Should They Stay or Should They Go: The Issue of Wisdom Teeth

It is believed that due to evolutionary changes in the human jawbone, changes in diet and eating utensils, which require less use of teeth, and lack of decay thanks to proper cleaning and awareness, wisdom teeth are no longer necessary.  Referred to as wisdom teeth because they are the final teeth to develop, Wisdom teeth are the third set of molars and they generally erupt between the ages of 16 and 25.  However, these teeth often cause problems because the human jaw has become smaller through evolution leaving no space in the mouth for them to fit into a normal position.  As a result, these teeth frequently become impacted in the gums or only partially erupt through the gums causing more of a problem than serving a purpose.

When teeth are completely impacted in the gums and bone, they have no room to grow.  These impacted teeth may cause problems if not removed.  Should a person in this state opt not to remove these teeth and a problem such as bone loss or the development of a cyst or jaw tumor around the impaction site occur later in life, that person’s health status may not make surgery as easy as it would be if the teeth were removed when that person were younger.  As people age, their bones become more calcified making the healing process take longer, not to mention the risk of complications is higher for us as we age.  Also, studies have proven that there can be complete regeneration of the jawbone following wisdom teeth removal when done before the age of 25.

When only a small portion of the tooth breaks through the gum, this is referred to as a partially impacted tooth.  These teeth need to be removed for several reasons.  The most common problem faced with these types of impactions is Pericoronitis.  Pericoronitis is an infection located in the tissues surrounding wisdom teeth that have not fully emerged into proper position.  Bacteria become trapped in the open space around the tooth causing an active infection.  Symptoms of this infection may include swelling, jaw stiffness, a bad odor, and taste in the mouth, and pain.  Other potential complications, which can occur if these teeth aren’t removed, are decay caused by the inability to thoroughly clean these teeth, not to mention tooth decay on a wisdom tooth’s neighboring tooth.  Poorly aligned wisdom teeth often create a trap for plaque between the second and third molars.  Of course the other significant problem resulting from the inability to clean these teeth is the development of periodontal (gum) disease, which is damaging to both the gum and bone surrounding the tooth.  Just as in bony impactions, cysts and tumors may also develop in the tissue surrounding partially impacted wisdom teeth.  These teeth may impede the movement of teeth during orthodontic treatment, and they have been known to cause lower jaw fractures as they are angled in a position that causes a weak point in the jawbone.

Not all wisdom teeth have to be extracted.  When the third molars are able to fully erupt into proper alignment, sometimes dentists will elect to let them stay, but will monitor them at routine cleanings and exams. If however, gum disease, decay or plaque control become an issue, even those wisdom teeth with adequate space may need to be extracted.  It must be noted that there are some severe impaction cases where the risks of removing the teeth may outweigh the benefits of extraction. These cases are rare and your dentist or oral surgeon will certainly discuss all risks and benefits prior to removal of any tooth. For most however, wisdom tooth extraction is worth consideration as a procedure with many potential health benefits, including serving as a source for stem cells.

Dr Horowitz is a 1991 graduate of The Medical University of South Carolina, College of Dental Medicine and completed a General practice residency at the Mountainside Hospital In Montclair, N.J. He is a Fellow of the Academy of General Dentistry as well as a member of the American Academy of Cosmetic Dentistry, the American Orthodontic Society, and The American Dental Association. He is the owner and dentist at the Carolina Center for Cosmetic and Restorative Dentistry at 1515 9^th Ave., Conway, S.C. He can be contacted at (843) 248-3843 or via the Web at www.carolinacosmeticdental.com