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article imageAll Full Up! Wisdom Teeth And Their Struggle For Space

By Sandra Hoffmann     Oct 18, 2000 in Lifestyle
Mainz (dpa) - They lurk unseen in darkened corners, unnoticed for years, but in the end they are inevitably going to want out. When wisdom teeth start to stir, their migration is more often than not accompanied by excruciating pain.
For this reason they are now often removed while still buried deep within the jaw bone. In many mouths there is an acute shortage of space and there is simply no room for these late developers.
"The problem is that wisdom teeth are the last to come through and therefore just have to make do with what's left over," explains Thorsten Reichert, head consultant at the University of Mainz clinic for oral, maxillary and facial surgery.
The space available in the mouth is shrinking all the time because the jaw is shrinking as humans evolve, he says. This process has meant that some people simply do not grow any wisdom teeth at all.
However, these are the exceptions - in most cases four wisdom teeth still try to push their way through. If there is too little space, they might stop growing half way.
Interrupted growth can lead to cysts and infections. Moreover, the pressure exerted by a wisdom tooth can damage the root of the mature tooth which is blocking its path.
"Using X-rays we can examine children to see if there is going to be enough space," says Reichert. "If there are no problems we can leave the wisdom teeth in. But if it becomes clear that it's going to get too crowded, the wisdom teeth should be removed as soon as possible."
The "dens serotinus", or latecomer tooth, usually breaks through between the ages of 17 and 24. However, it is possible to get to the root of the problem much earlier.
The ideal age for removing the wisdom teeth is between 15 and 25," says Professor Friedrich-Wilhelm Neukam from Erlangen University. The older the patient, he warns, the more likely it is that complications will set in.
"With adolescents the roots are not so well developed, but in adulthood they tend to grow deeper into the jaw bone," Neukam reveals. It follows that extracting wisdom teeth not only becomes more difficult and more painful with increasing age but also carries higher risks. The recovery period extends, making infections more common.
Surgery on the lower jaw can also damage nerves. "If the root is in an awkward position," says Neukam, "one could, for example, run the risk of damage to the tongue nerve which runs along the inside of the lower jaw bone."
The professor emphasises that the lower labial nerve is equally at risk. To minimize the chances of injury, unlike other teeth which are pulled out all in one piece, wisdom teeth are often first carved up inside the mouth before being removed piece by piece.
Surgery is carried out by dentists or so-called oral surgeons. If preliminary examinations point to a complicated operation, patients should consider transfering to a clinic specialized in oral surgery.
There, patients who are unusually nervous or whose operation is particularly complex can be treated under a general anaesthetic. Wisdom teeth are usually removed under a local anaesthetic on an out- patient basis.
"On average the operation lasts about an hour. The patient then rests for one hour to recover. After that he is free to go home, although for reasons of safety he is not permitted to drive," says Christof Schumacher from the German Federal Dentists Association, based in Cologne.
Just how long a patient is put out of action by the operation varies from individual to individual. As Thorsten Reichert explains, in the most straight-forward of cases there is no difference between removing wisdom teeth and a standard tooth extraction.
If the operation is more complicated, it can take up to a week for swelling and pain to subside.
As a rule, stitches can be removed after ten days, by which time the mucous membrane should have grown back over the wound. The patient is then able to bite down on his teeth without feeling there is something missing.
Wisdom teeth are not normally used for chewing, and in the majority of cases that is just as well. Relics of another evolutionary age, they are often rather puny. Nevertheless, they can sometimes prove useful.
"If, for example, an important molar is lost as a result of caries, it may be possible to use the wisdom tooth as an anchor for a bridge," says Thorsten Reichert. If the root is strong enough, the wisdom tooth can be shifted or transplanted.
In this way, the late developers of the tooth world can come on as substitutes for their frail and faltering elder brothers.
More about Dentist, Mouth, Bad breath, Surgery, Wisdom teeth