My dentist recommended that my child’s wisdom teeth should be removed. Is this typical?
If I had a quarter for each time I was asked this question, I would be retired on a beach, relaxing with an umbrella drink in my hand! This question, as well as the one after it, has many different answers, depending on who you talk to. The reason being is this: Removal of wisdom teeth is predominantly a practice philosophy rather than an exact science. What I mean is, there is much leeway, discussion and debate among all types of dentists as to what is the best treatment of wisdom teeth is. So, what I will give you is my personal philosophy, but the decision is ultimately yours!
Wisdom teeth are the last teeth to erupt and are the teeth furthest toward the back of the mouth. They are also referred to as “third molars,” and will frequently never appear in mouth. This can be due to lack of space in the mouth or simply because many people are born without them. Often times, there is no room for the wisdom teeth to erupt, leaving them trapped in the jaw or only partially erupted. So let’s discuss a few of the problems which arise from extracting them vs. leaving them and you will quickly see why there is so much debate.
If the wisdom teeth do have space to come in completely, then a few scenarios can occur. If your child is able to reach all the way back there and keep them immaculate, then typically there are not any problems with keeping them. However, it has been my experience that few adults are able to keep them clean enough to avoid cavities or gum disease around the teeth. It is extremely rare that I actually get to witness the miracle of cavity-free wisdom teeth. Generally, it takes awhile to get a cavity back there (it usually shows up in your mid-twenties to mid-thirties.)
Once a cavity is present, the tooth either needs to be filled or extracted. Attempts to fill wisdom teeth are mediocre at best, unless you have the ability to open very wide. Because the teeth are so close the jaw-joint, it is very difficult for the dentist to see if all the decay has been removed, or keep the tooth dry enough to retain the filling.
In most cases, the filling eventually fails and the tooth has to be extracted anyway. The same holds true for gum disease. Because they are hard to clean, they very often are afflicted with moderate to severe gum disease. If left, the gum disease can cause bone loss around the tooth, bad breath and possibly increase the risk for spreading the disease to the rest of the mouth.
As adults, we heal much slower, experience more pain and have the added trouble of having to take time off of work. I personally tend to be more pro-active with recommending extraction of wisdom teeth, especially those that will likely fully erupt into the mouth. This is because I know the child will be thankful I did once they are an adult!
The other advantage is, that when you remove the wisdom teeth before they are completely developed, they are actually much easier to remove. This results in less pain after surgery, faster healing time and less of a risk of complications from the procedure. So, the possibility of reducing these risks by extracting them as an adolescent is very appealing to me as a mom and a dentist!
Well, let’s suppose that the wisdom tooth is not in at all, partially in (but stuck that way), or has no space whatsoever to come in. An x-ray (a panorex or panoramic film) will have to be evaluated by the dentist or oral surgeon before a decision can be made. Most times the teeth can still be removed with relative ease and without complication. However, there are situations which may predispose your child to temporary or permanent complications.
Close proximity of the lower wisdom teeth to the main nerve supplying all the teeth can be a concern. Injury to this or any other nerves in the areas can cause partial or complete, permanent or temporary numbness to the lip, chin, teeth, gums, tongue or skin in the area. In addition, the top teeth may be so high up in the jaw that risk of damage to the sinuses and other structures can occur. Your oral surgeon will be aware of these complications and any others as they apply to your child.
So, if the wisdom teeth seem risky to extract and the likelihood of the teeth ever erupting is low, then I typically recommend leaving them. The benefits of extraction must be carefully measured against the risks involved and be sure to discuss them in detail with your surgeon.
I also want to bring up the importance of the oral surgeon here. As we discussed earlier, specialists exist in dentistry because they are necessary! While there are general dentists who can take out wisdom teeth with great proficiency, I still strongly encourage having an oral surgeon perform the procedure.
An oral surgeon does this procedure every day, many times a day and they are simply better, faster at it and are more familiar with the complications which can occur from their removal. They are also more familiar with the internal jaw anatomy which is rarely seen by a general dentist. This is not to say that a general dentist is not capable, as there are plenty out there that would do just as good as any oral surgeon. However, my experience has been that this is the exception and not the rule.
