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Toothaches and Dental Wisdom Teeth (Third Molars)


Dr Ramzi Matar (Winter Park Dentistry):

Hello, and welcome to this episode of our podcast. Today’s episode we’re going to revisit the topic of wisdom teeth. Wisdom teeth are source of a lot of emergencies, a lot of emergency dental care, late night phone calls, late night tooth aches and every dentist knows that wisdom teeth are somewhat controversial in the sense that a lot of patients don’t want to take them out, they feel like it is a waste to take them out, because they’ve known people that have had their wisdom teeth all their life, and they feel reluctant to put themselves through surgery.

There is a journal, Oral Surgery Update, and this is from the Spring 2015, it is now May of 2015, so still pretty accurate information. This journal article dissects the most common causes of wisdom teeth removal. Which one are emergencies, and why we take them out, and what percentages of people are able, a question I get asked often is “how do I know if I need to get them out”, or “when do I need to get them out?” or “do I need to get them out?”, and of course there are some things we just don’t know. We can look for evidence, look for problems, but sometimes you don’t, and a lot of times we recommend removing them as patients are in their teenage years, which is when people are considered to gain wisdom.

Here’s how this article broke down the reasons for removing these teeth. It broke down in different groups, Group A, B, C and D. I’ll explain briefly what each is group is. Group A is when wisdom teeth had both symptoms and disease was present, so those are two delineations. Symptoms mean the patient was feeling something, this is the typical dental toothache, dental emergency, so symptoms were present, and disease was present, which means there was  an actual clinical reason for it, such as an abscess or infection, or maybe a cavity, or inability to clean the area, gum disease… So again, symptoms and disease were present, that was Group A. Most commonly we see this in dentistry as what’s called pericoronitis, people tell us it’s usually the lower wisdom teeth, they’re very back, gums start to get infected, and the patients bite down. This is a lot of times when you have a wisdom tooth that’s partially coming out and the gums around there swell up, so it’s get packed underneath there and it’s difficult to clean around that tooth. As the swelling gets bigger, it’s hard to bite down, because now you’re biting down on the infected gum, and it’s just a snowball effect and they come in as a toothache, as a dental emergency, and it’s called pericoronitis. Anybody watching this can easily go google search that.

Group B is symptoms are present and disease was absent, which means people are having pain, they say “well, gee, it hurts every once in a while”, usually it’s when I see people at their cleaning appointment, they go “yeah, it hurts for a couple days, and then it stops hurting”. When you look at the X-rays, you see a wisdom tooth there, and often times it’s sideways or something, but it’s not a particular cavity, there’s not gum disease yet, there’s not any clinical symptoms but the patients are having some sort of vague posterior pain. We call it atypical pain, which means it’s not typical obviously.

And then Group C. You had symptoms absent but disease present. This is the one that us dentists are always telling patients to get them out, but the patients kind of don’t want to, for obvious reasons, they don’t want to go through surgery. They take an X-ray, and we see a cavity, and we see gum disease developing, a lot of times there’s gum disease on, in and around the wisdom tooth, especially when it’s up against the molar, which is the tooth in front of there. A lot of times we take a panoramic x-ray, which is a sort of an x-ray that goes around your entire head, anybody who’s had it done, they usually remember it, you can see the entire mouth, including the jaws and all the structures around the teeth. We can see cysts on there, so typically it’s cavities, cysts and gum disease. A lot of times these can be pain free, I’ve seen patients that have giant cavities on the tooth in front of the wisdom tooth, one that I for sure think would be painful, and I think the patients would have no idea what’s going on… Unfortunately patients a lot of times defer this, because they’re not feeling anything, and they don’t want to go through the surgery, and life gets busy as for everybody, so it’s very easy to defer this. These three groups, I want to summarize briefly, because these three groups make up 90% of people’s wisdom teeth. Which means, when somebody asks “how do I know if I have to get them out?”, well this study suggests that 90% of the population, for this study, will need their wisdom teeth out for one of these three reasons.

Then you have group D, which means symptoms are not present, and disease is not present. And this is basically the healthy wisdom teeth, these are the ones that are in, have no cysts, no gum disease, no cavities, and are not affecting the teeth around them. And this makes up about 10% of the population. And I find that to be pretty accurate, because of the people, patients of mine that have wisdom teeth, I’d say 90% have some sort of a problem. A lot of times they’re in Group C, which means they are asymptomatic, no symptoms, but there is a disease, gum disease, periodontal pocketing, this is the thing that if you’ve ever been to dentist means “measure your gums”, and this is a number that’s a 5, or a 6, or a 7, and the higher numbers, we usually want 3 millimeters or less for healthy gums, occasional fours are not unusual in healthy mouths, but when you get to the 5s and 6s and 7s… 10% of my patients I think do exhibit healthy, symptom-free, disease-free wisdom teeth, but again that’s 10%. 90% do have problems. 90% will have problems, if it’s not currently, then maybe in the future.

Certainly wisdom teeth removal is much much easier the younger you are. At 18 years old, you take out your wisdom teeth, three days later, four days later, you’re back up and going to school. In your 40s, and 50s and 60s, boy, it’s tough… 70s and 80s, man, surgeons generally do not like doing those surgeries because you’re in for several weeks of problems and healing, four or five weeks I’ve heard, many weeks of problems and it’s just a much bigger deal, the older you get.

To summarize, if you’re a patient out there, and your dentist told you to get your wisdom teeth out, here are some cold heart facts that will help you make a decision. Ultimately we recommend what we think is best, and patients are to make whatever decision they want… Most of the time, I do have patients go to an oral surgeon, that’s a dental specialist, and I typically do recommend they be put to sleep, because it’s generally a more comfortable procedure, when you don’t remember it. They can do it without putting you to sleep but often times it’s just not as comfortable with the surgery itself. I hope everybody enjoyed this podcast, there’s more to come, thank you.