Wisdom teeth — what we check when the decision is not obvious

What kind of tooth is a wisdom tooth?

A wisdom tooth is the molar furthest back and the last to come through. The number and the direction differ from person to person, and in some cases it never comes through at all. A wisdom tooth buried in the gum, or lying sideways as it comes through, is called an impacted wisdom tooth.

D-day Dental Clinic provides wisdom tooth extraction as part of its general dentistry.

Cases that lean toward extraction

• When the gum around the wisdom tooth swells and hurts again and again
• When a toothbrush cannot reach and a cavity has developed in the wisdom tooth or the molar in front of it
• When it lies sideways and pushes the molar in front, or food keeps getting caught between them
• When bad breath keeps coming from the wisdom tooth side

Where this keeps happening, extraction is often considered to protect the molar in front rather than for the sake of the wisdom tooth itself. If a cavity develops in that molar, the scope of treatment can widen, stage by stage, to a composite filling, an inlay, root canal treatment or a crown, as set out above.

Cases that lean toward watching

• When it has come through straight, meets the opposing tooth properly and is used for chewing
• When it can be kept clean by brushing and there are no symptoms
• When it is completely buried in the jawbone and nothing around it is changing
• When the timing of extraction has to be adjusted because of your general health or the medication you take

Having no symptoms does not mean it will stay that way indefinitely. Taking regular X-rays to check whether anything has changed is the condition for choosing to watch it.

What is used to decide?

1. Panoramic X-ray — the whole upper and lower jaw is captured in a single image to check the number, direction and depth of the wisdom teeth.
2. Three-dimensional imaging (CT) — where needed, the Vatech SmartPlus dental CT is used to check the distance from the nerve and the shape of the roots in three dimensions.
3. Checking the neighboring teeth — whether a cavity or a gum problem has already developed in the molar in front is looked at as well.
4. Checking your general health — if you take medication or have a systemic condition, the timing and the method are discussed together.

D-day Dental Clinic states as a treatment principle that it shows you the CT images and intraoral photographs directly and explains as it goes. You can see on screen why a tooth should come out, or why it is reasonable to keep watching it.

Worth knowing

The difficulty of a wisdom tooth extraction can vary a great deal with its position and direction. Where impaction is severe or the tooth is close to the nerve it can take longer, and depending on the condition it may be judged that treatment at a higher-level medical institution is needed.

After an extraction there can be bleeding, swelling and pain, and recovery differs from person to person. Both directors of D-day Dental Clinic are board-certified specialists in Integrated Dentistry certified by the Ministry of Health and Welfare, and both hold a master's degree in Oral and Maxillofacial Surgery from Korea University.