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The Wisdom of Remaining

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The Wisdom of Remaining

The Wisdom of Remaining

June 20, 2005
By Shelagh McNally for Dental1

Wisdom teeth can cause more problems than any other tooth. They often grow in crooked or remain underneath the gum as impacted teeth. In fact nine out of 10 people have at least one impacted wisdom tooth that causes problems such as gum inflammation, infection or tooth decay. More complicated problems include cysts or tumors. Automatic removal of wisdom teeth has become a rite of passage for many teenagers when they reach 18. But according to a new report that may not be the best course of treatment.
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When is removal right:

  • When gum infection from bacteria collecting under the gum is present.

  • If there is decay caused from improper cleaning, wisdom teeth are difficult to maintain.

  • If there is pressure or pain from wisdom teeth pressing on other teeth.

  • When you experience orthodontic shifting caused by wisdom teeth coming in and causing the other teeth to shift.

  • If cysts develop around the soft tissue, which can lead to bone loss.

    Common types of impacted teeth include:

    Mesial: Angled forward towards the front of the mouth

    Distal: Angled backwards towards the back of the mouth

    Vertical: The tooth remains just below the gum upright

    Horizontal: Tooth remains just below the gum but on its side

    Partial eruption: Tooth has broken through the gums, opening the gum up to bacteria

  • “Interventions for treating asymptomatic impacted wisdom teeth in adolescents and adults” appeared in the April 2005 Cochrane Database of Systematic Reviews, an international organization that evaluates medical research. The investigation, led by Dr. Dirk Mettes of Radboud from the University Medical Centre Nijmegen in the Netherlands, reviewed more than 40 existing studies done on wisdom teeth and came to the conclusion that monitoring of asymptomatic wisdom teeth may be a more appropriate strategy. “Prudent decision-making, with adherence to specified indicators for removal, may reduce the number of surgical procedures by 60 percent or more,” said the review authors. “The conclusion drawn from [the larger] study was that the removal of impacted third molars to reduce or prevent late incisor crowding cannot be justified,” wrote Dr. Mettes. The report also suggested that the health risks and cost of the surgery also be taken into consideration.

    Dr. Richard Haug of the American Association of Oral and Maxillofacial Surgeons disagrees. “ Getting these teeth out earlier makes sense,” was his response to the report. As Executive Associate Dean of the University of Kentucky College of Dentistry, Haug has participated in two studies that examined the mouths of 300 patients between the ages of 14 and 45. They found that 25 percent of the patients had at least one wisdom tooth in danger of developing periodontitis and those patients over 25 had a 33 percent higher rate of decay. Their conclusion was that removing wisdom teeth could prevent further decay and that the best time for removal was between the ages of 17 to 21 when the roots are softer and not fully formed.

    Eric K. Curtis, DDS, spokesman for the Academy of General Dentistry and a private-practice dentist in Safford, Arizona believes it comes down to what the individual dentist thinks is best for each patient. "If a wisdom tooth is completely horizontal, I almost universally recommend taking that out," Curtis said. "The chances of bone disease are so high that I can predict with pretty good probability that 10 or 20 years down the road that person will have gum problems that will pose a risk to other teeth as well." But he also cautions that dentists should talk to their patients about the possible risks of surgery before proceeding.

    “The third molar controversy is still ongoing,” concludes Mettes. “As with all surgical procedures, the surgeon wants to do surgery, it is his or her profession. However, systematic prophylactic removal of impacted third molars is not evidence-based but only practice-based and usual care. From a patient point of view, non-surgical treatment should be the first option in an asymptomatic environment.”

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