A Guide to Wisdom Teeth
It seems that everyone in their late teens and early 20's have been urged by their dentist to have their wisdom teeth removed. Some of the rumors about wisdom teeth are true ..... many of the rumors are not. The following is a patient's guide to wisdom teeth:
Wisdom teeth appear as the last tooth in the mouth and begin to erupt around the age of 16 years. This has been called the age of wisdom although that parallelism would be questioned by many. Depending on the reference source, up to 90% of the population does not have enough room for wisdom teeth to erupt into a position which is accessible for good hygiene.
A commonly asked question is, "Why do we have wisdom teeth if there is no room in the jaws for them?". The answer has to do with diet. According to the British Journal of Oral and Maxillofacial Surgery, in an article entitled, "Management of Asymptomatic Impacted Wisdom Teeth", Vol. 34 October 1996, the author notes that in Neolithic man the average, highly abrasive diet caused attrition of the teeth resulting in a reduction in the size of the molars from front to back. This decrease in size from the abrasive nature of the food ingested allowed for the forward migration of the teeth and adequate space for the eruption of the wisdom teeth. With the arrival of processed foods and a reduction in the amount of chewing necessary to reduce the food for swallowing, less wear occurs. This coupled with a decrease in the loss of teeth as a result of a decrease in cavities, requires modern generations to address impacted and partially impacted wisdom teeth.
When the wisdom tooth cannot be cleaned, infection results. It is the potential for infection and the potential for this infection to spread to other teeth that usually motivates the patient to have the wisdom teeth removed. Other commonly sited justifications for the removal of wisdom teeth include the potential for them to cause cysts, tumors, or cancer or the potential for them to cause crowding and shifting of the other teeth in the mouth are highly suspect. Although many believe that wisdom teeth cause crowding, this has never been definitively proven in any well controlled scientific study. Additionally, the potential for them to cause cysts or tumors is very, very low. Although removing a wisdom tooth can weaken the jaw for a short period of time post-operatively, leaving a wisdom tooth in does not cause the jaw in the area to be inherently weak. As mentioned before, cancer occurring in wisdom teeth is a rare phenomenon.
Having dispelled the evils of leaving wisdom teeth in, it is important to reemphasize the primary reason for taking them out.
Wisdom teeth are removed primarily to eliminate the potential for infection and damage to adjacent teeth. Remember, the jaws of most individuals are not large enough to accommodate the wisdom teeth and they remain either under the gum tissue where they have a three to five percent chance of becoming cystic or they become partially exposed where they have a much, much greater potential for becoming infected. Infection causes bone loss, damage to adjacent teeth and PAIN. When the dentist determines that no room exists for the wisdom teeth to erupt into a normal position, the decision then becomes, do you wait for the infection to occur or do you remove the tooth before infection and pain begins. Study after study has been done to show that infection commonly occurs around malposed wisdom teeth. Study after study confirms that complications from the extraction of wisdom teeth increases dramatically as the patient enters their 30's. Once symptoms of pocketing, swelling, food impaction or pain begin, removal is the most prudent course since the symptoms will not abate until the teeth are removed. Should the patient have only symptomatic wisdom teeth removed and leave other asymptomatic wisdom teeth in the mouth until later? This depends on the relative position of the other wisdom teeth and whether or not the patient wants to be operated on more than once. Most dentists agree that one surgery is best and that multiple trips to the oral surgeon for the removal of wisdom teeth is not in the best interest of the patient and only raises the potential for complications from multiple anesthetics.