Dr Anish Berry
BDS (Lond) PGCert MFDS RCSEd
what are they?
The last teeth to develop in the adult mouth are the third permanent molars - more commonly referred to as 'wisdom teeth'. They are absolutely normal teeth. In the average adult dentition, you would expect to have four wisdom teeth developing throughout mid-to-late teens, but some people can have less, and some can have more.
However, in many patients there is not enough space within the jaw for these teeth to erupt fully, and they can become stuck, or impacted. And this is where, sometimes, problems can begin.
impacted wisdom teeth
Teeth develop within follicles inside of the jaw bone, and as they mature, the teeth grow and 'erupt' into the oral cavity. Unfortunately, in many people, there simply isn't enough space in the mouth for the wisdom teeth to erupt. If this happens, a wisdom tooth can become blocked, and this is called an 'impacted wisdom tooth'. There is some anecdotal variation in the number of patients with impacted wisdom teeth, across gender, ethnicity, and genetics.
Most of the problems associated with wisdom teeth occur when they are partially erupted or unerupted. You will probably already know if you have an impacted wisdom tooth, if it's 'partially erupted' and is just poking out of the gum.
The most common complaint associated with impacted wisdom teeth is pain from the surrounding gum - this is called 'pericoronitis'. Pericoronitis occurs when the gum covering the wisdom tooth becomes inflamed, usually because the area is extremely difficult to keep clean and there is a build up of debris and bacteria. Sometimes the pain can be associated with a bad taste, bad smell, and inability to open the jaw fully.
Other increasingly common complications with wisdom teeth can include the introduction of dental caries on the adjacent molar teeth, as the degree of impaction means that the adjacent tooth is extremely difficult to keep clean, and therefore dental decay has opportunity to affect the tooth.
Wisdom teeth can also get decay and infection just like other teeth, and in fact if partially erupted they can be more likely to get this due to difficulty in cleaning. Unerupted wisdom teeth are also at risk of developing into cysts.
indications for treatment
In the UK, there are strict guidelines about the removal of impacted wisdom teeth. It is not acceptable to remove these teeth 'prophylactically', if they are not causing any problems. However, if any of the following apply, then the tooth meets the requirement for removal (please note this is not an exhaustive list):
Recurrent inflammation/pain of the surrounding gum (Recurrent Pericoronitis)
A particularly severe bout of inflammation/pain of the surrounding gum (Severe Pericoronitis)
Decay or infection of the wisdom tooth
Decay of the adjacent molar due to the position of the wisdom tooth
Development of a cyst associated with the wisdom tooth
tests and treatment options
If you think you have a problem with your wisdom tooth, then you can contact us for a consultation. At the consultation you will be examined thoroughly clinically, and will have some x-rays of your jaw/teeth to assess your wisdom teeth. We will then be able to tell you a diagnosis and treatment options.
If you have gum inflammation around the wisdom tooth, you will likely be offered a minimally invasive solution first. This involves professionally cleaning around the tooth and under the gum, under local anaesthesia (so you don't feel anything.) After a washout, you will be advised to take painkillers and allow the inflammation to settle. Additional minimally invasive solution include removing excess gum tissue, and gently adjusting the shape of opposing teeth to avoid further trauma to the gum.
If however you meet the requirement then you will be offered a surgical option. In most cases, the removal of wisdom teeth is a minor oral surgery procedure, which can usually be carried out under local anaesthesia. In few cases, if the wisdom tooth is very close to a large nerve running through your jaw, you may be offered an alternative procedure to remove the top portion of the tooth, and leave the bottom portion buried under the surface, so as not to disturb the nerve.
The surgical removal of a wisdom tooth is a quick procedure which can usually be carried out in a clinic setting, under local anaesthetic. You have an option, should you wish, to be seen in a hospital setting if you require general anaesthesia. The procedure will involve making a small cut to the gum to expose the wisdom tooth, surgical removal of the wisdom tooth, and then placement of dissolvable stitches to rejoin the gum. Healing is usually very quick, with minimal pain, and post-operative recovery is generally predictable and excellent. You can usually go back to work within 48 hours.
It is important that you understand the risks and benefits associated with any procedures that you wish to have. At your consultation and assessment, you will be talked through all of your options, outcomes, and all associated risks and benefits should you wish to have treatment.
Dr Anish Berry
Dr Anish Berry trained as a dental surgeon at St Bart's and The Royal London Dental School, where he excelled in Oral Surgery and found a real passion for surgical procedures including the removal of teeth. After spending some time treating a wide variety of high needs patients in primary care in Kent, Surrey and Sussex, he completed further postgraduate studies including a Post Graduate Certificate in Primary Dental Care, and the Membership Exam to the Faculty of Dental Surgery, Royal College of Surgeons. He then spent time working as an Oral and Maxillofacial House Officer at UCLH and Great Ormond Street, and worked within the Oral Surgery Department at the prestigious Eastman Dental Hospital where he spent most of his time removing teeth and wisdom teeth referred in by General Practitioners, with local, sedation and general anaesthesia. He now works solely in private practice in the prestigious Harley Street District, where he splits his time between Oral Surgery procedures, General/Cosmetic Dentistry, and Facial Aesthetics.
book a consultation
If you feel you might have an issue with your wisdom tooth, you can book a no-obligation consultation with Dr Anish Berry at Sensu Dental Clinic in Wimpole Street, Marylebone, or Borough High Street, London Bridge. The fee for the consultation is £50, however should you require treatment this will be deducted from the treatment cost. To find out more information, fill out the form below and one of our team will be in touch. If you need an emergency appointment for your wisdom tooth, please select the emergency box and we'll respond ASAP.