The Tribune

By ALESHA CADET

Tribune Features Reporter

acadet@tribunemedia.net

EVER wondered why the third molars are called “wisdom teeth”?

If you were hoping that your wisdom teeth growing in might finally make you a little bit wiser, you are unfortunately out of luck, said local Dr Shamika Strachan, president of the Bahamas Dental Association.

These specific teeth, she explained, got their name because they develop later in life, usually between the ages of 18 and 25.

Wisdom teeth are the third adult molars to grow and break through the gums; meaning, in each section of the mouth – the mouth is divided into four quadrants – there are three molars: a total of 12 altogether. The last set of those three molars are the wisdom teeth.

Dr Strachan said while children normally have two baby or primary molars in each quadrant, adults have three. She said one fun fact is that baby molars are not replaced by adult molars. When a primary molar exfoliates or falls out, it is replaced by a permanent adult premolar, also known as bicuspids.

“All teeth have a function. As many would have learnt in elementary health science: incisors are for cutting food, canines (eye teeth) for tearing food, premolars to crush food, and molars to grind. So, like any other molar, wisdom teeth are supposed to function as a grinder,” said Dr Strachan.

Unfortunately, she said, by the time the “Johnny come lately” third molar comes into the mouth, all of the other adult permanent molars have already occupied most of the space, leaving very little room for the wisdom tooth to erupt, if at all. This is particularly the case in individuals with smaller jaws or perhaps larger teeth.

“Wisdom teeth may also erupt after another tooth anterior is extracted for whatever reason as more space would be available. The ability of the wisdom tooth to erupt upright depends in the direction it was impacted (unable to come out because it is positioned against another tooth, bone, or gums). Many people have wisdom teeth, but as stated above, they could be impacted and therefore not visible in the mouth. Often times these teeth are detectable on dental X-rays. For some, however, the wisdom teeth never develop. The third molars, along with the lower second premolars and the upper lateral incisors, are the most common teeth that fail to develop; they are called hypodontia,” said Dr Strachan.

Anthropologists believe wisdom teeth were essential for our ancestors, who consumed hard-to-chew foods like nuts, roots and meats – mostly uncooked – that required immense jaw strength to break down in bits small enough to swallow and digest.

During our ancestors’ development, however, the human brain grew, which caused the jaw to narrow. This is also attributed to the availability of cooked, chopped and soft foods.

Wisdom teeth are essentially no longer needed, and are considered vestigial organs along with the appendix and tonsils – organs and structures that have lost all or most of their original function through evolution.

While many people do not have the necessary space for wisdom teeth and suffer dental problems and pain because of them, some have no issues with them and do not require removal.

“One school of thought is the preventative ideology, which says take them out while the individual is in their mid-teens. It is thought is that the risk is lower, the bone is less dense, lifestyles are more flexible, the patient is under the care of their parent guardian and there is less chance of developing other oral complications such as periodontal problems,” said Dr Strachan.

“Others, like myself, were trained to watch and remove the tooth as the need arises. A guide used to determine when it’s the correct time to extract the tooth is also the frequency of something called pericoronitis: inflammation around the crown of a partially erupted tooth. If a person develops this complication three times within a year, then I would recommend an extraction. Other measures may be used to prevent accumulation of plaque and food in the hard to reach areas of the third molars.”

Proper brushing, she added, is recommended to minimise debris from building up.

If food and plaque accumulate within the operculum (gum flap) around a wisdom tooth, pericoronitis may develop. The gums then become red, inflamed and very tender. Some people even develop a fever and have difficulty swallowing and chewing. For severe cases, antibiotics are prescribed along with irrigation of the gums as an emergency management. The patient can then return for an extraction or operculectomy.

Operculectomy is the surgical procedure of removing the gum flap that partially covers a tooth, but Dr Strachan said as not all wisdom teeth are created equal, not all patients are candidates for this procedure. She believes an individual’s dentist is the best person to make the determination.

“The second most common complication that arises if a wisdom tooth is not removed is bone loss and tooth decay. Not only is the wisdom tooth further compromised, but many times the tooth immediately in front of it, the second molar, may develop decay or bone loss at the back (distal). Often times if one waits too long to have a wisdom tooth removed that is recommended, they end up losing two molars,” she said.

Most times it is recommended to have all four wisdom teeth removed during one appointment. Alternatively, two on the same side of the face, upper and lower, can be removed on two separate visits to the dentist.

Many factors are considered to determine what’s best for the individual, including position of the wisdom teeth, medical complications, finances and patient flexibility, vacation/sick leave et cetera, said Dr Strachan.

Aftercare

After removal, a complication that can occur is the s-called “dry socket”.

Dr Strachan said a dry socket, also known as alveolar osteitis, is a painful oral complication that may occur after any permanent adult tooth is extracted, not necessarily just a wisdom tooth, though most often due to the possible complexities of extracting these teeth. She said dry sockets develop when a blood clot at the site of the tooth extraction does not form, or it dislodges or disintegrates before the wound has healed.

“What’s really dry,” Dr Strachan said, “is the bone where the tooth was removed from, causing inflammation within the bone which is very painful.”

“After a dental extraction, it is critical to follow all of the post-operative instructions given by your dentist. Any anti-inflammatory painkiller such as Motrin, Ibuprofen, Aspirin or Cataflam will help to reduce pain. Some feel that Tylenol works better, however, Tylenol is not an anti-inflammatory, so for the purpose of pain relief for an impacted wisdom tooth it’s not my first go-to,” she said.

“Antibiotics may also be prescribed on a case-by-case basis. However, medical history, pregnancy and allergies would determine what painkiller or medication is best. Ask your dentist or pharmacist before taking any medication. Home care such as saltwater rinses may help or flushing the gums at home if the equipment was made available by your dentist.”