Wisdom teeth
- What is a Wisdom Tooth?
- Wisdom Teeth: 8th or Third Molars?
- Why Do We Have Wisdom Teeth, and Why Do We Often No Longer Need Them?
- Do Wisdom Teeth Always Erupt?
- What Happens If I Choose Not to Have My Retained Wisdom Teeth Removed, and They Remain in the Bone?
- What Symptoms/Issues Can Arise?
- In What Situations Are Wisdom Teeth Removed?
- When Is the Ideal Time for Extraction?
- What Investigations/Assessments Are Carried Out Before Wisdom Tooth Extraction?
- What Kinds of X-ray Examinations Are Performed?
- How Is Wisdom Tooth Extraction Performed?
- How Should You Behave After Wisdom Tooth Extraction?
- What Are the Risks of Wisdom Tooth Extraction?
- How Long Do I Need to Stay Home After Wisdom Tooth Extraction?
- When Does Health Insurance Cover the Cost of Wisdom Tooth Removal?
WHAT IS A WISDOM TOOTH?
Most people have four wisdom teeth, two on the top and two on the bottom. They are located at the back of the dental arch, sometimes barely visible or erupting in a different direction. In some cases, wisdom teeth only partially erupt or do not erupt at all. Due to their unusual positioning, access is often difficult, making proper oral hygiene challenging. As a result, bacteria can accumulate there, leading to bad breath, tooth decay, gum disease, or an acute infection. Whether complications with wisdom teeth occur and when they occur cannot be predicted. In some individuals, the misalignment causes no problems, while in others, it can lead to often painful issues.
WISDOM TEETH, 8TH OR THIRD MOLARS?
All three terms are synonymous and refer to the last molars that typically erupt between the ages of 18 and 25, sometimes later.
The term “wisdom teeth” dates back to medieval times when people were considered “wise” by the time these teeth emerged, given the shorter life expectancy of 35 to 40 years at the time.
“8th” or “third molar” refers to the position of the wisdom tooth in the dental arch. The mouth is divided into four quadrants (upper/lower + left/right), and each quadrant has two incisors (1, 2), one canine (3), two premolars (4, 5), and three molars (6, 7, and 8).
WHY DO WE HAVE WISDOM TEETH, AND WHY DO WE OFTEN NO LONGER NEED THEM?
Wisdom teeth are a remnant from an earlier time when humans used their teeth as tools for tasks like processing objects or breaking down very tough food. Back then, particularly the molars experienced significant wear, which created additional space for wisdom teeth.
However, as we evolved and developed tools and technology, as well as cooked or processed food outside of the mouth, the size and length of the jaw have biologically decreased over time. This reduction in jaw size has led to less space for wisdom teeth in today’s human population.
DO WISDOM TEETH ALWAYS ERUPT?
No, they do not always erupt fully or at all. In many people, there are eruption disturbances with wisdom teeth due to a lack of space:
They may deviate from the ideal eruption direction, causing them to be oriented horizontally or at an angle, preventing them from properly aligning in the dental arch. If they are still partially covered by the gum tissue (partial retention), a pocket can form around the crown, which can periodically become infected.
Wisdom teeth can also remain embedded in the bone and be completely covered by the gum tissue (complete retention). In this case, they can become wedged under the crown or root of adjacent teeth, leading to tooth damage (subordinate resorption).
It is recommended to assess wisdom teeth at a younger age. This way, it can be determined early whether wisdom teeth are present and whether prophylactic (preventive) removal, for example, due to lack of space, should be considered before pain or significant inflammation occurs.
WHAT HAPPENS IF I CHOOSE NOT TO HAVE MY RETAINED WISDOM TEETH REMOVED, AND THEY REMAIN IN THE BONE?
In most cases, nothing significant happens. However, there are rare instances where a retained wisdom tooth may, later in life, trigger bone resorption around the tooth’s crown and lead to the formation of a cyst, even if the position of the wisdom tooth remains largely unchanged. In these cases, the cyst must be surgically removed. This can potentially result in bone or jaw fractures, necessitating bone reconstruction procedures.
WHAT SYMPTOMS / ISSUES CAN ARISE?
If there are problems with the development or eruption of wisdom teeth, or if they are difficult to access for daily oral hygiene, leading to the accumulation of bacteria, the following symptoms/issues may occur:
- Tooth decay/cavities, poor oral hygiene resulting in bad breath
- Pain, tension, or pressure in the jaw or facial area
- Inflammation/abscess in the gums, jaw, or facial area
- Dental misalignments, caused by wisdom teeth or affecting the entire dental arch
- Damage to adjacent teeth and their roots
IN WHAT SITUATIONS ARE WISDOM TEETH REMOVED?
Wisdom teeth are typically removed in the following situations:
- Poor accessibility for oral hygiene (difficult-to-clean areas) and an increased risk of cavities
- Cavities
- Inflammation of the surrounding mucous membranes/gums and/or the bone
- Pus-filled cysts and/or abscesses
- (Potential) undermining resorption or damage to neighboring teeth
- Pressure on the dental arch, leading to the displacement of adjacent teeth
- Neuralgic facial or head pain
Unfortunately, when wisdom teeth cause problems, there are often few viable alternatives to extraction!
WHEN IS THE IDEAL TIME FOR EXTRACTION?
