Do I Really Need My Wisdom Teeth Removed?
As a surgeon, I am commonly asked by my patients and their families “Do I really need to have my wisdom teeth removed?” Everyone is hoping that my answer will be “No, of course not! Who gave you that crazy idea?!”
If only it were so simple.
How I decide whether you need to have your wisdom teeth removed is dependent on several things that have to do mainly with: 1.) the size of your jaws; 2.) whether you are having pain with the teeth and 3.) whether there is pathology associated with the teeth. This post is meant to help you understand what I am looking for when I am evaluating wisdom teeth and why I may make a recommendation for their removal.
Wisdom teeth are also known as third molars. Most patients have four third molars, one on each side of the upper and lower jaws. They are located behind the last tooth in your mouth.
The majority of problems associated with third molars arise from a lack of space in the jaw. Both the upper and lower jaws need to have enough length to accommodate the length of the third molar (which is on average about 12 mm long) in order for the tooth to be able to erupt into the mouth. Most people do not have enough room for this to happen.
Lack of sufficient length of the jaw will cause impaction of the developing third molar. Impacted teeth can cause many problems for patients including infection, bone loss around the second molar, decay in either the third or second molar and in the worst cases, loss of the second molar tooth. In certain circumstances, cysts can also arise from impacted teeth.
Teeth, like people, come in different sizes. Some people have smaller than average teeth with longer than average jaws. These folks probably won’t need to have their third molars removed. They have won the oral surgery jackpot! Other patients however have very large teeth with very small jaws. These patients tend to have the most severely impacted third molars and may need to have them removed at an earlier age than average. In general, I like to remove third molars when there is little root development as this minimizes risk of complications associated with surgery.
If you are having pain with your third molars, I will check to see if you are developing an infection. Infection is caused by bacteria that builds up around the third molar and the back surface of the second molar. Bacteria will build up if you can’t keep the area clean. It is almost impossible to perform adequate oral hygiene if the third molar doesn’t have space to erupt into the mouth properly. Infection can lead to bone loss that affects the back surface of the second molar which can lead to eventual loss of the tooth.
Sometimes, patients report that they are feeling pressure and they are worried that their teeth are shifting. Their bite is changing. If the third molar is close to the roots of your second molars, removal may be indicated in order to prevent damage to the roots of the second molars.
Finally, all third molars that have pathology, such as cysts, need to be removed. If I see cystic changes associated with a third molar, I am going to recommend it’s removal. Cysts associated with impacted teeth can cause bone loss and lead to jaw fracture.
Happily, not all third molars require removal. If the tooth is completely covered by bone, it will be protected from the bacteria of the mouth and will most likely not need to be removed.
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