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.

There have been many scientific developments in the field of oral health in the last decade. One of the most important studies has to do with the link between gum disease and several other health conditions. I won’t go into depth here about the other health conditions, as they don’t relate pregnancy but I will briefly mention them due to their extreme importance. There has been a proven relationship of gum disease to diabetic complications, stroke and heart disease. The oral bacteria which causes gum disease (which is different from those causing cavities) has been found in the heart and brain tissue of those who have had a fatal encounter with a stroke or heart attack. Diabetics with gum disease also experience more uncontrolled blood sugars. I would suggest a Google search the internet if you are interested in finding out more on the details of this relationship.

So, what does this have to do with pregnancy? Well, let me first give you a quick lesson on gum disease, since most of the population really doesn’t understand what it is. What it typically means to most people is the dreaded “you have to floss more” lecture from your dental hygienist. Basically, flossing your gums (notice I did not say teeth here) allows you to clean out the debris below the surface of your gums-in the area where popcorn kernels get caught. If that debris is not removed, it can turn into a concrete-like, bodily substance called “tartar” or “calculus” from the minerals in your saliva. This tartar can then become strongly adhered to the tooth root beneath the gums, causing inflammation which may be called gingivitis or gum disease.

Once tartar is present, it is not possible to be removed by flossing any longer. It will only come off with those dreaded scrapers we all hate at your dental cleaning appointment. Everyone gets tartar, but some people get it more abundantly than others either due to genetics, nutritional habits and/or mineral composition of saliva. This is why a dental cleaning or “prophylaxis” is needed every six months. It takes about six months for the body to develop enough tartar to elicit the start of the gum disease process.

If you don’t have your teeth cleaned, the tartar stays on the tooth root and allows more tartar to continue building on top of the existing tartar layer. This causes an even more inflammation of the gums. Eventually, the body “sees” this tartar layer as a “foreign object” and tries to get rid of through chemical and biologic means. So, this is good, right? Well, I have only told you part of the story. While the body is trying to help, it also releases special mediators that unfortunately destroy the bone around the teeth in an effort to get rid of the tartar.

If left untreated, the cycle of tartar deposited and more bone destroyed continues, causing the teeth to become loose. I always use the analogy of a “For Sale” sign in the yard-if you keep taking away the dirt around the big wooden post, eventually it becomes loose and falls out. Teeth are really as simple as that analogy. Eventually the teeth either fall out on their own, or have to be pulled because they cause a choking hazard.

In addition to this, pregnancy causes a huge hormonal shift which causes a lot more than tears, weight gain and cravings. An increase in the hormone progesterone during this time causes the gums to become more sensitive and prone to gum disease if plaque and tartar are not controlled. Signs of gum disease may be as follows: Sore, sensitive, swollen, red gums which may bleed spontaneously or especially while brushing or flossing. You may notice a black, yellow or brown, rough-appearing, grainy-looking substance along the gum-line of your teeth. You may also notice an increase in bad breath or a bad taste in your mouth.

You may hear your dentist call this process “gum disease” or “periodontal disease” (they mean the same thing) and they may tell you that you have “pockets” around your gums. These “pockets” are the popcorn-kernel-catching areas I was referring to earlier and get deeper with the deposition of more tartar over time. Certain ethnicities, such as African Americans and Hispanics are more genetically prone to getting gum disease. If you are of either of these descents, I strongly encourage you to see a dentist regularly and be sure that they are actually checking your gums every 6 months. Especially if your gums bleed when you floss or are highly sensitive.

So, of course we can see that one implication of gum disease as it relates to pregnancy would be the loss of teeth and therefore inadequate nutrition due to the inability to chew. While this is a huge concern, the primary concern is actually systemic in nature. Scientists have linked the presence of gum disease to increased incidence of pre-term delivery and low birth weight.

As mentioned earlier, the body’s attempts to resolve gum disease result in the release of bodily chemicals. These chemicals can cause the early onset of contractions, leading to pre-mature birth. Premature birth can cause a myriad of problems for the baby including, breathing difficulties (due to immature lung development), seizures and bleeding in the brain, difficulties in feeding and thus slow weight gain and poor nutrition. There are many other problems which can arise from pre-term labor and if you have concerns regarding this link with gum disease, talk to your physician and dentist. The best protection against this is to brush and floss regularly and to see your dentist regularly for a check-up and cleaning before, during and after pregnancy.

I know most people hate flossing (myself included) and despise going to the dentist. I know too that food is one of life’s greatest pleasures, especially during pregnancy. However, as parents, something in us changes and causes us to care for our children (event the unborn ones) and allows us to do the best for our children. Modification of routines and following a few simple guidelines will only eliminate one more thing to have to worry about during pregnancy. They are factors which we can control when so many other things during this amazing time are out of our control.