Wisdom Teeth Age of Eruption

Wisdom teeth Age of eruption

Wisdom teeth eruption age is not a single-digit to predict. It can show emerging in the mouth at the age of 15 in many people, however, literature shows the delay in eruption of wisdom teeth in many people as late as age 30. It should be understood that most third molars will not come out completely (semi-impacted) or not at all in most people.

There are quite a few exceptions, but take a look at your surroundings and you will realize that there is hardly a person who has 32 teeth out, well placed and working.

For those in whom they will come out, it can take months or years and can occur in late adolescence or adulthood. These teeth are the most unpredictable. The comments below (questions at the bottom of the page) contain several testimonials from people who saw their wisdom teeth come out at the age of 40, 50, 60 and even 70! Wisdom teeth are more likely to come out if other teeth have been extracted for different reasons (orthodontic treatment or other).

So, how long will it take for wisdom teeth to come out? An eternity because it will not come out for most of you! Look at the following examples of x-rays that show the behavior of wisdom teeth over several years.

Who would have predicted what happened?

Evolution of the position of the lower wisdom teeth over a period of 6 years. As soon as it is obvious that the teeth will not come out properly, it would be preferable to extract them to avoid that the intervention (extraction) is more complex later (for the patient and the surgeon).
(A) By age 15, the lower wisdom teeth are already tilted forward.
(B) 3 years later, the teeth tilt more forward. There is not enough growth in the back of the mandible to allow the impacted molars to straighten and allow them to erupt. It would be advisable to have these molars extracted at this time, as it is impossible for these teeth to come out properly. The upper wisdom teeth continue to grow, but the left one remains stuck behind the second molar.
(C) At age 21, the lower wisdom teeth are made horizontal, which will complicate their extraction.
(D) Right upper third molar when extracted.
(E) Left upper third molar.
(F and G) The lower third molars had to be cut into several pieces to be extracted. The skill of maxillofacial surgeons can still extract teeth in a very bad position, but these extractions are much more complex for both the patient and the surgeon. It is therefore preferable to extract the impacted wisdom teeth as soon as it is considered that they will have no chance of coming out and before the inclusion worsens and makes the procedure more difficult.

It is indicated to extract wisdom teeth which, even if they come out, will not have an antagonist (*) in the lower arch.
When a tooth is partially erupted, the gum covering it is a place where plaque and food debris can build up and cause infection, cavities and inflammation. It is then indicated either to release the tooth by removing the excess gum or to have it extracted if the tooth cannot be released properly to complete its eruption.
A semi-impacted third molar is more difficult to clean and can decay more easily. This tooth shows the beginning of decay in the furrows of the surface.

SEMI-IMPACTED TEETH

Teeth that have partially erupted but have completed their eruption are called “ semi-impacted ” teeth . They present a particular problem because they are not completely included but having pierced the gum, they are exposed to the whole oral environment with all the problems that this can cause (bacteria, dental plaque, accumulation of food debris, etc.). Erupting molars go through a “semi-inclusion” stage as they come out but if they stay that way it can be problematic.

HISTORICAL CONTEXT

Prior to the 1990s, the literature strongly recommended that wisdom teeth not having enough space for eruption be routinely extracted in order to “maintain periodontal health of adjacent teeth” and to do so in young adults. before the root formation of these teeth is complete. In the 1990s, in order to assess the risks vs. the benefits (cost, health, etc.), the trend shifted towards the “non-extraction” of asymptomatic wisdom teeth on a routine basis. It was recommended to keep these teeth under observation and to extract them only if they became problematic.
Unfortunately,1 More recently, new bacteriological data have documented the relationship between chronic oral inflammation and systemic health, particularly with regard to heart disease and preterm birth. Obstetricians now stress their pregnant patients the importance of periodontal health to minimize the risk of premature births 1.
Anything that can prevent chronic oral infections will minimize the chances that the spread of bacteria will go beyond the mouth and reach the systemic bloodstream and help the spread of anaerobic bacteria known to play an important role in the development of coronary heart disease. . We now know that the presence of these same microorganisms increases the risk of premature births.

THE PROBLEM OF SEMI-IMPACTED TEETH

Semi-impacted teeth can be covered to varying degrees by the gum. Sometimes there is only a small part of the gum (called an operculum) at the back (distal) that covers the tooth or the tooth may be almost completely covered and only a small part of the tooth crown (enamel) is visible .

These teeth are usually more difficult to access and are more difficult to clean even for patients with good oral hygiene. This often results in an accumulation of dental plaque which will lead most of the time to the appearance of dental caries and gum problems ( periodontal problem ; inflammation, infections, bone loss, etc.).

A wisdom tooth partially covered with gum tissue provides an ideal site for colonization
Data from four studies involving a total of 8,500 patients documenting the relationship between third molars and periodontal disease revealed that a third molar partially exposed or covered with gum tissue provides an ideal site for colonization by bacterial periodontal pathogens , which creates a systemic risk . Recent data show that inflammatory periodontal disease can predict periodontal pathology in regions other than third molars and that over time asymptomatic patients with visible molars have an increased risk of early periodontal disease in the anterior region 2 .

WHAT TO DO WITH SEMI-IMPACTED MOLARS?

Observe - If the tooth has not finished erupting and looks relatively well placed on a panoramic x-ray, it can be observed for a while and seen if the full eruption will improve the situation. The portion of gum covering the tooth can be excised to clear the tooth and minimize the risk of infection. However, as explained above, studies have shown that such teeth can contain pathogens in their immediate environment that can spread elsewhere in the body and cause other infections so it is suggested to extract them.

If the radiological evaluation reveals that the tooth is:
slightly misplaced but there appears to be enough space at the back to accommodate it, partial orthodontic corrections limited to this area as needed can be considered.

too badly positioned and lacking a lot of space, it is advisable to extract this tooth .
The part of the gum (operculum) that covers a semi-impacted tooth with the potential to complete its eruption can be cut ( operculectomy ) and reduce the risk of infection and decay if this tooth is kept.
However, the new guidelines consider pericoronitis to be an indication for extraction and recommend extracting teeth affected by pericoronitis, not treating symptoms. 1
If this operculum remains in place, the patient can bite on it, it can become irritated, inflamed and infected and this can be very painful (operculitis or pericoronitis). It is then indicated to cut this operculum and / or to extract the molar according to the cases and recent recommendations.
Find out more about operculitis and pericoronitis .
In conclusion, it is not indicated not to treat semi-impacted molars because they will cause problems one day or another.

DECEPTIVE APPEARANCES!

Sometimes the physical examination gives the impression that the eruption of wisdom teeth is occurring well or normally, but the X-ray examination reveals a different reality.
(A) This 24-year-old's lower right wisdom tooth pierced her gum several months ago, but it does not appear to be progressing in its eruption.
(B) Although on the surface this tooth appears to come out normally, an x-ray reveals the severe horizontal malposition of this tooth.
The part visible in the mouth (circled) is in fact the back of the tooth which is tilted forward. This semi-impacted tooth will certainly be problematic one day (infection, cavities, etc.), so it is advisable to have it extracted.
As previously described, the reason for recommending the extraction is not the risk of this tooth moving the other teeth in front of it, but the fact that it could become infected and cause problems in that area of ​​the mouth.

Den Tim

Practicing dentistry for 20 years