Wisdom teeth – are we wiser without them?
As a dentist, probably the most unpleasant recommendation I have to give patients who are otherwise dentally healthy is 'you should have your wisdom teeth taken out'. Nobody likes having their teeth taken out, and when the process involves a 'surgery', it gets even less likeable.
The most common question I get when I make that recommendation is 'Do I really need to take them out?' It would probably be easier to answer 'you need to', but that doesn't really address your concerns.
There are 2 ends of the spectrum of thought in the dental profession on this issue. On one end is the view that all wisdom teeth should be taken out as early as possible. At the other end is that wisdom teeth, whatever their condition should (like any other tooth) be left where they are until they cause problems.
The existence of this (genuine) difference of opinion among dental professionals probably causes even more confusion for patients who may receive different advice from different dentists.
The most common question I get when I make that recommendation is 'Do I really need to take them out?' It would probably be easier to answer 'you need to', but that doesn't really address your concerns.
There are 2 ends of the spectrum of thought in the dental profession on this issue. On one end is the view that all wisdom teeth should be taken out as early as possible. At the other end is that wisdom teeth, whatever their condition should (like any other tooth) be left where they are until they cause problems.
The existence of this (genuine) difference of opinion among dental professionals probably causes even more confusion for patients who may receive different advice from different dentists.
I do not advocate that every single wisdom tooth be removed simply because they are there. Where there is plenty of space in the jaw and the wisdom tooth can come out into a good position and it has an opposing tooth to bite against so that it can function well and it can be cleaned well, it does not need to be removed.
What about when there is not enough space in the jaw for the wisdom teeth?
This is a situation called molar crowding. Even in this situation, there are cases where the wisdom teeth are useful and should be retained. For example, when a molar has been badly damaged, it may be possible (using braces) to create space for the wisdom tooth to move forward and take the place of the second molar. This is usually best done at an early age. If done in an adult, it almost invariably requires a course of treatment with braces to move the wisdom tooth into a proper position.
These are quite clear cut situations which can be detected after a thorough oral examination and evaluated easily using the CBCT scan (or dental x-ray)
What about when there is not enough space in the jaw for the wisdom teeth?
This is a situation called molar crowding. Even in this situation, there are cases where the wisdom teeth are useful and should be retained. For example, when a molar has been badly damaged, it may be possible (using braces) to create space for the wisdom tooth to move forward and take the place of the second molar. This is usually best done at an early age. If done in an adult, it almost invariably requires a course of treatment with braces to move the wisdom tooth into a proper position.
These are quite clear cut situations which can be detected after a thorough oral examination and evaluated easily using the CBCT scan (or dental x-ray)
What words of wisdom do we have?
Given this situation the 'best practice' which I advise is (as part of a regime of regular dental check-ups)
Given this situation the 'best practice' which I advise is (as part of a regime of regular dental check-ups)
- To have an orthodontic evaluation made of a child's teeth at around 8-10 years of age – if there is significant crowding detected orthodontic treatment can be initiated. How does this affect the wisdom teeth? - in evaluating the crowding of the other teeth we also consider the space available for the wisdom teeth.
- To have CBCT scan/ an x-ray examination done on the wisdom teeth (and all the other teeth and structures of the mouth) at age 16-20 years. This x-ray will help evaluate the position of the wisdom teeth. Just because there is enough space, it doesn't always mean they will come out in exactly the place we want them
- Where it is obvious that if a wisdom tooth is causing problems or will (not might) cause problems, the problematic tooth should be removed as early as possible.
What is it like after the procedure? What are the side effects?
Any surgical procedure causes trauma to the body tissues and the tissues react by becoming inflamed. Hence there is usually some swelling after a wisdom tooth surgery. This varies from person to person but the majority of our patients report very minimal swelling. Pain – this is because of the inflammation of the tissues and is quite variable also. The side effects are usually more severe when:
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What are the risks of taking out wisdom teeth?
No dental procedure is totally risk-free, and wisdom tooth removal is no different. The most common complications are:
No dental procedure is totally risk-free, and wisdom tooth removal is no different. The most common complications are:
- A dry socket, (alveolar osteitis - an infection that is prevalent among smokers), post surgical infection. This is generally treated with a course of antibiotics and it is important that patients complete the course of the medication.
- For lower wisdom teeth – damage to the inferior dental nerve (which sometimes runs close or entwined to the roots of the wisdom tooth). Most of the time, this numbness (if it occurs) may last for weeks or months, depending on the extend of the damage. Very rarely is this permanent.
- Post surgical bleeding/ bruising/pain/ difficulty to eat, talk, open mouth properly
What does a patient usually need to do after a wisdom tooth surgery? more
Given that a wisdom tooth should be taken out, when is the best time to take it out?
The earlier the better. There are a few very important reasons:
I hope that this article is useful and I tried to cover all the more common situations but it is obviously impossible to cover all possible situations in an article like this. This dental advice should not be used as a substitute for a professional advice.
Given that a wisdom tooth should be taken out, when is the best time to take it out?
The earlier the better. There are a few very important reasons:
- Younger people heal more quickly, because there is more cell activity in their bone and the surrounding tissues
- Younger people suffer less bone loss after the removal of a wisdom tooth. An impacted wisdom tooth occupies space that should be occupied by bone. When it is taken out, the space can either fill up with bone, the surrounding bone (and gum) can shrink or a combination of both effects. Bone growth is much more likely in young people.
- Younger people are much less likely to suffer longer term complications from the procedure. For example, people in their 30s are much more likely to suffer inferior dental nerve damage than people in their teens or early 20s.
- Perhaps most importantly, younger people have less opportunity cost. While it is true that young people lead lives no less busy than working adults, it is still probably easier to schedule the necessary medical leave.
I hope that this article is useful and I tried to cover all the more common situations but it is obviously impossible to cover all possible situations in an article like this. This dental advice should not be used as a substitute for a professional advice.