Some people are born without one, or even all, of their wisdom teeth! In fact, wisdom teeth are the most common teeth to be missing from birth. This suggests to us that even Mother Nature is trying to eliminate wisdom teeth. For the majority of us, who are not lucky enough to benefit from Mother Nature’s “phase out”, surgical removal of our wisdom teeth is frequently necessary. In fact, recent research has shown that the vast majority of wisdom teeth should be removed and that they are best removed between the ages of 15 and 25.
Being the last teeth to erupt, the wisdom teeth (a.k.a. third molars) frequently do not fit into the mouth and bite. This is because our other teeth have already nearly filled the available space. This causes the wisdom teeth to force themselves into strange positions in their quest to come in to the mouth. Not uncommonly these strange positions leave the wisdom teeth trapped partially in the jaw and partially in the mouth. This situation ends up trapping food and bacteria around the wisdom teeth, while preventing proper brushing and flossing of the malpositioned teeth. This then leads to the development of cavities, gum disease, and bone loss in the region, as well as creating a nest around the wisdom teeth for the bacteria that cause this damage.
Antiquated philosophies commonly held that patients should wait until the wisdom teeth “came in” or, worse yet, started “having trouble”, before they were removed. We now know that such a delay in removing the wisdom teeth is very counterproductive. By the time the wisdom teeth “come in” or start “having trouble”, damage has frequently already occurred. Additionally, delaying the removal of wisdom teeth allows their roots to grow longer and more curved, so that they are harder to remove as the patient ages. Just like a young, short-rooted weed is easier to pull than a large, old dandelion, so is a young, short-rooted wisdom tooth easier to remove compared to a fully formed one.
With the x-ray technologies we have available, as well as the research showing that the vast majority of wisdom teeth should be removed, it is easy to predict which ones need removal at an early age. Our office recommends a screening x-ray (“Panorex”) be taken at age 14 – 16. If the wisdom teeth are ready for removal then, we recommend proceeding to surgery. If the wisdom teeth are not positioned for reasonable removal on this initial x-ray, another film is taken in 2 – 3 years and usually indicates that it is time for removal.
As we age removing wisdom teeth becomes more difficult, therefore the recovery away from school and work is longer. Additionally, an adult’s ability to “bounce back” from surgery is less rapid than in the teenage years. Usually teenagers can schedule surgery during a vacation break from high school or college. As we enter the work force, finding the time to have surgery (and its recovery) becomes much more onerous. Given that removal of wisdom teeth after the mid twenties is notably more difficult, the frequency and severity of the surgical complications also rises proportionately with age. The younger the patient, the faster they recover, and the less short and long term complications there are. In the older age group, patients having wisdom teeth out are not uncommonly forced to have the adjacent molars removed, due to the long term damage caused by the wisdom teeth.
Wisdom teeth have been cited by some as causing crowding of the front teeth as they try to come in. This has never actually been proven or disproved to occur, though. Others note that wisdom teeth can be the source of large, destructive tumors and cysts of the jaws. Although very true, these cysts and tumors arise in a very small number of people. Wisdom teeth being the cause of painful infections, cavities on themselves, as well as adjacent teeth, and gum disease with bone loss on themselves and adjacent teeth are far more important and far more common reasons for their removal than crowding of the front teeth or the development of cysts and tumors. This is not to say that crowding, cysts, and tumors are of no concern, though, just less so than advertised.
Frequently the small x-rays taken at the dentist’s office do not reach far enough back in the mouth to properly image the wisdom teeth. Only the special “Panorex” type x-ray is adequate to image most wisdom teeth. Everyone should have at least one “Panorex” x-ray in their lifetime, preferably before the age of 20. If this film shows that the wisdom teeth need removal, then surgery should be performed in short order. In the uncommon case that it is decided to leave any wisdom teeth in place, they should be monitored, over the patient’s lifetime, with periodic “Panorex” x-rays, to make sure that no cavities, bone loss, gum disease, cysts, and / or tumors are developing, slowly, over time. The surgeons at Associates in Oral and Maxillofacial Surgery would be happy to perform these “Panorex” x-rays for you and counsel you regarding the proper treatment of your wisdom teeth.
The most common issue that all oral and maxillofacial surgeons deal with is wisdom teeth and the problems that they cause. Given their advanced, surgical training, oral and maxillofacial surgeons are the ones best suited to counsel patients regarding wisdom teeth and their proper treatment.