Wisdom Teeth … Extract or not to Extract?
This is a question that many parents have asked me numerous times since I have been in practice. I must say, my initial opinion on this matter has changed over the years. In my early years in practice, I believed in the “wait and see” approach concerning removing of wisdom teeth on young adults. However, my own experience over the years, has led me to recommend the extraction of wisdom teeth earlier than later to make the experience pleasant for both the patient and the dentist who will be performing the wisdom teeth extraction. This philosophy is in accordance with the data from the American Dental Association.
Let me explain why I have changed my mine for the early removable of wisdom teeth for the young adults in my practice. It is a rarity that a person can have the perfect criteria for not having the wisdom teeth removed. Here are the reasons for NOT extracting the wisdom teeth:
1. Perfectly healthy.
2. Fully erupted. This means that the top portion is completely out of the gums like the other 28 teeth.
3. Good occlusion. This means the wisdom teeth are in alignment and biting correctly with the other teeth.
4. Able to be cleaned easily and properly.
Unfortunately, I have not seen many young adult patients who fulfill all four of the reasons listed above. Typically, most young patients have 2 or 3 problems which point to the deciding factors in extracting their wisdom teeth.
My reasoning by taking each of the reasons above and demonstrating how unlikely all 4 criteria are ever met are as follows:
The chance of a wisdom teeth being perfectly healthy is truly a rarity due to the location of the teeth. Modern Man due to diet and environment still get 32 teeth like the Cave Man, but our jaws are just too small to accommodate all 32 teeth. In fact, some patients even need more space even with the 4 wisdom teeth removed and need to lose additional teeth during their orthodontic treatment (Braces). Due to the limited space, wisdom teeth are in areas that we can not properly clean and maintain and therefore, are not considered healthy. Many times, our jaws and cheeks prevent us from reaching the wisdom teeth for properly flossing and brushing. This will inevitably lead to plaque and calculus accumulating on the teeth; harboring bacteria which will lead to cavities and gum disease/infection.
Again, due to the limited space in the mouth, many wisdom teeth come partially out of the gums or not at all. So you say, if it does not come out, than would it not be a good reason for not extracting the wisdom teeth? Obviously, if it is not out of the gums, bacteria can not get to it, which means no cavities nor gum problems. Right? Logic would dictate that, but unfortunately the problems are not seen in the mouth, but clearly apparent in X-rays showing potential or current problems. Again it is a space issue, and typically the wisdom teeth start to lean against the 2nd molar and start affecting the roots of a tooth you want to keep for the rest of your life. Also, as the patient ages, the wisdom teeth starts to lean more horizontally in the bone, dictating a more difficult surgery. This usually means a more invasive surgery. Also, wisdom teeth can become ankylosed (fused with bone) as you age, again creating a more invasive surgery for removable of the wisdom teeth in the future. The early removable of wisdom teeth has so many positive reasons. It just makes sense.
Here is another reason why early removable of wisdom teeth on young adult patients are highly recommended. You have just invested money and time on your child’s orthodontic treatment (Braces). The last thing you want is your child’s teeth to shift because the wisdom teeth are pushing the straight teeth, causing crowding in the front teeth. I have seen many adult patients who had to have a 2nd orthodontic treatment (Braces) to correct this issue. As always, if you have any questions, feel free to reach out to us for the best treatment options for your child. With a little pre-planning, a very conservative dental treatment of extracting wisdom teeth goes a long way for maintaining a beautiful smile for a lifetime.
“Beautiful Smiles for Today and Tomorrow”