A recent article in Medical News Today reintroduced the age-old question of whether or not to remove those pesky third molars, also referred to as wisdom teeth.
Wisdom teeth are the last teeth to grow in, and typically erupt between the ages of 17 and 25.
They don’t typically cause problems when they first appear, except when they get trapped in the jaw or underneath the gums. Most people’s jawbones don’t have enough room for 32 teeth, which includes the four wisdom teeth, so if they do come through, they oftentimes are crowded. This can result in crowding, infections, swelling, and sometimes even ear pain.
Because of this crowding, they often will grow in an unfavorable direction; sideways, or tilted, or angled partially, causing problems with the adjacent teeth and surrounding gums. This improper angulation and crowding make them much more difficult to keep clean; rendering them particularly susceptible to bacteria which leads to decay and/or infection.
Many people, however, do not need them removed, providing there is ample room in the jawbone for them and they are able to keep them properly cleaned.
If a wisdom tooth gets stuck under your gum or doesn’t have enough room to break through the gum and bone, it’s considered “impacted.”
IMPACTED WISDOM TEETH can cause a wide array of problems, including:
- Swollen gums
- Damage to adjacent teeth
- Tooth decay
- Gum disease
- Crowding of the teeth it pushes against
- The need for orthodontic treatment
- Bad breath
- Bleeding gums
DO ALL WISDOM TEETH NEED TO BE REMOVED?
Dentists will often leave wisdom teeth alone if they are fully erupted, in the right positions, are healthy and are able to cleaned properly (daily brushing/flossing).
Considerations for removing wisdom teeth may include:
- They may be causing pain in the jaw or contributing to infection in the gums.
- There is often not enough space in the jaw for third molars to erupt into a healthy functioning position.
- It hinders the other teeth from developing properly.
- Third molars are easier to remove before the roots are completely formed. This is why it is recommended to get them taken out at a younger age; typically in the late teens to early 20s. Healing following surgery is also often much quicker in younger that older adults. (Most dentists consider the “cutoff “ age for elective wisdom tooth removal at around 40.)
- Wisdom teeth may interfere with orthodontic treatment.
- In most cases they don’t really help people chew their food unless there are other missing teeth.
- The potential for creating future problems (albeit unknown in many cases).
That being said, the case for keeping those third molars could be made if:
- There is enough room for them to erupt into a healthy maintainable position in the jaw.
- Potential complications such as infection and possible numbness are considered. (This is sometimes the case in severely impacted teeth which clearly lie on or extremely near the mandibular nerve, or are deeply and completely covered/buried in bone).
- (IF it’s not a problematic one; in other words, it is fully erupted and has room for proper hygiene, it’s not putting the adjacent tooth at risk, etc., then:) A third molar could potentially be used at some point to support a fixed or removable bridge, should the second molar (the tooth in front of it) become non-restorable at some point.
History and current practices:
Previously, people routinely underwent removal of their wisdom teeth, whether or not they were causing any problems. There is still an ongoing debate on whether to remove teeth that are not causing symptoms or to leave them alone.
There are two current schools of thought:
- Maxillofacial surgeons maintain that most third molars are potentially pathological and should be removed.
- The other, argues that only those third molars with associated pathology should be removed.
In a 2021 study, only 28% of the third molars underwent removal, while 76.4% of those, having had justifiable reasons for their removal.
These are just a some of the considerations that should be addressed in deciding whether or not to undergo removal of those wisdom teeth. Be sure to consult with us if you ever find yourself at this crossroad.
If you still have your wisdom teeth and you’re wondering if they should be removed or not, give our office a call and we will be happy to take an x-ray and evaluate you to help weight the pros and cons for your particular situation.
We do not, as a routine protocol, recommend that ALL wisdom teeth be extracted.
Our consultation is complimentary.