What are wisdom teeth? The term originates from the fact that they grow much later than the other teeth, when you presumably are "wiser" than when the earlier teeth came out. Normally, these large molars become visible when a person is between the ages of 17 and 25. You will get four, on each side at the ends of the top and bottom rows. However some have grown more than four.

What's so special about wisdom teeth? What you may hear about them is that they have to be removed and there is pain involved. However, this is not the usual case; most people don't need to have them removed.

There are several ways they can be a nuisance. Some of the main ones are outlined here:

Impaction: An impacted wisdom tooth is jammed sideways under the gums, i.e. it has not emerged out of the gums. That means it is wedged sideways against a barrier, such as the root of another tooth; therefore, it is not able to erupt through the gums. Three patterns are possible (with the most common listed first):

1. The tooth is angled in the direction of the front of the mouth.

2. The tooth is angled backward, toward the back of the mouth.

3. The tooth is growing at a 90-degree angle, bumping sideways into the next molar over.

Partial Eruption: What is meant by this term is that a molar emerges only partly through the gums. The main problem here is that the gums are firmly attached only at the base of the tooth. The upper part of the tooth is covered by loose gum tissue, which acts like a flap, also known as an "operculum." Food can easily get lodged in there, but it's hard to get to the pocket via toothbrush, so infection or tooth decay (or both) may result.

Infection: Infection or, worse, an abscess is usually marked by swollen gums and redness around the tooth, difficulty in opening the mouth, a bad smell or taste in the mouth, or a pain in the jaw, which can also run down the neck.

Even if a problem like one of the above occurs with any of your wisdom teeth, it does not necessarily constitute a reason to remove them. Your dentist or dental surgeon will make a clinical decision, depending on whether he believes it is going to cause more harm than good to keep the wisdom teeth. The loose gum (operculum) could be sliced off, but this operation is usually not done, due to possible nerve damage in the cheek or tongue.

Removing Wisdom Teeth: Some of the reasons to extract wisdom teeth are:

• They can cause pain due to rubbing against cheeks or tongue.

• They can be infection-prone, resulting in extreme discomfort or worse.

• They can push your teeth out of place, causing crowding.

• They can cause severe pain and medical problems.

The dental surgery itself is very complicated. Since a wisdom tooth is a large molar, usually embedded deeply in the gums and sometimes still stuck to the jaw bone, a high degree of care is taken to ensure the complete tooth is removed. Also, in the immediate area of the wisdom teeth, there are a number of nerves that go to the tongue and cheeks. Extreme precaution is taken not to disturb these at all, because permanent damage could be done.

Post-Operative Care:

Following surgery, after-care instructions are given and must be followed in order to prevent future problems. A post-surgical visit with your surgeon is necessary and usually recommended about seven to ten days after the operation. The surgeon will want to make sure that the healing of the wound is going well with no complications.

Usually the bleeding doesn't end completely for two to three days, but there is less blood after the first day. Most dentists suggest not to rinse the mouth, as this might hinder clotting and healing. You may have been given a number of gauze pads, but if you run out, you can substitute wet tea bags; the tannins present in tea help reduce bleeding. If the bleeding continues heavily after the first day, the dental surgeon should be alerted right away.

You may also notice an unpleasant odor coming from the surgical site for one to two weeks. This is normal and should disappear.

An empty tooth socket can get clogged with dirt or food. The surgeon can clear out the socket so it won't get infected.

A "dry socket" is an inflammation of the bone next to the socket. It is not completely known why this occurs, but the condition might be caused by pressure (such as suction or blowing) on the empty socket. Ibuprofen, or another anti-inflammatory, reduces the inflammation and pain, usually fairly quickly - within weeks, not months.

You can expect some swelling. However, it should not last more than a week or so. If the surgical area swells up again at a later time, your surgeon should be informed immediately.

Provided courtesy of Greenway Dental Group, MA