Is it Wise to Remove My Wisdom Teeth?

Is it Wise to Remove My Wisdom Teeth?

Wisdom teeth, also known as third molars, are the last set of permanent teeth to erupt, usually between the ages of 18 and 21. Although known as the “wisdom teeth”, these teeth are unfortunately not very smart; because of their tendency to grow in the wrong direction, they become impacted and cause a lot of problems in the process.

In recent years, it has been observed that more and more young adults are presenting with at least one impacted wisdom tooth, and although the exact cause is not known, it has been speculated that our modern diet has resulted in smaller jaws which cannot accommodate all our teeth. Consequently, the wisdom teeth do not have enough space to erupt properly and will become impacted. In Singapore, one study showed that almost 70% young adults between the ages of 20 and 40 have at least one impacted wisdom tooth1.

 

Types of Wisdom Teeth Impaction

Types of Impaction

Problems of Impacted Wisdom Teeth

  • Food trapping and difficulty in cleaning.
  • Bad breath.
  • Gum pain and infection.
  • In severe cases, facial swelling or swelling of the throat (potentially life-threatening condition known as Ludwig’s angina).
  • Decay and subsequently pain. The decay can form on the wisdom tooth itself, the tooth next to it (second molar), or both.
  • Cheek biting and ulcer formation.
  • Resorption of the second molar.
  • Cyst formation.

Problems caused by impacted wisdom teeth

 

Partially-erupted Wisdom Tooth

Partially-erupted wisdom tooth with an inflammed gum flap, known as pericoronitis.

Decayed impacted wisdom tooth

Decayed impacted wisdom tooth.

X-ray of decayed tooth caused by wisdom tooth

An X-ray of an impacted wisdom tooth causing a large decay (which appears darker) on the second molar, highlighted by the red circle.

root resorption of second molar

This X-ray of our patient shows a root resorption of the second molar, as outlined in red, which was caused by an impacted wisdom tooth.

severe resorption of second molar

An X-ray image of another patient, showing severe resorption of the second molar. The second molar cannot be saved and has to be removed together with the offending wisdom tooth.

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To Remove or Not To Remove? That Is the Question

It’s always best to see a dentist for an examination first before deciding if your wisdom teeth need removal. Radiographs or X-rays are also necessary as sometimes the wisdom teeth lie just beneath the gums and cannot be seen in the mouth.

panoramic x-ray showing impacted wisdom teeth
The panoramic radiograph above shows a patient with 4 wisdom teeth, 3 of them impacted. The upper right wisdom tooth with the red circle is not visible in the mouth, while the lower right and left (green arrows) are partially erupted. All 3 will need surgical removal.

If you are one of those lucky few whose wisdom teeth are all fully erupted and at the correct angulation, then there is no need for you to have any of them removed unless they are decayed or difficult to maintain.

fully-erupted wisdom teeth

Fully-erupted wisdom teeth which do not require removal.

If your wisdom tooth is deeply buried (fully encased in bone), it may not be necessary to remove it since it will not cause food trapping (which leads to gum infection and decay). However, due to its potential to turn into a cyst (an expanding fluid-filled pathology which erodes into the neighbouring bone and teeth), it is recommended that the tooth be monitored with regular X-rays.

If your wisdom tooth is partially erupted, it will remain so and is at high risk of developing symptoms; hence, it is recommended that you have it removed sooner rather than wait for it to become painful.

Should you remove problematic wisdom teeth before having any symptoms such as pain and swelling?

Yes, you should! Waiting for the wisdom teeth to start bothering you is actually not a good idea. There are two very good reasons to justify prophylactic removal of wisdom teeth:

  • Removal when you are younger usually means an easier surgery (as younger patients have softer bone) and faster recovery (better healing thanks to the power of youth).
  • When there is infection and swelling, removal becomes very painful as the tissues are very sensitive and sometimes anaesthesia does not work as effectively in the presence of infection and pus.
Decayed Wisdom Tooth

Impacted wisdom tooth which traps food and should be removed as soon as possible.

Should you decide to remove a lower impacted wisdom tooth, we sometimes recommend that you remove the upper wisdom tooth at the same time, even if it is not impacted, as leaving it will allow it to over-erupt and it will come into contact with the lower gums when you bite, leading to ulcers, cheek biting and pain. Also, the tooth is non-functional since it does not have an opposing tooth and may be challenging to clean.

Upper wisdom tooth

upper wisdom tooth

Upper wisdom tooth which is not impacted but is causing pain by impinging on the lower gums.

 

Removal under Local Anaesthesia vs General Anaesthesia

Most wisdom teeth surgery can be done under local anaesthesia. This means a chair-side procedure where the surgical area is first numbed up and the tooth removed while the patient is awake. After the surgery, the patient does not need to be accompanied home as there are no drowsy side-effects. If you are having the lower wisdom tooth removed under local anaesthesia, you can consider removing the upper wisdom tooth at the same time. That way, you can still chew on the unaffected side while you recover.

However, if you have 2 to 4 impacted wisdom teeth and you are very nervous about the surgery, you can opt for general anaesthesia, where you will be put to sleep for the entire duration of the surgery (technically, one is not asleep during general anaesthesia but unconscious). However, you can only have this done at facilities equipped with life support and resuscitation devices, and that would mainly be at hospitals. Additionally, be prepared to pay an additional $800 to $1000 on top of the surgical fees, in order to cover for the anaesthetist and operating theatre fees; you will also need to be accompanied home as you will be suffering from drowsiness and sometime nausea after the surgery.

Generally speaking, normally only 1 to 2 wisdom teeth on the same side is removed under local anaesthesia, whereas under general anaesthesia, all wisdom teeth should be removed at the same time. So do expect a longer downtime of around 8 days of medical leave after general anaesthesia, as opposed to 5 to 7 days medical leave for local anaesthesia, and a longer period on a soft diet as both sides would be sore and swollen after the surgery.

Table of LA vs GA

Can I Utilise Medisave for Wisdom Tooth Surgery?

If your wisdom tooth is fully erupted and can be removed without any surgical intervention, then this is considered an extraction and you cannot use your Medisave funds to pay for the extraction.

However, if your wisdom tooth is not fully-erupted, or is positioned underneath the gum or in the wrong direction (considered impacted), where surgery is required to expose the tooth completely and to remove the tooth, then yes, you may utilise your Medisave funds (or that of your spouse’s, parent’s, child’s or sibling’s, with their consent) to pay for the surgery, as well as any medications, consumables and radiographs taken on the day of the surgery.

If you suspect you have one or more wisdom teeth that are bothering you and would like to know if they need to be removed, you can request an appointment with us by clicking here or on the button below:

Request a Wisdom Tooth Consult with Us.

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