Trial Molars: Characteristics, Functions, Symptoms, Treatment, Complications and Alternatives

They are the four third molars located in the dental arch of the permanent dentition.

In the dental arch, four chordal wisdom teeth are usually formed, one for each buccal quadrant; they are placed in the last position of the denture line, at the bottom of the mouth.

The wisdom teeth develop in the back of the mouth, and usually, when they grow up, it is at the end of adolescence.

It is at this time when the 28 teeth of an adult are generally already in place, and the space in the mouth for the wisdom teeth to grow correctly is not enough.

That is why they usually grow crooked, sideways, or misaligned, and as they emerge, they push the other teeth out of alignment and cause agglomeration problems.

Although most people have wisdom teeth, some of the third molars likely never develop or become visible.

All this because they did not burst through the gums or also emerge at an angle or emerge partially.


When the wisdom teeth grow in this way, it is called “impacted.”

There is also the possibility that a person has more wisdom teeth than the usual four.

Wisdom teeth usually appear between 17 and 21 years old.

When young, the roots are not entirely formed, and the bone is softer, so there is less chance of damaging nearby nerves when they are removed.

The roots will continue to grow with time, making them more painful and more vulnerable to complications during wisdom teeth surgery.

Characteristics of wisdom teeth

  • Its anatomy is very variable and can present between one to four roots and one to six conduits in the form of C.
  • It may be inclined in a distal or vestibular direction, which is an even more significant disadvantage for its access compared to the second molar.
  • They can be blocked by other teeth or by the bone and placed under the gum that stops them and does not allow their exit.
  • The teeth located next to the wisdom teeth are the most affected and prone to presenting gum and decay problems.
  • Those wisdom teeth can not erupt in their entirety cause that part of the tooth is covered by pieces of the gum, being reservoirs of food and bacteria that can lead to infections or inflammations. This usually happens with the wisdom teeth located in the lower jaw.

Wisdom teeth functions

The wisdom teeth are considered relics of human evolution; anthropologists argue that these were useful for the first men by their type of diet (roots, nuts, canes, meats). They are foods that require a lot of chewing ability to form the food bolus.

When the teeth weathered or fell off, the wisdom teeth were the replacements.

With modern advances in oral hygiene and seeing that our current diets are based on softer and soft food, no teeth need these handsets.

So evolutionary biologists classify wisdom teeth as dysfunctional because of human evolution.

Space dental arch may contain 28 teeth, but when the wisdom teeth emerge, are 32 teeth in competition for space.

Adverse reactions usually occur due to overcrowding; these typically cause discomfort.

Symptoms of the wisdom tooth growth

The pain appears in the back of the gums, behind the last molars.

The pain gradually increases when the wisdom teeth continue to emerge in the small space where they are growing, compressing the nerves, the jawbones, and the surrounding teeth.

Wisdom teeth can emerge through the surface of the gums, and it is relatively easy for bacteria to enter through this opening of the gum around the tooth.

This causes the introduction of bacteria in this open tissue.

Food and bacteria are trapped, causing an accumulation of plaque, which can lead to:

  • Dental caries: Developed by the corrosive action of the plaque on the surface of the tooth, which advances and affects the adjacent teeth.
  • Diseases in the gums (gingivitis or periodontal diseases): The toxins released by the plaques irritate the gums, and redness and swelling appear, causing pain. This disease in the gums also affects the nearby teeth and the bone around the wisdom teeth.
  • Pericoronitis: An infection caused by the plaque in the soft tissue surrounding the tooth.
  • Cellulitis or abscesses: It is a bacterial infection in the soft tissues of the cheek, tongue, or throat, with an accumulation of pus in the wisdom teeth or the surrounding tissue. If immediate relief for these conditions is not sought, these oral infections likely pass into the bloodstream affecting the entire organism.

Wisdom teeth may be affected when the jaw bone and nearby teeth block the eruption of these teeth due to lack of space.

Being trapped without being able to emerge, their roots continue to be extended by the time they remain impacted.

If not treated in time, impacted wisdom teeth can give rise to cysts and, in some cases, even tumors.

Cysts and benign tumors are rare conditions where the gum develops a swelling due to the presence of fluid or a tumor mass.

The presence of cysts or tumors can damage adjacent teeth and tissues, including bone, complicating the extraction of wisdom teeth.

The symptoms of this impaction can include severe pain in the back of the gums, the presence of infections, and other complications.

The longer you wait to remove the wisdom teeth, the more procedures are likely required for surgical removal that is more invasive or that these molars cause permanent damage to the surrounding tissues.

Occasionally, these infections can cause inflammation not only of the gum tissue but also of the cheeks or other areas adjacent to the affected side of the jaw.

The swelling causes pressure on the adjacent structures and radiates to the ear, causing intense pain.

In some cases, an infection in the ear or a sinus problem can cause pain that radiates to the teeth, so it is essential to establish a differential diagnosis.

Treatment of wisdom teeth

The most recommended treatment for the symptoms that cause the appearance of wisdom teeth is the extraction of those teeth.