The ideal time for wisdom tooth extraction typically ranges from the ages of 16 to 25. During this period, the roots of the wisdom teeth are often not fully developed. Additionally, the body’s capacity for healing is strong, leading to fewer complications such as inflammation, swelling, and pain.
If this window has passed, wisdom tooth extraction is still possible. However, it may be more complex and the risk of complications increases with age.
WHAT INVESTIGATIONS / ASSESSMENTS ARE CARRIED OUT BEFORE WISDOM TOOTH EXTRACTION?
Before wisdom tooth extraction, the following steps are taken:
- Patient history and interview to gather information about current complaints, medical conditions, allergies, medication use, and smoking habits.
- Clinical examination of the face, oral cavity, and teeth.
- A dental X-ray (orthopantomogram or OPG) to visualize all teeth and the entire jaw.
- Informed consent discussion with the patient about the exact procedure, as well as potential risks and complications.
- A cost estimate is provided.
WHAT KINDS OF X-RAY EXAMINATIONS ARE PERFORMED?
Before wisdom tooth extraction, a two-dimensional (2D) dental X-ray, known as an Orthopantomogram (OPG), is typically obtained. This X-ray image displays all the teeth, the upper and lower jaw, and sometimes the jaw and sinus cavities. It allows assessment of the position of the wisdom teeth in the bone and their relationship to important anatomical structures like nerves and sinus cavities.
In more complex cases, a three-dimensional (3D) X-ray examination, known as a digital volume tomography (DVT), may be necessary. DVT provides a clear, three-dimensional view of the wisdom teeth and adjacent anatomical structures without overlap.
HOW IS WISDOM TOOTH EXTRACTION PERFORMED?
The procedure is typically carried out under local anesthesia, although in rare cases, it may be done under general anesthesia. Pain during the procedure is not expected, but you may feel some pressure.
If the wisdom tooth has fully erupted into the oral cavity, it can be loosened and removed using dental instruments like elevators or forceps.
If the wisdom tooth is partially or fully covered by gum tissue and/or bone, a small incision is made in the soft tissue, and the bone is carefully removed with a drill to expose the tooth. Once exposed, the tooth can be lifted out of its socket. In some cases, the wisdom tooth may need to be sectioned into smaller pieces for removal. Afterward, the surgical area is cleaned, and the wound is closed with stitches. A follow-up appointment is typically scheduled for wound inspection and stitch removal, usually 7 to 10 days later.
HOW SHOULD YOU BEHAVE AFTER WISDOM TOOTH EXTRACTION?
- After the operation: Bite on a gauze pad for 15-30 minutes.
- Do not rinse your mouth with water.
- On the first day, use cold compresses or a cold pack to reduce swelling in the surgical area.
- Wait until the local anesthesia has worn off before eating and drinking.
- Avoid hard, hot, or spicy foods and beverages.
- Try to avoid dairy products.
- Do not smoke or consume alcohol.
- Elevate the upper body at night with an extra pillow.
- Refrain from sun exposure, sauna, and strenuous physical activities or sports.
- Take the prescribed medications as instructed.
- Maintain good oral hygiene, but be cautious around the surgical area. Additionally, rinse gently with a chlorhexidine mouthwash solution.
WHAT ARE THE RISKS OF WISDOM TOOTH EXTRACTION?
Wisdom tooth extraction is typically a low-risk routine procedure performed daily in dental practices. However, certain complex situations can be challenging and may require the expertise of a specialized oral surgeon.
In the first few days following the surgery, the following issues may occur:
- Pain and swelling
- Limited mouth opening due to swelling
- Mild postoperative bleeding
Less commonly:
- Significant postoperative bleeding and hematomas in the face and neck area
- Wound healing disturbances
- Infections of soft tissues or bone
- Jaw joint issues due to prolonged mouth opening
Very rarely, the following complications may occur:
- Impairment or damage to nerves
- In the upper jaw: perforation of the sinus, requiring closure through suturing or a flap
- Damage to adjacent teeth, as well as loosening or damage to existing crowns or bridges attached to adjacent teeth
HOW LONG DO I NEED TO STAY HOME AFTER WISDOM TOOTH EXTRACTION?
Wisdom tooth extraction is an outpatient procedure. We recommend that you take it easy and avoid physical activities on the day of the surgery. In general, there is no work incapacity. However, depending on the extent of postoperative discomfort, a medical certificate for work incapacity may be issued on an individual basis.
WHEN DOES HEALTH INSURANCE COVER THE COST OF WISDOM TOOTH REMOVAL?
Health insurance (basic coverage/KVG) covers the extraction of wisdom teeth only if they are impacted and there is an associated “medical necessity.” This medical necessity may arise, for example, in cases of a cyst or undermining resorption of an adjacent tooth. In such cases, an application is submitted to the health insurance provider, and approval for coverage is obtained.
Additionally, many dental supplementary insurance policies contribute to the cost of wisdom tooth removal. The extent of coverage can vary significantly between different supplementary insurance plans. It is advisable to clarify this with your insurance provider beforehand.
Zudem beteiligen sich viele Zahnzusatzversicherungen an den Kosten einer Weisheitszahnentfernung. Der Leistungsumfang der verschiedenen Zusatzversicherungen unterscheidet sich teilweise stark. Es empfiehlt sich daher, dies vorgängig mit der Versicherung direkt abzuklären.
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