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Wisdom tooth

A wisdom tooth or third molar is one of

the three molars per quadrant of the
human dentition. It is the most posterior of
the three. The age at which wisdom teeth
come through (erupt) is variable,[1] but
generally occurs between late teens and
early twenties.[2] Most adults have four
wisdom teeth, one in each of the four
quadrants, but it is possible to have none,
fewer, or more, in which case the extras
are called supernumerary teeth. Wisdom
teeth may get stuck (impacted) against
other teeth if there is not enough space for
them to come through normally. While this
does not cause movement of other
teeth,[3] it can cause tooth decay if the
impaction makes oral hygiene difficult.
Wisdom teeth which are partially erupted
through the gum may also cause
inflammation and infection in the
surrounding gum tissues, termed
pericoronitis. Wisdom teeth are often
extracted when or even before these
problems occur. However, some, including
the National Institute for Health and Care
Excellence in the UK, recommend against
the prophylactic extraction of disease-free
impacted wisdom teeth.[3][4][5]
Wisdom tooth

Wisdom teeth
 3D CT of an impacted wisdom tooth near the
inferior alveolar nerve

Identifiers

MeSH D008964

TA A05.1.03.008

Anatomical terminology

Structure
Variation …
Agenesis of wisdom teeth differs by
population, ranging from practically zero in
Aboriginal Tasmanians to nearly 100% in
indigenous Mexicans[6] (see research
paper with world map showing
prevalence). The difference is related to
the PAX9, and MSX1 gene (and perhaps
other genes).[7][8][9][10]

Age of eruption …
There is significant variation between the
reported age of eruption of wisdom teeth
between different populations.[11] For
example, wisdom teeth tend to erupt
earlier in black people compared to Asian
and white people.[11]

Generally wisdom teeth erupt most

commonly between age 17 and 21.[1]
Eruption may start as early as age 13 in
some groups[11] and typically occurs
before the age of 25.[12] If they have not
erupted by age 25, oral surgeons generally
consider that the tooth will not erupt
spontaneously by itself.[2]

Function
Wisdom teeth are vestigial third molars
that helped human ancestors to grind
plant tissue. It is thought that the skulls of
human ancestors had larger jaws with
more teeth, which possibly helped to chew
foliage to compensate for a lack of ability
to efficiently digest the cellulose that
makes up a plant cell wall.[13] After the
advent of agriculture over 10,000 years
ago, soft human diets became the norm,
including carbohydrate and high energy
foods. Such diets typically result in jaws
growing with less forward growth than our
paleolithic ancestors and not enough
room for the wisdom teeth.[14]

Clinical significance
A wisdom tooth protrudes outwards from the gumline
with inflamed tissue at the back (pericoronitis; green
arrow)

Wisdom teeth (often notated clinically as

M3 for third molar) have long been
identified as a source of problems and
continue to be the most commonly
impacted teeth in the human mouth. The
oldest known impacted wisdom tooth
belonged to a European woman of the
Magdalenian period (18,000–10,000
BCE).[15] A lack of room to allow the teeth
to erupt results in a risk of periodontal
disease and dental cavities that increases
with age.[16] Less than 2% of adults age 65
years or older maintain the teeth without
cavities or periodontal disease and 13%
maintain unimpacted wisdom teeth
without cavities or periodontal disease.[17]
Some problems which may or may not occur with
third molars: A Mesio-impacted, partially erupted
mandibular third molar, B Dental caries and
periodontal defects associated with both the third and
second molars, caused by food packing and poor
access to oral hygiene methods, C Inflamed
operculum covering partially erupted lower third
molar, with accumulation of food debris and bacteria
underneath, D The upper third molar has over-erupted
due to lack of opposing tooth contact, and may start
to traumatically occlude into the operculum over the
lower third molar. Unopposed teeth are usually sharp
because they have not been blunted by another tooth.

