Inflamed wisdom tooth: this is a topic that always generates a lot of discussion! The name wisdom tooth comes from the fact that it erupts between the ages of approximately 18 and 22, a period when young people reach maturity (or at least should, hehe!).
Human teeth consist of 32 teeth. The last tooth to erupt (come in) and which appears as the last tooth on each side is the third molar. It is the eighth tooth counting from the central incisor. Therefore, we have 4 teeth, 2 on top and 2 on the bottom.
In another article We have a model with the names of the tooth groups and their location to help you understand better. But why does this tooth have so many stories to tell? In this article we will answer many questions about wisdom teeth.
Wisdom teeth: What is the reason for their fame?
Why do so many people have stories of suffering with wisdom teeth? It's because, most of the time, when the time comes for the tooth to erupt, it doesn't find enough space to position itself correctly. In some cases, the tooth can't even emerge from the gum because it gets stuck behind the second molar.
In other cases, the tooth is positioned lying down, rotated, or even upside down, in a position completely unsuitable for proper eruption and positioning. One of the reasons this happens is that at this age the young person's dentition is already developed and well-organized in balance with the jaws. This already defined situation does not allow for the arrival of another tooth. So, in short, there is not enough space for another tooth.
Theory of Evolution
Most scholars accept the theory that the reason we have such a high incidence of people experiencing problems related to lack of space for the eruption of third molars is linked to the evolution (or microevolution) of living beings.
1. Dietary Changes: Evolutionary theory shows us that human ancestors had a very different diet from our current diet. They used to consume harder, more fibrous foods, which wore down their teeth more quickly. Wisdom teeth were useful in this context, as they provided an extra tooth to assist in chewing. However, as the human diet changed and became more processed and soft, the need for wisdom teeth decreased.
2. Anatomical Changes: Evolution has also shaped the structure of the skull and jaw over time. With changes in diet and less intensive use of wisdom teeth, the human jaw has tended to become smaller over generations. This has created less space available for wisdom teeth to erupt correctly, resulting in impactions or semi-impacts.
3. Modern Problems: In modern times, wisdom teeth often lack sufficient space to erupt properly due to changes in diet and jaw anatomy. This can lead to oral health problems such as inflammation of the gums around the partially impacted tooth (pericoronitis). This condition favors the formation of cysts, pain, and pressure on adjacent teeth.
Can wisdom teeth cause other teeth to become crooked?
Things aren't that simple. During growth and development, the jaws experience a "forward" growth spurt each time a molar or premolar erupts. In other words, each time a tooth erupts, the jaws grow to create space for the new occupant.
Panoramic x-ray shows 3rd semi-included moles.
And this tendency for the maxilla to increase to accommodate another tooth also happens when the third molar arrives. And the arrival of this tooth can happen up to around the age of 25, mainly in males. Therefore, this residual growth of the (mandible mainly) can occur at a time when everything was already defined in terms of occlusion – but it wasn't! – and that's when the problems arise. When the mandible has to "make do," it can "mess things up.".
In some individuals, the mandible even attempts to grow slightly to create space for these teeth, but this can disrupt the anterior region of the dental arch. The lower incisors suffer from crowding because, when they encounter the barrier of the upper incisors preventing this advancement, it causes the lower incisors to tilt lingually (inward), decreasing the perimeter of the arch. Then they begin to compete for space and start to become crooked.
Can wisdom teeth cause cavities in neighboring teeth?
The words aren't exactly those; they don't cause cavities, but in semi-impacted third molars, it's very common to find a condition where the wisdom tooth prevents dental floss from reaching the cervical region of the second molar. Furthermore, this condition favors the accumulation of bacterial plaque hidden below the contact point between the two teeth.
For example, we can see in Figure 3 an X-ray showing an impaction of the lower left third molar (tooth 38), impacted behind the second molar, which developed a carious lesion in the cervical region. Incidentally, this is in a very unfavorable location for the dentist to reach the caries and repair the problem.
Besides being difficult to reach with the drill during restoration, the soft tissues – possibly the gum covering the area – can bleed and hinder the peripheral sealing of the restoration. The recommended approach is to extract the wisdom tooth, wait for it to heal, and then restore the second molar. Even then, achieving a satisfactory restoration will be an extremely challenging task.
