(DOES YOUR WISDOM HURT ???? )

INTRODUCTION

A wisdom tooth is a tooth which erupts next to the second molar , hence wisdom molar is also called the third molar. It is the last tooth to erupt in the oral cavity .

Wisdom molar usually appears between 17 to 25 years of age. Usually 4 wisdom molars are present , two on the upper jaw ( right and left) and two on the lower jaw (right and left )

HISTORY

Our ancestors had huge jaws and more teeth as they had to chew /grind plants. But with evolution the jaw size has reduced ,diet has changed and the number of teeth have reduced . Hence wisdom molar has now become vestigial.

Wisdom molar is most commonly impacted tooth (impacted tooth is a tooth which is stuck in the jaw bone and is not able to erupt In the mouth)

CAUSES OF WISDOM MOLAR IMPACTION

• The most important reason for impaction is the lack of space for the tooth to erupt . This is because of dicripancy between the jaw size and the the teeth size i.e. the jaw size is smaller and there is no space for the wisdom molar to come out.
• Genetics also play a major role in third molar impaction.

CAUSES OF PAIN DURING THIRD MOLAR  ERUPTION

• If the tooth is inside the bone then it might not cause any symptoms

• During eruption people usually complain of feeling of mild pressure in that area.
•  
• Most of the time tooth erupts partially in the oral cavity

• This partially erupted tooth is covered by a layer of gum called operculum . Food and bacteria gets accumulated between the gums and erupting teeth . The operculum gets red and inflamed resulting in severe pain to the individual.
• Also because this area is difficult to clean ,oral hygiene is not maintained well leading to tooth decay.
• People complain of bad breath and bleeding from gums.
• There is difficulty in opening the mouth.

• If an upper wisdom molar is erupted then its sharp cusp might keep hitting the operculum covering the lower wisdom molar causing immense pain
• The most common problem with a wisdom molar is it usually does not erupt straight in the mouth . it is tilted either towards the 2^nd molar or toward the tongue/palate or toward the cheek
• Because of this irregular positioning food keeps getting stuck between the 2 nd and 3^rd molar leading to damage and decay in 2^nd molar.

TREATMENT

• If the incidence of pain has happened for the first time antibiotics and analgesics can be given.  
• In case operculum is covering the tooth and causing the pain then removing the soft tissue (gum growth) followed by cleaning in that area can be done.
• But most of the time these symptoms recur and so the best option is removal of wisdom tooth.

• This can be done under local anaesthesia . (conscious sedation or general anesthesia can be given if patient is un co- operative  or having any medical problem )an x ray or OPG will b useful in assessing the position of the tooth and proximity of the inferior alveolar nerve

COMPLICATION

• Since wisdom molar removal is usually a surgical procedure , person might feel pain , discomfort for 2 -3 days. Gradually these symptoms subside.
• Patient will have difficulty in opening mouth for few days.
• Sutures are usually given during extraction which are removed are 7 days.
• If proper care is not taken after extraction it might cause a condition called dry socket. Dry socket causes severe pain , bad breath and delayed healing.
• Long term complications include bone loss on the 2^nd molar following 3^rd molar removal.
• If the tooth is close to inferior alveolar nerve and during extraction the nerve is nicked then it causes partial numbness of lower lips and chin.