Do I Really Need My Wisdom Teeth Out?

The 3 billion dollar third molar extraction market in the U.S. is supported by about 5 million surgeries on young adults each year to extract 10 million wisdom teeth, performed mostly by oral surgeons.

There are a number of legitimate reasons to have wisdom teeth removed, including, if there is pulpal infection, cellulitis, abscesses, difficult-to-treat dental caries, recurring pericoronitis, and damage to the surrounding bone. The American Association of Oral and Maxillofacial Surgeons recommends removal of them from high-school and college-aged kids, even if they are asymptomatic, before their wisdom teeth root tips finish growing and approximate themselves too close to the mandibular nerve (neurovascular bundle) in question. Young people can predictably recover quickly post-surgically. Preventing future “reasonably potential problems" is the objective.

Our modern jaws are smaller than those of our evolutionary ancestors, but we have the same number of teeth. So many third molars in people just don’t grow in easily for the lack of space.  The American Association of Oral and Maxillofacial Surgeons supportively states that "if there is insufficient anatomical space to accommodate normal eruption. . . removal of such teeth at an early age is a valid and scientifically sound treatment rationale based on medical necessity.” In support, this author needs to tesgreat tify that all of the people who have had their asymptomatic wisdom teeth removed…don’t have wisdom teeth problems (chuckle)!

But not all dentists agree that wisdom teeth should be prophylactically removed to prevent problems. There are real risks inherent to their surgical removal. Paresthesia of the lips, tongue, and cheek, along with altered speech enunciation and sense of taste, post-operative discomfort, TMJ problems, and deaths have been reported (google Jenny Olenick and Marek Lapinski). Also, much depends on the skill and control exhibited by the surgeon. 

Scientists and oral surgeons at the American Public Health Association (APHA) critically say that the routine practice of removing trouble-free wisdom teeth "subjects individuals and society to unnecessary costs, avoidable morbidity and the risks of permanent injury." And the National Institutes of Health only supports the removal of third molars when there is unrestorable caries, infection, cavities, tumors, cysts, or adjacent teeth and bone damage.

According to the APHA, two-thirds of all asymptomatic wisdom teeth are unnecessarily removed. Instead of scurrying to take the back-most teeth out on sight, the third molars in question may, as an option, be monitored with periodic x-rays, and if they remain problem-free, in the name of maintained anatomical integrity, serious consideration should be given to the idea of leaving them in the mouth as is (in situ).

If your wisdom teeth, or the gums over them, hurt some, bu are in otherwise good health, see a dentist and find out if better oral hygiene care and a course of antibiotics might make things better, before jumping to have them taken out. If you are an adult and your wisdom teeth are not causing any problems, and are in good health, my initial advice to you is to think twice about removing them, then possibly get a second opinion from another doctor, and then think again! That old adage--"let a sleeping dog lie"--wasn't made up for nothing!

May you have many…teeth waaaay back… smiles!