When should you get your wisdom teeth out

to reduce the chance of recurrent dental problems as you age.

Extract the teeth early to reduce the chance of recurrent dental problems as you age

Madam Tan made an appointment with a dentist only when she started having a severe toothache. She had three infected wisdom teeth, all of which were impacted or blocked by her gums.

Afraid that the removal of her wisdom teeth would be very painful, she had put off the visit to the dentist until she could no longer take the pain.

Madam Tan wanted to have all her wisdom teeth removed under general anaesthesia. This would have been possible, if she were not in her first trimester of pregnancy.

As anaesthesia can affect the development of a foetus' brain and central nervous system, she had to wait until her pregnancy stabilised in the second trimester to extract her wisdom teeth.

She also had to opt for local anaesthesia as it is less risky in pregnancy, though this meant that she would be awake and conscious of the noises and movements made during the surgery.

She could have avoided all this had she removed her wisdom teeth when her dentist first detected the problem.

Like Madam Tan, many people delay having their wisdom teeth removed until they develop symptoms. Common reasons for doing so include the fear of pain and the prevailing belief that wisdom teeth do not need to be removed if they are not causing problems.

However, there are good reasons for removing wisdom teeth as soon as it is practical to do so.

Wisdom teeth, or third molars, typically appear between the ages of 17 and 25, though people usually do not need them. If one is lucky, they erupt normally, are correctly positioned, can be easily cleaned and do not cause problems.

However, it is more common for wisdom teeth to erupt partially, sideways, in the wrong direction or in a manner that makes it difficult to clean them properly. This predisposes a person to caries, gum disease and infection.

A study done in Singapore in 2003 found that nearly 70 per cent of 1,000 patients aged 20 to 40 years old had at least one impacted wisdom tooth, putting them at risk of infections as well as rare but more serious complications such as cysts and tumours that may cause damage to the jawbone.

Dentists usually advise those who want to keep their wisdom teeth to brush and floss thoroughly.

However, the position of the tooth far back in the mouth and close to the second molar makes it challenging - if not impossible - to keep it clean.

Improper cleaning leads to bacteria build-up, causing tooth decay and inflammation of the surrounding gum. This is when most people decide to see a dental surgeon.

An erupted wisdom tooth can be removed with a simple extraction procedure, where the tooth is taken out after local anaesthesia is administered to numb the area.

When the tooth is impacted or in an awkward position, the removal process is more complicated and general anaesthesia may be required.

It would involve lifting the overlying gums to uncover the tooth and surrounding bone to remove the tooth. And often, the removal is done by sectioning the tooth and removing it in pieces.

In some cases, the jaw ridge then needs to be reshaped to promote better healing. The gums are then sutured back in place.

Recovery from both methods of extraction is generally faster for a young patient.

Studies have found that patients who have their wisdom teeth extracted when they are aged above 25 experience more complications. These include dry socket, a painful condition where the blood clot fails to form adequately or it dislodges before the wound is healed.

These older patients also have denser bone under their gums, making excision more difficult.

Having wisdom teeth removed at an older age can also give rise to other health complications.

For instance, being diabetic may pose problems, as a diabetic patient may take longer to recover from surgical procedures and may be more prone to infection.

Since wisdom tooth removal is preferably done when one's glucose levels are normal, a patient may have to put up with the pain and complications caused by an infected tooth while trying to achieve glucose control. This could take months.

But if the patient with poor glucose control is in severe pain, a surgeon may decide that it is better to remove the tooth to arrest the infection.

Patients with cancer or heart disease who need radiotherapy for head and neck cancer or heart valve replacement surgery require prior dental clearance to rule out potential dental infections such as those from impacted wisdom teeth.

Bacteria from the mouth can enter the bloodstream to travel to organs such as the heart, causing serious complications.

If the patient is found to have impacted wisdom teeth, he will likely need to have them extracted. This would then delay his treatment.

It makes sense to have your wisdom teeth extracted early. This will spare you recurrent dental problems, a longer recovery if you were to remove them at a later age and possible complications as a result of other health conditions in future.

Clinical Associate Professor Andrew B. G. Tay is a senior consultant and the head of the Department of Oral and Maxillofacial Surgery at the National Dental Centre Singapore (NDCS).

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