Trends in both clinical practice and research over the past decade suggest that wisdom teeth need not be removed, and perhaps should not be removed, merely because they are impacted or poorly aligned. It’s a dramatic departure from the protocol dentists have followed for decades. Previously, malposed or partially-erupted wisdom teeth were routinely viewed as if they were “white tumors” and had to come out. A recent study in the British Dental Journal, as well as the UK National Institute for Health and Care Excellence, have questioned the heretofore-unquestioned practice of extracting asymptomatic wisdom teeth.
Wisdom Teeth Are Not “Routinely” Extracted These Days
Certainly, for some, their wisdom teeth cause serious problems, including infections, cysts, damage to adjacent teeth, pain, and even a neoplasm or tumor. But, wisdom tooth removal, like any surgery, comes with risks (pain, swelling, and infection to name a few). In rare occasions, nerve damage is possible during extraction of the lower wisdom teeth. Sinus damage from extracting upper wisdom teeth is a rare, but real possibility.
Here’s how I am evaluating wisdom teeth these days based upon the new guidance. First I examine my patient and study their x-rays. If everything looks fine, then we’re good to go. If I feel I need more information, I might order a CT scan to help me to visualize the tooth, its position in three dimensions, and its proximity to vital structures such as the mandibular nerve. At that point, if I suspect extraction might be required, I’ll refer the patient to one of my oral surgeon colleagues and get their input. Two heads are always better than one, right?
If, after careful consideration and consultation with the oral surgeon, it makes sense to remove a wisdom tooth early, before the roots are fully formed. Coronoectomy (the removal of just the crown portion of the tooth) is a surgical approach that involves thinking “out of the box” treatment planning, but it’s being done more and more and can help a patient avoid more complicated and invasive surgery in the future.
Each and every patient who sits in my chair is carefully evaluated on an individual basis. My close working relationships with talented specialists is an essential resource for optimal patient care; even when the extent of that care may be the decision to leave well enough alone. I will never forget my patient Tim. When I first met Tim, he was a healthy 40-year old with a full complement of completely erupted and properly-aligned wisdom teeth. However, he showed up at my office one with significant swelling in his jaw. Conventional dental x-rays could not “reach” far enough back in his jaw for me to detect the source of his problem. (By the way, this is a common problem when taking x-rays of wisdom teeth in a small mouth because the X-ray sensor can cause a gag reflex and even dig into the delicate tissues of the mouth.)
I referred Tim to an oral surgeon, who took a panoramic x-ray and performed a CT Scan. Lo and behold, Tim had an impacted wisdom tooth and an associated dental tumor (Odotontogenic Keratocyst, if you must know). Not only did the wisdom tooth, extra tooth and tumor need to be removed, the procedure needed to be done in a hospital. Thankfully, Tim is fine, but I shudder to think what might have happened been if his condition was not discovered because the tumor was literally eating his jawbone.
The Bottom Line
While Tim’s situation is rare, it underscores the importance of having your wisdom teeth fully evaluated every six months, even if they are not causing you problems. To all you new freshmen, good luck! Remember to brush your teeth – parents, I encourage you to nag them. And be sure to make your Spring Break dentist appointment.