When should you remove wisdom teeth?

Spoiler alert: I still have my wisdom teeth. Also, a wisdom tooth is the same thing as a 3rd molar.

There are different viewpoints on 3rd molar surgery around the world. Europeans dentists tend to be conservative with recommending removal, while American dentists are more likely to recommend removal.


It is known - thanks to the well connected media - that there are medical professionals that recommend treatments for additional compensation. This is wrong, shameful and an insult to the establishment.


But, that doesn't mean every wisdom tooth should stay in the mouth. There are good reasons to remove them.


Below is a guide detailing the reasons you should or should not a wisdom tooth removed.


Remember that every case is different, so consult a trusted dentist or two for information pertaining to your personal health.

Recurring Pain and Inflammation = REMOVE


Teeth coming in is often uncomfortable. Ask a teething infant. Some level of discomfort is expected when a wisdom tooth enters the mouth, but it shouldn’t persist for months. Pain over the first few months is normal as the tooth erupts, but throbbing pain that impacts sleep and life quality is not normal. Swelling is also not normal.

When the tissue around a wisdom is irritated, the patient has something called pericoronitis. Pericoronitis may happen a few times as the tooth erupts. If the pain goes away, you might be able to keep them in place.

In general, we don't want our body inflammatory state. Most major chronic diseases are diseases of inflammation, so keeping out body stable s a good idea, especially if the wisdom tooth is not serving and purpose.

Not Enough Space = REMOVE

If you recently had braces or aligners, this is really relevant to you. Most people complete orthodontic treatment before their wisdom teeth come in.


Wisdom teeth can stop a retainer from fitting. They can also distort the bite if they are pushing against other teeth.


Cannot Clean the Wisdom Tooth = REMOVE


Third molars are notorious for having an odd shape to them - unique pits and grooves - so you want to ensure you can clean them. If you can't clean your wisdom teeth, its best to get them removed. Fillings on third molars are challenging and sometimes infeasible.

If you can't get your toothbrush back there, its a recipe for tooth decay.


Tip: To help brush teeth in the back, open you mouth to about 60% maximum and move you lower jaw to the side you are trying to brush. This makes the cheek more flexible.

If you can keep your wisdom teeth clean, keep them :)



Hurting other Teeth = REMOVE


A third molar can cause a second molar to breakdown. Also, if the third molar is in a weird position, the 2nd molar may be hard to clean. 2nd molars are very important for chewing and bite alignment. It's important to remove third molars if they are hurting any other teeth.

Infections = REMOVE


Sometimes, there is an infection underneath the tooth, which is seen on an x-ray. This would require extractions. Some of these infections are caused by tooth decay, while others occur due to other developmental errors. Infection or cysts are good reasons to remove wisdom teeth.

Final thoughts


Find a dentist you trust or get multiple opinions.


This means visiting dentists that have different views on how to treat a patient. Choose someone that explains the pros and cons of everything without bias. There is evidence to support and not support third molar extractions. Until the science is clear, having a uni-directional approach to wisdom tooth extraction is not appropriate or scientific.


A healthy wisdom tooth (no infection, easy to clean, and in proper alignment) is not a problem. Keep it in place.


Once you’ve found a Dr you trust, stick with them. As a patient you put your health into someone else hands and it just isn’t feasible to build report hopping from Dr to Dr.


Build a lasting connection for best oral health outcomes.


Sources:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1963310/

  2. https://www.joms.org/article/S0278-2391(14)01628-0/abstract

  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025689/

  4. https://pubmed.ncbi.nlm.nih.gov/10932022/

  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4593524/

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