Impacted wisdom teeth are classified by

the direction and depth of impaction, the
amount of available space for tooth
eruption and the amount soft tissue or
bone that covers them. The classification
structure allows clinicians to estimate the
probabilities of impaction, infections and
complications associated with wisdom
teeth removal.[16] Wisdom teeth are also
classified by the presence of symptoms
and disease.[18]

Treatment of an erupted wisdom tooth is

the same as any other tooth in the mouth.
If impacted, treatment can be restoration,
local treatment to the infected tissue
overlying the impaction,[19]:440–441
extraction[20] or coronectomy.[21]

The upper left (picture right) and upper right (picture

The upper left (picture right) and upper right (picture
left) wisdom teeth are distoangularly impacted. The
lower left wisdom tooth is horizontally impacted. The

lower right wisdom tooth is vertically impacted

(unidentifiable in orthopantomogram).

History
Although formally known as third molars,
the common name is wisdom teeth
because they appear so late – much later
than the other teeth, at an age where
people are presumably "wiser" than as a
child, when the other teeth erupt.[22] The
term probably came as a translation of the
Latin dens sapientiae. Their eruption has
been known to cause dental issues for
millennia; it was noted at least as far back
as Aristotle:

The last teeth to come in man

are molars called 'wisdom-
teeth', which come at the age of
twenty years, in the case of both
sexes. Cases have been known in
women upwards of eighty years
old where at the very close of life
the wisdom-teeth have come up,
causing great pain in their
coming; and cases have been
known of the like phenomenon
in men too. This happens, when
it does happen, in the case of
people where the wisdom-teeth
have not come up in early years.

— Aristotle, The History of

Animals[23]
Nonetheless, molar impaction was
relatively rare prior to the modern era. With
the Industrial Revolution, the affliction
became ten times more common, owing to
the new prevalence of soft, processed, and
sugary foods.[24]

