Nearly every day, I have the dubious opportunity to do fillings or other work on wisdom teeth for patients who many years ago decided to keep them.
Work on wisdom teeth is difficult for many reasons including: The lowers are an anesthesia challenge, the uppers are difficult to see without the aid of a mirror (for which there is essentially no room while the drill is turning), pulpal (nerve) position is often unpredictable, typical equipment is not made with the length needed to access these teeth without a lot of improvising. Wisdom teeth are just plain hard to work on, and uncomfortable for the patient while the work is being done.
Let’s look at some of the items that are known these days about wisdom teeth and what a person who keeps them can expect in the long term. Normally speaking, eruption occurs late in a person’s teens or into their twenties. Movement can occur much later even past 40 years old. Even with advances in dentistry, predicting whether a particular wisdom tooth will erupt and at what angle is not very accurate. Even if a wisdom tooth erupts, that still does not say much about whether it will be useful or healthy. If a patient is not able (or willing) to access all of the surfaces of the tooth a couple of times a day for cleaning (including the back of the tooth using floss) the chance of later troubles is virtually 100%. And this is where most of the troubles come in. Most patients who keep their wisdom teeth cannot or otherwise do not clean the wisdom teeth adequately or at all. One study concluded that 40% of wisdom teeth kept in the mouth will develop caries (cavities) by 40 years of age. As well, the incidence of periodontal disease (bone loss) around retained wisdom teeth is higher than around other teeth. In fact, presence of wisdom teeth makes periodontal disease more likely throughout the entire mouth.
One of the often cited studies concluded that nearly one fourth of impacted (not visible in the mouth) wisdom teeth caused resorption (disappearance) of root structure on the molar next to the impacted wisdom tooth. Virtually all of these resorption cases are completely without symptoms until the tooth next to the wisdom tooth is nearly or completely destroyed. There are other potential problems associated with retaining impacted wisdom teeth as well. One study found that up to 34% of retained impacted wisdom teeth will develop cysts. A cyst will typically destroy bone in the area of the wisdom tooth affected and will do it painlessly, so the patient has no way of knowing the cyst is there until the jaw is severely compromised. I have seen some cases where enough bone disappeared that the jaw was severely weakened. And after cysts like these are removed, their recurrence rate is high.
Of course, not all retained wisdom teeth will develop problems, but it is difficult (meaning not very reliable) to predict which ones will. Waiting until later in life to get wisdom teeth out only makes them more difficult to remove and more likely to develop problems related to the surgery. Surgery when one is older is more likely to result in increased pain and swelling on removal, as well as an increased chance of fracture when the teeth are removed when compared to removal on a younger person, as well as an increase in complications when healing. As well, if a person decides to keep the teeth and periodontal disease has begun on adjacent teeth because of keeping the wisdom teeth, it is very difficult to replace bone. For most cases, it could be said that bone loss can usually be stopped if it has not progressed too far, but addition of bone is still an emerging technology.
The bottom line is, if the dentist has some reasons why your wisdom teeth should be removed, your wallet and your health would be better served to remove them as a younger person rather than waiting until later. If you do keep them, what does it mean when a dentist says a filling or a crown was “difficult”? Usually what it means is that in order to maintain an acceptable level of quality, extraordinary measures had to be taken. Sometimes quality suffers in this kind of case. And if a patient is going to all this trouble for a wisdom tooth when the adjacent teeth are present and in fine shape, and cleaning is difficult or impossible in the area at home, why is the patient keeping this tooth? If you have wisdom teeth, you might want to ask your dentist about your individual case.
- This article was written by Dr. Mike Christensen and published in the Daily Miner and News, and Enterprise. Local Kenora News Publicatons (1998-2006)