The pain of wisdom

The pain of wisdom
By Dr. Gita Mathai

EVERYONE knows that wisdom comes with age and maturity. That is why in all languages and cultures, the belated appearance of the last molar is equated with the accrual of wisdom. In Europe, the word for this tooth is derived from the Latin root "dens sapientiae", meaning "far standing and wise".
Evolution has made our mouths smaller. We have invented implements to externally cut our food into smaller pieces. We do not need to tear at our food as it is mashed, minced and cooked to a comfortable edible texture. The net result is that most people have smaller jaw-bones that can comfortably accommodate 28 teeth. Once the last (third) molars appear, the mouth has 32 teeth. This makes for a very cramped and uncomfortable environment. The last four teeth (that make the total 32) have no space to erupt in nine out of ten people.

Sometimes the last or third molar does not appear it all. These lucky people have "hypodontia" or less than the normal number of teeth. Some unfortunate people have supernumery teeth (more than 32), they have a mouth obviously full of many teeth crowded together.

Wisdom teeth usually erupt around the age of 17-24 years. They actually start to develop by the age of 9-11 years as small sacs inside the jaw, behind the second molar. They then grow and the roots become firmly planted in the jawbone. By the early 20s, the crown of a wisdom tooth begins to emerge from the gum. By the time you hit 40, the roots of the wisdom teeth are solidly planted within the dense bone of the jaw.

All teeth (except the wisdom tooth) have two teeth on either side holding them in place. The last molar has no tooth behind it. Unable to find its way out upwards in a normal position, it may get totally stuck or "impacted". A sac that surrounds the impacted tooth can fill with fluid and enlarge to form a cyst. This enlargement can encroach on the jaw and erode the bone causing permanent damage to the adjacent teeth, jawbone and nerves. Infection can set it with pain and swelling. It can remain as a tumor-like swelling in the jaw.

Signs heralding impending impaction or eruption are pain, tenderness, swelling both inside and outside the jaw, bad breath and difficulty with eating and swallowing. There may or may not be fever. Initial rumbling symptoms tend to progress with shorter and shorter pain-free intervals.

Painkillers and antibiotics (if there is fever) can provide only a certain amount of relief. There are no miracle cures. Hoping for spontaneous recovery is an exercise in futility. The troublesome tooth has to be surgically tackled.

Choose a dental surgeon who speaks kindly and explains the procedure. Lignocaine (local anaesthetic) and a comforting speech go a long way towards easing pain and anxiety. The numb mouth cannot feel the pain as the extraction is done, but often the gut-wrenching crunches made by the implements can be heard.

Once the surgery is over, the worst is yet to come. As the local anaesthetic wears off, the pain kicks in. Ice packs applied to the outside of the cheek help with the pain. Do not be a hero. Take a few days leave and use painkillers liberally. Eat only soft solids and don not chew on the affected side. There may be some oozing of blood, so the mouth may need to be rinsed with slightly salted water.

In Korea, wisdom teeth are called "love teeth" and in Japanese, its name literally means "unknown to the parents".

They all have the right idea. For most young adults the eruption of the third molar occurs when they have just fallen in love or started life on their own, either in a job or marriage. As they handle this major painful, though not life threatening, illness on their own, they truly attain maturity and wisdom.

The writer is a paediatrician with a family practice. She can be contacted at gitamathai@yahoo.com