Additional reasons to remove wisdom teeth.

- Pain, pressure, headaches, cysts, tumors, soft tissue trauma, 2nd molar root resorption.

This page outlines additional reasons why your dentist might determine that your wisdom tooth needs to be removed. This includes:

 

If you don't see the specific topic you're seeking listed above, this menu leads to additional pages explaining other reasons why third molars are extracted.

Or after you've finished reading this page, you may find our related one titled "Is it always necessary to remove impacted wisdom teeth?" of interest.


Reasons to extract third molars -

A) Wisdom teeth that cause pain.

  • The most common reason why people seek an evaluation of their wisdom teeth is because they've recently experienced a painful episode.
  • Having pain is the most common third molar symptom. 33% of patients who experience problems report having it. Pogrel (2007) [page references]
The discomfort may be nebulous in nature.

It's not uncommon for a patient's symptoms to be vague or indistinct. The pain or sense of pressure noticed may be generally associated with the region of a third molar but not centered directly on it.

Sources of 3rd molar pain / pressure / headaches.

Obviously it's the dentist's goal to be able to directly attribute their patient's discomfort to events taking place with their wisdom teeth. Some likely circumstances include:

a) The tooth's eruption process.

It's possible that the discomfort a person notices with a wisdom tooth is associated with the process of it coming in (its "eruption"). If so, what's experienced may either be intermittent or of constant duration. Patients sometimes describe what they feel as a vague sense of pressure.

b) Additional causes.

It's more likely that a person's discomfort is due to some other type of wisdom tooth-related issue. This could include most any of the conditions or situations discussed either below or on our previous page.

c) Pressure on adjacent nerves.

In rare cases, an impacted lower wisdom tooth may place pressure on the nearby inferior alveolar nerve (the major nerve of the lower jaw). This may cause intermittent pain, a general sense of pressure or even headaches. (Haq 2002)

d) Pain of unknown origin.

There can be situations where the pain or pressure felt by the patient certainly seems to be centered on the region where an impacted wisdom tooth lies. But due to the absence of obvious pathology, the dentist can't be certain that the tooth itself lies at fault.

  • If there are no absolute contraindications for removal, these teeth are sometimes extracted. If so, the patient must understand that pain relief may not be achieved and ultimately the procedure they endured unnecessary.
  • In other cases the patient and dentist may determine that the best plan of action involves the implementation of palliative treatment (possibly including the use of a prescription pain reliever) and then further monitoring until a diagnosis can finally be made.

Non-odontogenic conditions.

This second approach can be a good one. Indistinct symptoms involving pain, pressure sensation or headaches are sometimes ultimately attributed to non-tooth conditions.

One common one is tempromandibular joint (jaw joint, TMJ) dysfunction or the spasm of its associated muscles. This scenario is especially likely if the person has a habit of clenching or grinding their teeth. It's also possible that a medical condition (migraine, cardiac, vascular or neuropathic pain) is the underlying problem.


B) Poorly positioned wisdom teeth.

Some wisdom teeth manage to erupt but nevertheless have a positioning that causes, or has the potential to cause, problems. For example:

Tissue trauma and associated wisdom tooth.

Trauma to both flap and cheek tissue in the area of a 3rd molar.

a) Crooked teeth.

Teeth whose final positioning is tilted or angled may poke, scrape, crush (bite) or otherwise irritate adjacent cheek or gum tissue. For the most part, the only solution that exists is to extract the offending tooth.

Chronic tissue trauma may cause hyper-keratinization (like the line of dense tissue that makes up the white streak on the inside of the cheek in our picture).

b) High gums or gum flaps.

Gum tissue that creates a tall collar around a third molar, or lies as a flap over its chewing surface, may constantly be traumatized by hard foods or opposing teeth.

This may cause the tissue to become chronically inflamed (reddened, sore and swollen, like the "flap" tissue in our picture).

In some cases, the excess tissue can be successfully trimmed away. In others, it may tend to grow back over time. (It depends on the tooth to jawbone relationship that exists.) If your dentist determines that the latter is the likely outcome for your situation, then the tooth will need to be extracted.

c) Supererupted third molars.

Wisdom teeth that don't have an opposing tooth to bite against often supererupt (poke through the gum tissue further than normal).

These teeth may cause tissue irritation or trauma. Their abnormal positioning may interfere with jaw movements, or create traps between teeth where food and debris tend to accumulate. Teeth having this problem should be extracted.

d) Teeth that are hard to clean.

Some wisdom teeth occupy a position that makes them very difficult to brush and floss. If so, both they and their neighboring tooth are placed at increased risk for complications with tooth decay and gum disease. And for that reason, they should be removed before problems develop.


C) Cysts and tumors.

While they're not an especially common occurrence, cysts and tumors can develop in the tissues around an impacted wisdom teeth.

A dental cyst associated with an impacted wisdom tooth.

They're frequently associated with the developmental tissues that have formed the tooth. And as they grow in size, they may cause damage to surrounding bone, nearby structures such as adjacent teeth or cause a distortion of the jawbone.

If pathology is observed (in early stages, this is frequently via the use of x-ray examination), the associated tooth should be removed and its cyst or tumor evaluated by a pathologist.

Monitoring impacted wisdom teeth.

In cases where a decision has been made not to remove a person's impacted wisdom tooth, it should be evaluated periodically via x-ray examination. Doing so allows the dentist to compare current and previous films, in search of changes that may indicate that a cyst or tumor is forming.


Impacted wisdom teeth can cause root resorption on neighboring teeth.

Misdirected eruption can trigger resorption of adjacent teeth.

D) Root resorption of neighboring teeth.

The attempted eruption of a misdirected impacted wisdom tooth can cause damage (root resorption) to a person's 2nd molar. Fortunately, this is an uncommon occurrence.

This event is somewhat similar to what happens with baby teeth. When they fall out, they look as though they don't have a root. That's because as the permanent tooth underneath erupted, its presence caused the baby tooth's root to dissolve away.

In similar fashion, when a misdirected wisdom tooth attempts to erupt, its pressure can cause resorption of the rear root of the 2nd molar. The worst case scenario in this type of situation is one where the offending wisdom tooth and the damaged 2nd molar will both have to be extracted.

 

 
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