Is it wise to remove wisdom teeth early?
Dr. Christy Cranfill, a dentist at the highly rated Marketplace Dental Care in Indianapolis, prepares a tray to examine her next patient. (Photo by Katie Jacewicz)
Just mention wisdom teeth, and friends, family and coworkers inevitably pipe up with harrowing stories about their post-surgery recovery period, including swollen jaws, liquid diets and pain pills.
Like your tonsils and appendix, your wisdom teeth are vestigial leftovers from hunter-gatherer ancestors who had smaller brains, bigger jaws and diets that required more chewing. But for us, wisdom teeth rarely fit in our modern jaws quite right. More formally called third molars, they can become impacted or grow crooked or even horizontally. Some may not come in completely—or “erupt” to use dental lingo—and barely poke through the gum. And because they’re way back in your mouth, many of us just can’t get floss or a toothbrush back there to clean them properly, which can breed bacteria and promote infection.
Even when wisdom teeth come in straight, the American Association of Oral and Maxillofacial Surgeons (AAOMS) reported in a October 2011 study that two-thirds of people who let their wisdom teeth come in will eventually experience problems such as infection, cysts or even decay and damage to adjacent second molars. So just because those back choppers aren't bothering you, they still might be silently causing trouble.
Not everyone agrees with the proactive approach. Some dentists and oral surgeons endorse a more cautious method that involves close monitoring of the teeth and extracting only when the tooth becomes infected or starts to cause trouble. The American Dental Association advises removing wisdom teeth when there is pain, infection, cysts, tumors, damage to adjacent teeth, gum disease or tooth decay.
Is early removal unnecessary surgery? That comes down to the judgment of the oral surgeon and the patient. "There is no pat answer, cookbook recipe or flow chart that is universally accepted regarding the decision making process," states the AAOMS, which emphasizes that it does not advocate "the performance of unnecessary surgical procedures, including the prophylactic or unwarranted removal of third molar teeth."
“Like everything else, each person's tooth development varies,” says Dr. Christy Cranfill, a dentist at the highly rated Marketplace Dental Care in Indianapolis. “As a general rule, the ideal time to extract third molars is when the roots of the teeth are one-third formed, which translates to between the ages of 17 and 20. Our bones are softer and more resilient when we are young, and our bodies simply heal more quickly.”
“Current data suggests patients should be evaluated in their late teens, and if surgery is the best option, it should be completed by their mid-20s,” concurs Dr. Raymond White, Jr., professor of oral and maxillofacial surgery at the University of North Carolina Chapel Hill School of Dentistry. “After that, you can expect a delay in quality of life recovery of several days.”
Dr. Cranfill encourages almost all of her younger patients to get their wisdom teeth removed for several reasons. “Most individuals simply do not have enough room in the dental arch for their wisdom teeth to fully erupt and function properly,” she says. “If the teeth do have room to erupt, many times they will develop cavities or inflammation in the gums surrounding the tooth because they are too difficult to brush well.”
She finds that “unerupted wisdom teeth that are never removed can have complications such as cyst or tumor formation around the tooth, pericoronitis (infection in the gums above a partially erupted tooth), and even unexplained pain from the pressure of the tooth.
“Deciding to remove or retain third molars in younger individuals involves a search for the most favorable ratio of risk to benefit,” advises Dr. Stephen J. Stefanac, professor of oral medicine and periodontics at the University of Michigan School of Dentistry. “The risks include damage to adjacent teeth, nerves and bone. The primary benefit is earlier, easier and less traumatic removal of these teeth, particularly before the roots have fully developed. Families and patients may decide to obtain a second opinion or postpone surgery and monitor the development of the teeth periodically with an X-ray.”