Why do impacted wisdom teeth need to be extracted?
The precise reasons why an individual's wisdom teeth might need to be extracted should be explained to them by their dentist, after an examination which almost certainly will need to include dental x-rays. While each person's situation will be unique, some of the more common topics dentists discuss when they describe to a person why their wisdom teeth should be removed are listed below.
The rationale associated with the first group of reasons given here is based on the fact that wisdom teeth, either partially or fully erupted, are often very difficult to clean. (The term "erupted" used here means that the wisdom tooth has, at least to some degree, penetrated through the gums.)
Any location in the mouth where plaque is allowed to accumulate and persist, such as around a partially erupted wisdom tooth, a person will run the risk of developing dental problems such as tooth decay ("cavities"), periodontal disease ("gum disease"), or recurring infections. Typically it is the partially erupted impacted wisdom tooth that is more unpredictable or troublesome for a person than an impacted wisdom tooth that has never penetrated through the gum tissue.
Recurring pericoronitis.
One condition that can occur, often repeatedly, when wisdom teeth are impacted is pericoronitis. The term pericoronitis refers to an infection located in the tissues that surround a tooth that has not fully emerged through the gums and on into its proper position (this type of tooth positioning would be termed "partially erupted").
Gum tissue is attached at pretty much the same level on all teeth. This means that if just a portion of a wisdom tooth has poked its way through the gums an opening will have been created that connects the space that lies between the gums and the crown of the submerged wisdom tooth and your mouth. (The "crown" portion of a tooth is the "non-root" part, the portion of a normally positioned tooth that is visible above the gum line. Gum tissue is never attached to the crown portion of a tooth.)
Dental plaque will accumulate in this hidden space and, unfortunately, there is no way for a person to effectively clean it out. As a result, from time to time the bacteria contained in the dental plaque can cause an active infection, which then spreads to the tissues surrounding the wisdom tooth. Dentists give the name "pericoronitis" to this type of infection.
The signs of pericoronitis are tenderness and swelling in the gum tissue surrounding a wisdom tooth. There can also be severe pain, an unpleasant mouth odor, and even a bad taste coming from the infected area.
Persons who have pericoronitis should be seen by their dentist. In most cases a dentist will place a patient on antibiotics and, if possible, show them methods by which they can flush out the space between the tooth and gum (the area that harbors the bacteria causing the infection).
Even wisdom teeth that are destined to eventually erupt on into proper alignment will go through a transitional period where they are only "partially erupted." This is because it takes some time for a tooth to fully penetrate through the gums and achieve its final positioning. During that time frame when a wisdom tooth is only part way through the gums it is at risk for developing pericoronitis.
A dentist who evaluates a patient when pericoronitis is present will need to determine whether the pericoronitis seems to just be associated with a transitional phase of the normal eruption process of the wisdom tooth or if the wisdom tooth is impacted, and therefore it is likely that pericoronitis will be a recurring phenomenon. In the later case, extraction of the offending wisdom tooth is usually indicated.
New or recurrent tooth decay in the wisdom tooth.
Cavities get a chance to form in teeth when dental plaque is allowed to remain on a tooth's surface for prolonged periods of time. If the position of a wisdom tooth is one where you are not able to clean it thoroughly, then the tooth will be at risk for developing decay.
If tooth decay does form in a wisdom tooth the tooth often can, just like with any other tooth, be repaired by way of placing a filling. This would be especially true in those cases where the amount of decay is readily accessible and small. However, sometimes a dentist will advise against filling a wisdom tooth. As an example, the decay found on the tooth might be in such an awkward location that the dentist does not feel that they can access that part of the tooth adequately so to place a filling. As you can well imagine, if a tooth has been hard for you to clean with a toothbrush and floss it is likely your dentist will have the same problem of access also when using their tools.
Even if a filling has been successfully placed, if a wisdom tooth still cannot be cleansed properly and plaque is allowed to continue to accumulate on its surface it will still run the risk of developing recurrent decay. The term "recurrent decay" simply means that a new cavity has formed on an aspect of a tooth adjacent to an existing filling. For all of these reasons given, if a tooth can't be cleansed properly and a cavity has formed it is quite possible that the best, and possibly even the easiest and cheapest, solution is to have the tooth extracted.
New or recurrent tooth decay in a wisdom tooth's neighboring tooth.
Poorly aligned wisdom teeth can possess a positioning that creates a trap for plaque and debris between the wisdom tooth and the next molar forward (the 2nd molar). If this debris trap is not cleansed regularly and thoroughly, not only is the wisdom tooth placed at risk for developing decay but so is the 2nd molar. The worst case scenario in this type of situation is that decay will form on both teeth and it will advance to such a great extent that both the wisdom tooth and the 2nd molar will need to be extracted.
Periodontal disease ("gum disease").
Whenever a tooth cannot be properly cleansed (brushed and flossed), the bacteria found in the dental plaque that accumulates on and around the tooth can lead to the formation of periodontal disease ("gum disease"). If allowed to advance, periodontal disease can significantly damage not just the gums but also the bone surrounding the tooth. Enough damage can occur that the tooth may need to be extracted.
It may seem a bit of a conundrum that a dentist will recommend the removal of a wisdom tooth now just so you won't develop periodontal disease around it and subsequently have to have the same wisdom tooth extracted later. What you need to realize however is that a portion of the gum tissue that surrounds a wisdom tooth is the same tissue (and bone) that abuts the backside of the next molar forward (the 2nd molar). Gum disease is not an isolated event that occurs around an individual tooth, it also affects a tooth's neighboring teeth. It would be a shame to damage or lose a valuable 2nd molar simply because a wisdom tooth you could not clean properly was not extracted.
Topic Index for :
Impacted Wisdom Teeth
