Wisdom teeth: why they have to go out often

In many cases there is no more space in the dentition for the wisdom teeth. What helps with toothache and when to pull wisdom teeth

The wisdom teeth are also called eights because they are placed in addition to the seven regular teeth in each quadrant of the dentition

© W & B / Szczesny / arr. Neisel

"Occasionally, wisdom teeth are already a problem for 15-year-olds, but I've also had a patient in the practice where they first reported at the age of 85," says dentist Dr. Angelika Brandl-Naceta from Düsseldorf-Friedrichstadt.

What are wisdom teeth anyway?

"A relic from our time as hunters and gatherers," explains the dentist. In the Stone Age, our ancestors had to chew their food mostly unprocessed. Wisdom teeth are also called eights because, in addition to the seven regular teeth in each quadrant of our dentition, they are placed at the very back of the jaw.

"Some ethnic groups in Asia and Africa, who mainly eat vegetarian and raw food, still have up to ten teeth on each side of their upper and lower jaw," reports Angelika Brandl-Naceta, the chairwoman of the German Dental Association .

Why can wisdom teeth cause pain?

In "modern" people, on the other hand, the teeth have receded so much in the course of evolution due to soft, cooked food that there is often no space left for a wisdom tooth. "It then presses against the bone, the skin that spans it, and the adjacent molar, the seventh," explains the Düsseldorf dentist. "That can hurt and also lead to inflammation." So the patient may feel terrible pain on the seventh, even though this tooth has no caries hole and is perfectly fine.

What can relieve the pain?

A trick from grandmother's medicine cabinet often helps with minor problems. "Dip a chamomile tea bag briefly in cold water, squeeze it out and place it in the vegetable compartment of your refrigerator for about ten minutes," recommends Angelika Brandl-Naceta. If the pain sufferer then lays it on the affected area for a quarter of an hour and grits the teeth firmly, the cooling reduces the pain and swelling. In addition, the active ingredients in chamomile can reduce inflammation.

When do wisdom teeth need to be extracted?

If the symptoms persist, there is a risk that the root of the neighboring tooth will be irreversibly damaged. Mainly in the lower jaw, it sometimes happens that a mucous membrane hood forms over the growing figure eight. Food remnants can slide underneath and cause swelling.

If the afflicted bite on this spot, it often develops into a very painful inflammation. This can even lead to a lock: the mouth can no longer be opened or closed. The dentist must then clean the pocket and stop the inflammation. Occasionally he will also open the hood with a cut or electrosurgically.

To prevent this from happening, the wisdom tooth usually has to be extracted. In rarer cases you remove the seventh instead and pull the eighth into the gap created or use it to anchor a bridge to the six. Due to their training and regular advanced training, every dentist is allowed to perform surgical interventions in the oral cavity. However, because the roots of many wisdom teeth sit in the jawbone with sometimes adventurous ramifications, an oral or maxillofacial surgeon is usually required.

How is the operation going?

"The patient first receives local anesthesia, that is, local anesthesia," says Professor Ralf Smeets from the University Medical Center Hamburg-Eppendorf, describing the usual procedure. If desired, he can also be given a short anesthetic. "Nobody likes to have their jaw milled, and the surgeon can work better when the patient stays still." Later, after two or three hours in the recovery room, the patient goes home again. "However, it should be picked up and is not allowed to drive a car for 24 hours," adds the specialist in oral and maxillofacial surgery and a specialist in oral surgery.

Should I have all four wisdom teeth removed at once?

Because a wisdom tooth rarely causes problems on its own, some surgeons say: "We'll pull all four at once, then you'll have it behind you." But: "In addition to swelling, four wounds in the mouth mean a considerable reduction in the quality of life when eating and drinking," says Smeets.

In most cases, he therefore recommends his patients to proceed in two steps during the consultation. "We'll first draw the figure eight in the upper and lower quadrants on one side, and then the other two a few weeks later."

What should I watch out for after the procedure?

"A clot of blood forms in the fresh wound, from which new connective tissue and ultimately new bone mass develop," explains Angelika Brandl-Naceta. Therefore, the patient should not drink anything hot for two or three days after the operation. "It should only rinse with water, not with a solution such as chlorhexidine," adds Ralf Smeets.

Also taboo: Smoking, because nicotine is a tissue poison. Crumbly foods like nuts also increase the risk of inflammation. In addition, the freshly operated person should avoid any exertion: Exercise, like housework, can lead to secondary bleeding. To prevent this, the patient should sleep with the upper body slightly elevated - an incline of 20 to 30 degrees is ideal.

If it does bleed: To avoid nausea, do not swallow, but spit it out. Painkillers help the body to calm down and not to release too much adrenaline. The dentist and oral surgeon expressly point out that cooling is very important - not with ice, but with a cool, damp washcloth.