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.

This is a common concern among parents and has a fairly simple response. In general, your pediatrician will recommend that you plan on discontinuing the use of a bottle by age one. There is, of course, a little flexibility with this so that the child can undergo a relatively smooth transition to the use of a sippy-cup.

Every child is different in their need for that warm bottle of instant comfort. It is indeed an amazing cure-all for infant displeasure, but like all addictions, it isn’t easy to stop. Other children will give it up easily, gladly welcoming the new benefits of becoming a toddler. Most child-rearing books, like the “What to Expect” series, will give you tips and tricks of how to wean both the bottle and the pacifier. My biggest advice would be to start sooner rather than later, especially if you have a strong-willed child.

If you are successful in weaning both the pacifier and the bottle around 12 months, then you have no concern that either one will affect the orthodontic relationship of your child’s teeth. If you go much beyond this time frame, then it is possible that you may have some future orthodontic problems. Again, there is leeway with this, and in general we say that most of the permanent effects occur if the child has not completely stopped by age four. Of course I assume that your four year old is not drinking out of a bottle anymore, so I am speaking particularly about the use of a pacifier. If your four year old is still drinking from a bottle, you are way overdue for a crisis intervention!

The other big concern to be aware of is that, the pacifier can also cause trauma to the child’s gums. This can cause painful ulcers but can also cause the gums to recede from the tooth. This can cause many problems including gum damage for the soon erupting permanent tooth, tooth decay of the baby-tooth or painful root exposure. Your child may experience mild to severe sensitivity to hot and cold foods or even just when the air from speaking passes by the area where the gums have receded. Adults experience this too, but generally it is not caused by the use of a pacifier! There are many causes for adults, but the end result is the same resulting in sensitivity, pain or possible loss of the tooth from becoming loose. So again, stop the habit early, as it will be better for everyone!

The great news is that your child is perfectly normal! Spaces between baby teeth are a great thing-especially for your wallet! As I said earlier, the body is amazing and the design of teeth is no exception to the rule. Those little gaps are the body’s pre-built mechanism to allow enough room for the larger, later erupting permanent teeth. Those spaces (called Leeway spaces) are your hopeful chance that you will avoid having to pay for braces later on.

The time to be more concerned is when your child has teeth like a supermodel. In other words, they have no spaces and perfect alignment. Beautiful as they may appear now, you are pretty much guaranteed that without any orthodontic treatment or strategic preplanning, your child will have crowded teeth as a teenager and adult. The good news is that dentistry has advanced in ways that now make it possible to understand the relationship between baby teeth, permanent teeth and skeletal growth in children. This knowledge now allows us to pre-plan in certain situations, possibly avoiding braces altogether. For further information, please refer to the “general questions” section of this book. More information will be found under the question: “How early should my child be placed in braces. How do I know if my child needs braces?”