Wisdom teeth are probably the most variable and problematic teeth to form in the human dentition. In fact, many times wisdom teeth don’t form at all and are the most common of teeth to be absent from mouth (followed by the upper lateral incisor). It’s when wisdom teeth are present that problems can arise most often leading to the need for extraction.

Wisdom Teeth – The Third Molars

Wisdom teeth are actually third molars and are the last teeth to develop and appear in the mouth, generally between the ages of 17 and 25. Hence the name wisdom teeth for they arise during the “Ages of Wisdom” (but don’t tell your teenage kids that for they just may try to “outsmart” you with their newly found intellect).

Oftentimes, wisdom teeth erupt fully into the oral cavity where they’re meant to be, and they function and behave like any other molar. Molars are the large back teeth upon which most of the motion and machination of mastication occurs. They literally pulverize and grind your food to make for easier digestion.

Our Stone Age ancestors (remember we were once hunters and gatherers) had a tougher, more fibrous diet requiring larger more powerful jaws and greater tooth surface to ruminate otherwise indigestible cellulose (think of cows chewing grass). As we evolved, our diets changed (softer) and so did our bone structure. Our jaws got smaller and the third molars were crowded out over many millennia, which leads us to the heart of the problem with most wisdom teeth: not enough room!

A less Darwinian explanation for the lack of space for those pesky molars is simply that one can inherit small jaws from one parent and large teeth from the other. The end result of this tooth/jaw size discrepancy can result in partially erupted or impacted wisdom teeth. Tooth/jaw size mismatches also explain why orthodontic treatment is often necessary to correct a crowded dentition.

An impacted wisdom tooth is a third molar that has not erupted fully into place and through the gum-line. There are different classifications describing impactions. A full boney impaction is when a wisdom tooth is fully encased within the jawbone. A soft tissue impaction is when the tooth has emerged from the jawbone but is still covered by the gum. There are also degrees of impaction where a tooth can be partially impacted within the gum or bone.

Perhaps the most troublesome situation involves the incompletely erupted wisdom tooth that is also partially impacted. Partial exposure to the oral environment, even just a little tooth peeking through the gum, is like the tip of an iceberg and can lead to disaster. Tooth decay, periodontal problems, and acute infection can develop on and around the tooth beneath the gum and lead to damage of its more important neighbor, the second molar. In this scenario, extraction is often necessary.

But don’t despair! Not all wisdom teeth require treatment. In fact, there is ongoing debate whether fully impacted asymptomatic wisdom teeth should be extracted at all. Some experts recommend leaving these hidden pearls alone and just examine them periodically to detect the possible development of cysts, tumors or other pathological changes.  As mentioned before, third molars that erupt “normally” often only require routine care. And, about 25% of the population is completely lacking one or more of their wisdom teeth!

Wisdom teeth are thought to be on their way out as we continue to evolve as a species. Who knows, 10,000 years from now, they may actually be a thing of the past. In the meantime, evaluation for the presence of un-erupted or partially erupted wisdom teeth as well as careful monitoring of them is of paramount importance to ensure good oral health.

As the saying goes, “A word to the wise is sufficient.”

It’s 5pm. Do you know where your wisdom teeth are?  Make sure you have them checked out.

Photo Credit: http://www.fairview.org/healthlibrary/Article/89767

Dr. Michael Sinkin is a NYC dentist that has been in practice for over two decades. He truly cares about the experience his patients have and takes great pride in making them feel relaxed and comfortable during every visit. Come in for an appointment and experience a different kind of dental practice. To find out more about Dr. Sinkin, please click here.