Caring for the dental health of the Macarthur community

• First molars come though the gums at about 6 years old, and are called “6-year-old molars”.
• Second molars come through the gums at about 12 years old, and are called “12-year-old molars”.
• Third molars are the last of the molars to come through at about 16 years and older. They are usually called “wisdom” teeth because this is often the age of adulthood. Not everyone grows “wisdom” teeth, and some people only grow 1, 2, or 3.

By this time, there may not be much room for the “wisdoms” to fit into the remaining jaw space. They can become stuck (impacted) under the gum, or under the 2nd molars. It is a sensible precaution to arrange an X-ray of teenagers at about 16 years old to see how the “wisdoms” are developing. Most of this article

The possible options for “wisdom” teeth are as follows:

1. The “wisdom” teeth come through the gums all the way into an upright position, and can be used as normal teeth. This is a very rare result.
2. If the “wisdoms” stay fully enclosed under the gum and bone, with no microscopic access for bacteria, then it may be OK to leave them alone. Periodic X-rays are advised to check that cysts do not occur. This is a rare result.
3. The “wisdoms” become impacted deeply against the second molars. Although they may not be visible in the mouth, there is often a very thin break in the gum which allows bacteria to get in around the sac of the “wisdom” tooth. This is a common result.
4. The “wisdoms” manage to fit partly through the gums. This is the most common result.

If the “wisdoms” can be reached by bacteria (as in 3. or 4.), then it is impossible to clean them completely.  It is best to consider having them removed as soon as practicable before a gum infection occurs, or decay occurs in either the “wisdom” tooth or the adjacent second molar.

The method of extraction of the “wisdoms” may be done at the dental surgery under local anaesthetic (LA), or by an oral surgeon under intravenous sedation (IV) in his rooms, or by an oral surgeon under general anaesthetic (GA) in day surgery at a private hospital. Treatment can be sometimes arranged in a public hospital but the waiting period is usually at least 2 years.

The method for each patient depends upon a few factors and must be discussed individually:

• The difficulty of the extraction - the more difficult cases are done by the oral surgeon.
• The number of teeth to be removed - if there are only 1 or 2 teeth this may be handled by the dentist
• The temperament of the patient - nervous patients with little dental experience are best handled by the oral surgeon.
• Time constraints - patients with full-time jobs will find it quicker to have all 4 “wisdoms” removed in a single session by the oral surgeon. This may also apply to students.
• Financial costs - the cost increases from LA to IV to GA.

Wisdom teeth

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