoronitis:

Inflammation may develop beneath the gingival tissue covering a partially erupted tooth. Symptoms include pain, swelling, halitosis, and limited mouth opening (trismus). Infection may spread to facial and cervical regions, and recurrent episodes often necessitate extraction.

Pressure-related pain:

An erupting wisdom tooth may exert pressure on adjacent teeth, causing pain and contributing to tooth wear or crowding.

Orthodontic considerations:

Eruptive forces from wisdom teeth may contribute to relapse and crowding following orthodontic treatment, prompting extraction recommendations.

Prosthetic planning:

The presence of wisdom teeth must be evaluated during prosthetic treatment planning, and extraction may be required to optimize prosthetic outcomes.

Cyst formation:

Impacted teeth may be associated with cyst development, leading to bone loss, jaw expansion, tooth displacement, and, rarely, neoplastic transformation. In such cases, extraction and cyst removal are indicated.

Why Extract Poorly Positioned Wisdom Teeth Even Without Symptoms?

·         The posterior region is difficult to clean, increasing caries and infection risk.

·         Bacterial accumulation may cause persistent halitosis.

·         Horizontally impacted teeth can exert pressure on adjacent teeth, leading to malalignment.

·         Subgingival bacterial retention may cause recurrent infections.

Therefore, if clinical and radiographic evaluation indicates a high risk of future complications, extraction may be preferred over periodic monitoring.

Optimal Timing for Extraction

Extractions performed at younger ages are generally easier and associated with faster healing. After the age of 40, increased bone density and reduced elasticity may complicate surgery and prolong recovery.

Can Extraction Be Performed During Acute Infection?

Extraction is generally not recommended during acute pericoronitis. In such cases, infection control with antibiotics and antiseptic mouth rinses is prioritized, and extraction is planned once acute inflammation subsides.

How Does Wisdom Tooth Extraction Differ from Other Extractions?

The difficulty of extraction depends on tooth position, root morphology, and bone density:

·         Simple extractions may involve mild swelling, pain, and bleeding.

·         Surgical procedures may be required in some cases.

·         Rarely, dry socket (alveolar osteitis) may occur, causing pain due to clot loss; appropriate treatment typically resolves symptoms within a few days.

·         Healing may be slower in older patients.

Adherence to postoperative instructions significantly reduces the risk of complications.

Postoperative Care Recommendations

·         Avoid disturbing the surgical site.

·         Do not chew on the extraction side for the first 24 hours.

·         Refrain from smoking (delays healing and increases bleeding risk).

·         Avoid spitting or using straws (may dislodge the blood clot).

·         Apply gauze pressure for 30 minutes if bleeding occurs; repeat if necessary.

·         Cold compresses may help reduce swelling (20 minutes on, 10 minutes off).

·         After 24 hours, gentle warm saline rinses may be used (patients with hypertension should exercise caution).

If necessary, the dentist may prescribe medications and provide additional care instructions.