See also

References
1. McCoy, JM (September 2012).
"Complications of retention: pathology
 associated with retained third
molars" . Atlas of the Oral and
Maxillofacial Surgery Clinics of North
America. 20 (2): 177–95.
doi:10.1016/j.cxom.2012.06.002 .
ISBN 978-1455747887.
PMID 23021395 .
2. Swift, JQ; Nelson, WJ (September
2012). "The nature of third molars: are
third molars different than other
teeth?" . Atlas of the Oral and
Maxillofacial Surgery Clinics of North
 America. 20 (2): 159–62.
doi:10.1016/j.cxom.2012.07.003 .
PMID 23021392 .
3. Friedman, JW (September 2007). "The
prophylactic extraction of third molars:
a public health hazard" . American
Journal of Public Health. 97 (9):
1554–9.
doi:10.2105/AJPH.2006.100271 .
PMC 1963310 . PMID 17666691 .
4. "1 Guidance | Guidance on the
Extraction of Wisdom Teeth | Guidance
 | NICE" . www.nice.org.uk. Retrieved
2019-12-03.
5. "Opposition to Prophylactic Removal
of Third Molars (Wisdom Teeth)" .
www.apha.org. Retrieved 2019-12-02.
6. Rozkovcová, E.; Marková, M.; Dolejší, J.
(1999). "Studies on agenesis of third
molars amongst populations of
different origin". Sborník Lékařský. 100
(2): 71–84. PMID 11220165 .
7. Pereira, Tiago V.; Salzano, Francisco
M.; Mostowska, Adrianna; Trzeciak,
Wieslaw H.; Ruiz-Linares, Andrés;
Chies, José A. B.; Saavedra, Carmen;
Nagamachi, Cleusa; et al. (2006).
"Natural selection and molecular
evolution in primate PAX9 gene, a
major determinant of tooth
development" . Proceedings of the
National Academy of Sciences. 103
(15): 5676–81.
Bibcode:2006PNAS..103.5676P .
doi:10.1073/pnas.0509562103 .
 JSTOR 30050159 . PMC 1458632 .
PMID 16585527 .
8. Bonczek, O; Balcar, VJ; Šerý, O (2017).
"PAX9 gene mutations and tooth
agenesis: A review". Clin Genet. 92 (5):
467–476. doi:10.1111/cge.12986 .
PMID 28155232 .
9. Lidral, AC; Reising, BC (April 2002).
"The role of MSX1 in human tooth
agenesis" . J. Dent. Res. 81 (4): 274–
8.
 doi:10.1177/154405910208100410 .
PMC 2731714 . PMID 12097313 .
10. Tallón-Walton, V; Manzanares-
Céspedes, MC; Carvalho-Lobato, P;
Valdivia-Gandur, I; Arte, S; Nieminen, P
(2014). "Exclusion of PAX9 and MSX1
mutation in six families affected by
tooth agenesis. A genetic study and
literature review" . Med Oral Patol Oral
Cir Bucal. 19 (3): e248–54.
doi:10.4317/medoral.19173 .
PMC 4048113 . PMID 24316698 .
11. Tsokos, Michael (2008). Forensic
Pathology Reviews 5 . Springer
Science & Business Media. p. 281.
ISBN 9781597451109.
12. "Wisdom Teeth" . American
Association of Oral and Maxillofacial
Surgeons. Retrieved 2019-11-19. "They
come in between the ages of 17 and
25, a time of life that has been called
the “Age of Wisdom.”"
13. Cooper, Rachele (February 5, 2007).
"Why Do We Have Wisdom Teeth?" .
 Scienceline.org. Archived from the
original on 2016-05-03.
14. von Cramon-Taubadel, Noreen (2011-
12-06). "Global human mandibular
variation reflects differences in
agricultural and hunter-gatherer
subsistence strategies" . Proceedings
of the National Academy of Sciences
of the United States of America. 108
(49): 19546–19551.
Bibcode:2011PNAS..10819546V .
doi:10.1073/pnas.1113050108 .
 ISSN 0027-8424 . PMC 3241821 .
PMID 22106280 .
15. "Magdalenian Girl is a woman and
therefore has oldest recorded case of
impacted wisdom teeth" (Press
release). Field Museum of Natural
History. March 7, 2006. Retrieved
February 15, 2013.
16. Juodzbalys, Gintaras; Daugela, Povilas
(Apr–Jun 2013). "Mandibular Third
Molar Impaction: Review of Literature
and a Proposal of a Classification
 (review)" . J Oral Maxillofac Res. 4 (2):
e1. doi:10.5037/jomr.2013.4201 .
PMC 3886113 . PMID 24422029 .
17. Marciani RD (2012). "Is there
pathology associated with
asymptomatic third molars (review)". J
Oral Maxillofac Surg. 70 (Suppl 1): 15–
19. doi:10.1016/j.joms.2012.04.025 .
PMID 22717377 .
18. Dodson TB (Sep 2012). "The
management of the asymptomatic,
disease-free wisdom tooth: removal
 versus retention. (review)". Atlas Oral
Maxillofac Surg Clin North Am. 20 (2):
169–76.
doi:10.1016/j.cxom.2012.06.005 .
PMID 23021394 .
19. Newman MG, Takei HH, Klokkevold PR,
Carranza FA (2012). Carranza's Clinical
Periodontology. Elsevier Saunders.
ISBN 978-1-4377-0416-7.
20. Pogrel MA (2012). "What are the Risks
of Operative Intervention (review)". J
Oral Maxillofac Surg. 70 (Suppl 1): 33–
 36. doi:10.1016/j.joms.2012.04.029 .
PMID 22705215 .
21. Ghaeminia H (2013). "Coronectomy
may be a way of managing impacted
third molars (systematic review)". Evid
Based Dent. 14 (2): 57–8.
doi:10.1038/sj.ebd.6400939 .
PMID 23792405 .
22. "Wisdom tooth". Oxford English
Dictionary. Oxford: Oxford University
Press. 1989. ISBN 0-19-861186-2.
23. Aristotle (2015). The History of
Animals . Translated by D'Arcy
Wentworth Thompson. Aeterna Press.
p. 49.
24. "What teeth reveal about the lives of
modern humans" . Retrieved
2018-10-22.

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