Should wisdom teeth stay or should they go? 1


By Mac Lee

Originally posted in the Victoria Advocate

 

A panoramic patient's view of jaws, teeth, joints and sinus's. The upper jaw has only two molars on each side and no wisdom teeth. The lower left (has an L at the bottom) has a vertical wisdom tooth. If you look closely, you can see a darker space behind the tooth. This is bone loss because of infection. This tooth needs to come out. On the other hand, the one on the right is laying down sideways. It is fully encircled by bone. This one stays but needs to be checked every few years because it can become cystic.

A panoramic patient’s view of jaws, teeth, joints and sinus’s. The upper jaw has only two molars on each side and no wisdom teeth. The lower left (has an L at the bottom) has a vertical wisdom tooth. If you look closely, you can see a darker space behind the tooth. This is bone loss because of infection. This tooth needs to come out. On the other hand, the one on the right is laying down sideways. It is fully encircled by bone. This one stays but needs to be checked every few years because it can become cystic.

 

Wisdom teeth, also known as third molars, start their eruption process in the late teens and early 20s, a time when we are supposed to be wise.

Rarely do people have enough room for retaining wisdom teeth and no one knows why. There are two basics thoughts but neither can be proven. One is the diet of early man was tough on teeth and the wisdoms were replacement teeth for the ones lost. But this doesn’t make sense because when a person loses a tooth, it is like pulling a book out of a bookcase, they collapse instead of moving over to fill the gap.

The other thought, and my favorite, is when mankind developed, they lived off the land and never ate anything processed. Theory is because of diet, they had no allergies and could breathe correctly during all stages of their life. This allowed a better, broader development of the face and a longer mandible which would have given room for third molars.

One question I hear often is, “Why do I need my wisdom teeth out?”

The basic rules for keeping or extracting is based on how straight and natural they erupt. If you can clean them, you can keep them more or less. The problems is that more than 95 percent do not erupt correctly and cannot be cleaned.

 

Different eruption positions of wisdom teeth

Normal – Patient can brush and floss with ease and they are parallel with the other back teeth. They do not have to be removed if healthy.

Angled – The tip of the wisdom tooth is leaning over against the second molar which traps food. The food feeds the bacteria and the bacteria can cause tooth decay and gum disease. The decay usually occurs on the tooth next to the wisdom which is a very much needed tooth. Removal is needed to save the other teeth.

Partially erupted – The tip of the wisdom is partially sticking out of the gum. It reminds me of an iceberg with just a tip sticking out but a whole tooth underneath. These are the ones that can cause some pretty severe pain. This iceberg creates a pocket in the gum that food gets under. It can’t be cleaned out so the area becomes infected, swells, catches more food, more swelling, etc. This swelling causes the infected area to hurt all the time, especially when the patient bites down. The skin swells so much that the upper teeth hit the gum on closing. There is no choice except removal.

Soft tissue impacted – Impacted is a fancy word that simply means it never erupted through the gums. Just because you can’t see it sticking out of the gum doesn’t mean everything is OK. It is still creating a pocket next the adjacent tooth and tiny particles of food can get trapped. Yep, needs to come out.

Boney impacted – The tooth has not even come up out of the bone much less through the skin. It depends on the situation, but if it is not even close to touching gum tissue or the other tooth, it can stay. The saying dentists have on this issue is let sleeping dogs lay.

Special note on tooth extraction

Anytime a tooth is removed from the body, it is serious business. The tooth is in bone and in gums, and both are living tissue. The hole left after a wisdom or any molar tooth can be as big as a thumb. Bone is bone and when you operate on it, it demands some respect.

Some dentists refuse to do any surgery at all, so it is important to know your dentist and have an open and honest relationship with him or her.

In summary, any dentist who is removing wisdom teeth will have some type of X-ray that shows the entire mouth. They can and will explain the position of the wisdom teeth as I have done. It should all make common sense, and obviously you need a trusting relationship with whoever is going to be working in your mouth. It’s your money and your mouth, so you have the right to know.


M.Lee

 

Dr. Mac Lee practices in Edna. He is an international speaker and trainer to dentists. He is dedicated to educate the public about dental disease. To learn more about dentistry, visit drmaclee.com or call 361-782-7191.

 

 

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