Contrary to popular wisdom
LTCOL Sven Bohnstedt gives some sage advice about the removal of wisdom teeth.

Only wisdom teeth that are partially-grown and which become stuck or impacted are removed.

Rumour: All wisdom teeth are removed when members enlist.

Fact: The ADF uses the same guidelines as would be applied to civilians when deciding if wisdom teeth need to be extracted or left alone. There are plenty of members who still have their wisdom teeth. The growth of wisdom teeth happens at about 18-26 years of age. A large percentage of the Service population is in this age bracket so there is a possible need for surgical intervention.

Rumour: All wisdom teeth are removed before an operational deployment.

Fact: An upcoming operational deployment may make routine scheduling of wisdom teeth removals more difficult to fit in with pre-deployment training and so surgery will have to be brought forward. In such cases, the reasons for wisdom teeth removal remain unchanged, but the scheduling of surgery has to been brought forward to allow time for healing. So having your wisdom teeth removed before a deployment does not represent a change in policy to the ADF’s standard approach of preventive removal.

DEFENCE satisfaction surveys find that members are generally very satisfied with the dental services they receive, but no other dental treatment becomes as emotional as the removal of wisdom teeth. Unfortunately, there is a general lack of understanding within the ADF about wisdom teeth and why they are removed.

Growing up wise

Wisdom teeth are normally the last teeth to grow in the mouth, any time between 18 and 26 years of age. Most people have four wisdom teeth, one in each corner of their mouths. Some people have less than four, very few have none and very few have more than four. When a wisdom tooth is coming through, like all teeth, it can do three things:

Removing infection

A partially-grown and impacted wisdom tooth can cause a lot of problems if it is left in the mouth.

It is an area in the mouth that cannot be cleaned easily and properly, which can lead to two common problems:

First, it can cause tooth decay in the wisdom tooth itself or in the tooth next to it. This tooth decay can get quite large before it is discovered and be very difficult to repair. You may lose both the wisdom tooth and the tooth next to it because of extensive decay.

The second problem is gum infection around the wisdom tooth, called pericoronitis. This infection causes mildly uncomfortable to very severe pain and sometimes some gum swelling that makes eating difficult. In some cases, the infection can cause swelling of the cheek and the neck.

Because wisdom teeth are at the back of the mouth, close to the airway, any infection around the area can potentially become very serious. Before the days of antibiotics, people could die from an infected wisdom tooth. Luckily, this is very rare today and most cases of pericoronitis will get better with a mouthwash and a course of antibiotics.

But once a tooth has had a case of pericoronitis, the infection tends to return every few months and get worse each time around, because the cause of the infection (the tooth) is not removed.

Pericoronitis tends to occur when a person is run-down, which may be caused by a cold, flu or stress. It also occurs when oral hygiene is not good enough. Oral hygiene is most often neglected under the duress of operational conditions.

That is why the ADF places such a high priority on removing partially-grown and impacted wisdom teeth – to reduce and remove the need for evacuation from operations for dental treatment.

Unfortunately, removing problem wisdom teeth on operations is a very compromised option, even if it is possible without a specialist surgeon and hospital readily available.

The infection is active, the patient is sick, oral hygiene is most often neglected and uninterrupted recovery is most likely short-changed under operational duress. As a general rule, the longer a wisdom tooth is left in the mouth, the more difficult it is to remove because the tooth is bigger and the bone is harder.

Good riddance options

Because wisdom teeth are at the back of the mouth, they are difficult to reach to properly clean and this can lead to infection and the need to remove them.

Photos by CPL Belinda Mepham

There are a number of ways that wisdom teeth can be removed and your dental officer will discuss these options and suggest the best course of treatment.

The surgeon can be a dentist, an oral surgeon who has postgraduate training in removing wisdom teeth, or an oral and maxillofacial surgeon who is a specialist.
Wisdom teeth can be removed under local anaesthesia in the dental chair, similar to having a filling. This is only appropriate for relatively simple and easy extractions of wisdom teeth.

For more difficult cases or when a number of teeth are required to be removed, it may be appropriate to use local anaesthesia and intravenous sedation.

Amnesic and sedative drugs are given through a needle in your hand or arm to make you drowsy and help you relax. Local anaesthetics are then given to numb your teeth and gum. It is not a general anaesthetic because you can still talk to the surgeon throughout the procedure.

However, the sedation drugs affect memory and very little is remembered of the procedure afterwards. A dental sedationist or an anaesthetist can provide this sedation in the dental chair or in theatre. The majority of wisdom teeth can be removed this way and it works very well.

For complex and particularly difficult wisdom teeth cases, it is best that these teeth are removed under general anaesthetic in a hospital theatre, be it military or civilian.

ADF dental facilities and your supervising dental officers will ensure that all members who have their wisdom teeth removed in any of the ways mentioned above are well cared for before, during and after surgery, to enhance a quick and uncomplicated recovery.

For more information contact your local dental officer or see Health Directive 404 – Indications for Removal of Third Molars in the ADF.