Wisdom tooth and caries at the impaction point.
I have witnessed several cases where decay destroyed the second molar to the point where the patient sought professional help because they were already experiencing pain – not from the wisdom tooth – but from the second molar. This was to the point where they had to perform a root canal on the second molar. And in other cases, the destruction of the second molar can render the tooth unviable. The result: the loss of the second and third molars, unfortunately.
It is very common for young people to only notice the presence of this tooth when the gum covering the tooth begins to suffer chewing trauma caused by the opposing tooth. Or, malpositioning promotes the accumulation of bacteria inside the gum and around the crown of the wisdom tooth, leading to episodes of pericoronal abscess – more popularly – pericoronitis.
Inflamed Wisdom Tooth
Pericoronitis – Pericoronal Abscess
This condition is quite common, very uncomfortable, and varies in intensity. It can be transient or a one-off episode, but it can become more chronic with recurring flare-ups. There is a risk of it developing into dangerous infections that require close attention and may eventually necessitate antibiotic treatment.
Rarer cases can develop into Ludwig's angina – a highly morbid infection that leads to the development of a large abscess – a large accumulation of pus. This abscess covers the entire neck and requires drainage intervention in a hospital because it threatens the patient's airways.
These pericoronal abscesses can also trigger autoimmune disease crises in individuals with a tendency towards rheumatoid arthritis, endocarditis, vasculitis, and an increased risk of thrombosis.
In other situations, the crown of an impacted or partially impacted wisdom tooth may touch the posterior part of the second molar, either at the root or the cervical region (the boundary between the crown and the root). This situation can be seen in Figure 2B. This contact favors the formation of caries in the second molars because it is impossible to clean in that area. I have seen cases of caries associated with partially impacted third molars leading to the second molar requiring root canal treatment. I have also treated cases of destruction to the point of requiring the extraction of the second molar in addition to the third molar, which was causing the problem.
Diagnosis of Pericoronitis
What should you do if you suspect that a certain discomfort is related to the eruption of wisdom teeth?
During the visit to the dentist's office, the dentist will examine the area to check if the wisdom tooth is present and if its position is harmonious or if it has the potential to produce pathological changes. If the tooth is impacted or partially impacted, the dentist will most likely ask the patient to have a panoramic radiograph taken.
When a tooth is "impacted," it means that it is completely covered by gum tissue, making it impossible to even know if the tooth is present in its place – radiographic confirmation is required.
Does everyone have wisdom teeth?
Some individuals are fortunate enough to be born genetically free of this group of teeth. They may have agenesis of 1, 2, 3, or even absence of all 4 wisdom teeth. So, some people don't have this tooth.
When a tooth is in the "semi-impacted" category, it means it is partially covered by the gum. This is the form most associated with pathological conditions because oral bacteria invade the area surrounding the tooth through communication with the mouth. Similarly, when we use the word "impacted," it means the tooth is trapped, stuck behind the second molar. The tooth is prevented from completing the eruption process.
Inflamed Wisdom Tooth
How to treat it?
It is generally not advisable to operate on – extract – teeth in cases of acute infection. The most recommended course of action is to control the infectious/inflammatory process with antibiotics and... hygiene Using mouthwashes. Once the condition is stabilized (elimination of the infection), the possibility of subjecting the patient to surgery with antibiotic and anti-inflammatory protection is evaluated. In some cases, muscle relaxants and corticosteroids may be used post-operatively to reduce swelling and discomfort.
Radiographic examinations are particularly important for analyzing cases of impacted semi-impacted third molars – planning the removal surgery may even require CT scans to assess the proximity of the alveolar nerve and the blood vessels near this nerve.
In addition to professional experience, surgical and drug therapy planning, a good medical history, and appropriate instruments are essential for patient comfort during and after surgery.
So if you're feeling any discomfort in the area of your back teeth, don't let it get worse. Don't wait until the weekend when everything is closed for the pain to start. Try to schedule a visit to the dentist.
Author: Nivaldo Pinho Gonçalves, Periodontist, CROSC 9696.
Refer to: JAN, Lindhe; LANG, Niklaus P.. Treatise on clinical periodontics and oral implantology. 6. Rio de Janeiro: Guanabara Koogan, 2018, 1292 p.