At the beginning of the winter holidays, Bayern forward Jamal Musiala had his wisdom teeth removed. First of all, this is not an unusual procedure: wisdom tooth surgery is one of the most common outpatient surgical procedures. In Germany alone, about a million wisdom teeth are removed every year..
What seems unusual is the reason for the procedure: the 20-year-old’s wisdom teeth were identified as a possible cause of his muscle injuries. How can it be?
Bacteremia due to tooth inflammation
Sven Otto, Professor and Director of the Department of Oral and Maxillofacial Plastic Surgery at the Ludwig Maximilian University of Munich,
“The classic example of this is marginal periodontitis (Bacterial gingivitis with progressive bone loss. Note. Red.), which can lead to inflammation of the heart valve. “It’s well documented,” Otto says.
Local inflammation, such as a wisdom tooth, can lead to bacteremia: microbes enter the bloodstream, for example, through chewing or oral hygiene. When carried throughout the body in the blood, pathogens can settle in other places, for example, in the heart valve, and cause inflammation there.
Other organs, joints or joint replacements, and possibly skeletal muscles may also be affected. It’s not yet scientifically proven that dental inflammation can contribute to muscle damage, but it’s possible, Otto says, if only because it makes it harder for the body to repair itself during an infection.
Do Wisdom Teeth Really Cause Common Problems?
In principle, bacteria can enter the bloodstream during any infection – not only during inflammation of wisdom teeth. But because of their position, wisdom teeth often serve as a hiding place for streptococci and other dental microbes: in the farthest corner of our teeth, the “eight” as it is called in technical jargon, is difficult to reach with a toothbrush.
It is estimated that 80 percent of young people have at least one wisdom tooth that is missing or only partially erupting. Because when wisdom teeth are the last ones to erupt into the mouth in people between the ages of 14 and 25, there is often not enough space in the entire jaw. There are evolutionary reasons for this: over time, the lower half of the human face has become smaller, but the number of teeth has remained the same.
Problems are primarily caused by partially preserved wisdom teeth, that is, teeth that are still partially covered with mucous membrane. Infections that can spread to other teeth are more common here. “This hood of mucous membrane is a real haven for bacteria. It cannot be cleaned – no matter how well you clean,” explains Otto.
Problems can also arise if wisdom teeth do not grow straight up, but to the side and press against the adjacent tooth. Not only can this be perceived as irritation, but it can also damage adjacent teeth and tooth roots.
When should wisdom teeth be removed?
So is it better to get them out now? In the past, a commonly used rule was that wisdom teeth that had not fully erupted by age 26 should be removed for preventive purposes. This was done to prevent later problems. Today the recommendations are in Guidelines but less general.
“There are good medical reasons for wisdom teeth removal,” Otto says. “But this is by no means a case where every wisdom tooth needs to be removed.”
The need for removal depends on the specific case. If wisdom teeth are painful or repeatedly infected, the situation is clear: let’s remove them. However, a tooth that is fully erupted and fits well into the ridge may remain in the jaw.
It may make sense to keep your wisdom teeth as a backup if you subsequently lose teeth. If we lose one of the molars, it can be replaced with a wisdom tooth – provided that the root growth has not yet completed and the shape and size of the tooth fit into the resulting gap. “If the conditions are right, this is a good way to avoid an implant,” says Otto.
However, if it is predicted that there will not be enough space in the jaw and this will lead to complications, it is better to remove wisdom teeth before the age of 26. At this age, the jawbone becomes even more elastic and the conditions for wound healing are especially good. “Ultimately, it’s always a risk assessment: Are the benefits of removal greater than the risks of the procedure?”
What are the risks of treatment?
Like all surgical procedures, wisdom tooth surgery also carries risks. Bleeding, secondary bleeding, swelling and inflammation may occur. More serious risks include loss of sensation in the lower lip or tongue if nearby nerves are damaged. “Fortunately, this rarely happens, and when it does happen, it is usually temporary,” says Otto.
There is a risk, especially in older patients, that bone regeneration will not begin immediately. “It can then take six to eight weeks, sometimes even three to four months, for the bone to grow back,” Otto says. During this time, there is an increased risk of breaking your jaw if you fall, play contact sports, or chew very hard foods.
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What should you consider after surgery?
Therefore, in the first three days after surgery, the expert recommends rest, cooling and soft foods – not only for older patients. It is also recommended to take painkillers.
“One thing you definitely shouldn’t do is smoke—it seriously interferes with wound healing,” says Otto. You should also avoid drinking alcohol and caffeine after surgery, as well as excessive exercise.
Although sports or cycling can be safely resumed after about two weeks, contact sports such as kickboxing or soccer should be avoided for the first one to three months after surgery. Hitting the face at this time can not only be especially painful, but also have more serious consequences.
Is surgery possible under general anesthesia?
All the information about the risks and complications may make some people sweat. The idea quickly arises – if necessary – to remove wisdom teeth under general anesthesia.
“This is more of an exception,” says Otto. There must be good reasons for this – for example, a particularly difficult case or severe dental phobia. Although anesthesia is very safe today, there is always a residual risk. Typically, wisdom teeth are easily removed under local anesthesia. The next level of anesthesia is sedation using drugs through a vein. “But you are awake, breathing and reacting,” Otto says.
Otto, of course, can understand the desire to participate as little as possible in the operation. Some patients find wisdom tooth removal a traumatic experience. Therefore, the expert recommends that the procedure be performed by experienced dentists or oral surgeons who have experience in performing such procedures.
If you’re not sure whether you really need to have your wisdom teeth removed, you can always get a second opinion, says Otto. “There can be different points of view on the same tooth.”
To the individual
- Prof. Dr. Dr. Sven Otto is a specialist in oral and maxillofacial surgery (another name for plastic surgery in the head and neck area), as well as a dental specialist in the field of maxillofacial surgery and heads the clinic and clinic for oral, maxillofacial and plastic surgery facial area at the Ludwig Maximilian University in Munich.
- Telephone interview with Professor Sven Otto
- Recommendations of the Working Group of Scientific Medical Societies e. V. (AWMF.org), 2019: “Surgical removal of wisdom teeth” (PDF)
- AOK.de: “Wisdom teeth: what problems can they lead to?“
- Federal Medical Association: “Wisdom tooth removal“
- Hallab et al., 2022, Annals of Medicine and Surgery:”Quality of life after removal of mandibular wisdom teeth: a systematic review»
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