The wisdom teeth extraction is done by an oral surgeon and under local or general anesthesia.

The options and any complications will be discussed before starting the extraction procedure with the patient.

If the wisdom teeth have already begun to erupt through the surface of the gums, they can be removed with relative ease, as is done with any other tooth.

It is a little harder to eliminate when the wisdom teeth are impacted.

Extraction of the wisdom tooth is a common practice and is undoubtedly the best option to alleviate the symptoms that wisdom teeth generate.

Currently, specialists recommend the preventive extraction of wisdom teeth before the discomfort occurs, which is a problem for the oral health of the individual.

If swelling, infections, swallowing difficulties, fever, or a lot of pain occur, antibiotics should be prescribed to prevent the disease from increasing or spreading to other parts of the body.

You can also prescribe the use of rinsing with warm salt water or with an antibacterial mouthwash.

These actions are short-term to reduce inflammation and tooth pain until definitive treatment can be performed.


This procedure can be as simple as the extraction of any other dental piece or so complicated that it requires a more complex surgical intervention.

As with any dental problem, the specialist in your regular dental checkup must review the state of the wisdom teeth and recommend the ideal time to perform the extraction.

First, a panoramic radiograph of the mouth should be performed when it is necessary to remove the wisdom teeth.

This gives the dentist a clear view of the position of the teeth and allows the diagnosis to program how the extraction of the wisdom teeth is performed.

A local anesthetic is administered to numb the area around the tooth to perform the procedure.

It is necessary to make an incision in the gum, and it may be required before extracting the tooth sectioned into small pieces.

The time it takes to extract the tooth varies; in some cases, the procedure only takes a few minutes, but it is possible that in other cases, it may take more than 30 minutes.


After removing the wisdom teeth, you may experience swelling, pain, and discomfort inside or outside the mouth; these symptoms are more intense during the first three days.

The medical guidelines must be followed without modifications.

The specialist prescribes analgesics, anti-inflammatories, and treatment for infections and other recommendations such as:

  • Do not rinse until 24 hours after surgery.
  • You can not brush your teeth. When the brushing is done on the area of ​​the surgery, it should be done after 48 hours, gently and with great care.
  • At 48 hours after the surgery, you should rinse your mouth at least 5 to 6 times a day, especially after eating, with a mixture of warm water with salt or mouthwashes containing chlorhexidine for 15 days.
  • If the clot forms and normal bleeding has stopped, it is recommended to gently bite sterilized gauze with cold water in cold water for 45 minutes. This helps accelerate the clotting process.
  • If the side of the face where the extraction was made is immediately inflamed after surgery, a bag with ice should be placed for 30 minutes every 3 hours. This will help the inflammation to reduce rapidly.
  • Do not smoke or drink, as nicotine irritates mouth sores, and alcohol inhibits the effects of antibiotics.
  • Points should be removed about a week after the surgery.
  • Day-to-day activities should be restricted during surgery, and vigorous physical exercise should be avoided.
Possible complications

Like all surgery, some risks are associated with wisdom teeth extraction.

These risks include infections or delays in healing, which are more likely when the patient smokes during recovery or if they have diabetes.

Another complication is the so-called ” dry alveolus, “which occurs when the coagulum typically formed after extraction is lost in the dental alveolus.

So the bone and nerves are exposed to the air, causing pain and delaying recovery.

This manifests as a painful sensation in the gum or jaw and, in some cases, the presence of a foul smell or taste that comes from the empty tooth socket.

There may also be a risk of damage to the nerves, which cause pain or numbness of the lower lip, chin, teeth, tongue, gums, and a slight tingling sensation.

Other options

The removal of all wisdom teeth is not necessary.

When the wisdom tooth erupts cleanly through the gum tissue without compromising the adjacent tooth, the wisdom tooth can remain in the dental arch without any problem.

In these cases, dental hygiene is stricter; good brushing should be done, and flossing is recommended.

The wisdom teeth must be inspected regularly by a dentist to determine the proper diagnosis and the course that these teeth follow over time.

The situation of the wisdom teeth varies significantly between the ages of 16 and 23 years.

Eventually, the wisdom teeth can cause pain produced by a small flap of gum tissue that has been displaced by the exit of the wisdom tooth, which has swollen and barely covers the back of the tooth.

If there is enough space for the accommodation of the tooth, the excess tissue of the gum can be removed to solve this problem, and extraction of the wisdom tooth is not necessary.

It is necessary to modify the brushing angle and increase the frequency of flossing.

It can help protect gum tissues by keeping them healthy and preventing conditions such as painful gingivitis or infections around the wisdom teeth.

When the third molar has started its eruption through the gum tissue, but there is no occlusion or contact with other teeth, which interferes with its exit, the extraction should be considered.

When reviewing the position of erupting wisdom teeth, these teeth are often difficult to keep in good cleaning condition.

When these teeth acquire cavities, it is usually recommended to remove them instead of eliminating holes or repairing wisdom teeth using fillings, root canals, or crowns, which are indicated for the rest of the teeth successfully.