Tuesday, October 27, 2009
Wisdom Teeth: most do NOT need to be removed!
Do you need your 3rd molars (wisdom teeth) extracted?
The short version:
Sometimes, but NOT to prevent your teeth from shifting, and NOT generally because you were told that they are "impacted." So unless there is a clear dental-health problem, then you may pretty much leave them alone and have your dentist check them periodically. If they have not erupted, there is rarely any orthodontic justification for third molar extraction.
Examples of possible dental-health problems:
1. A tip of a lower 3rd molar is erupted, it has no room to erupt further, and a pocket or infection of the tissue overlapping the molar is present.
2. A 3rd molar has erupted at an unusual angle or position (ectopic eruption).
3. The molars have erupted but are in such a position in the mouth that the patient frequently bites their cheek.
4. The 3rd molar is decayed and the decay cannot be physically removed by the dentist due to insufficient access.
5. There is a cyst or damage to an adjacent tooth.
The long version:
The almost universal "need" for 3rd molar extraction is slowly going the way of the tonsillectomy phenomenon of my youth in the 1960's. It used to be almost a right of passage to have your tonsils out in grade school. Now is generally requires far more medical proof before a patient is subjected to the discomfort, risks, and expense of such a procedure.
Historically, wisdom teeth have been blamed as the cause of lower incisor crowding. However, we have known in the orthodontic literature for over 20 years that when comparing people born without wisdom teeth with those who've had them removed and with a third group of patients who still "own" theirs have the same average amount of shifting with the passage of time.
Therefore, tooth shifting is an age-related problem. This is why the orthodontic community switched recommendations with respect to retainer wear. Rather than asking each patient to wear retainers "for two years," or "until you are 18," or "until you get your wisdom teeth removed," for at least the past 25 years we in the profession state in our informed-consent forms that you must use your retainers both consistently AND for the rest of your life. This usually means night-times only and as the years go by, less and less nights per week.
Probably the best summary on the topic that I have found discussing the myths surrounding wisdom teeth was written by Jay Friedman, DDS, MPH (Master of Public Health) in the September 2007 issue of the American Journal of Public Health (vol 97, No 9). He has 28 citations if you are interested in seeing some of the original research. His concluding paragraph reflects my feelings on the subject:
The short version:
Sometimes, but NOT to prevent your teeth from shifting, and NOT generally because you were told that they are "impacted." So unless there is a clear dental-health problem, then you may pretty much leave them alone and have your dentist check them periodically. If they have not erupted, there is rarely any orthodontic justification for third molar extraction.
Examples of possible dental-health problems:
1. A tip of a lower 3rd molar is erupted, it has no room to erupt further, and a pocket or infection of the tissue overlapping the molar is present.
2. A 3rd molar has erupted at an unusual angle or position (ectopic eruption).
3. The molars have erupted but are in such a position in the mouth that the patient frequently bites their cheek.
4. The 3rd molar is decayed and the decay cannot be physically removed by the dentist due to insufficient access.
5. There is a cyst or damage to an adjacent tooth.
The long version:
The almost universal "need" for 3rd molar extraction is slowly going the way of the tonsillectomy phenomenon of my youth in the 1960's. It used to be almost a right of passage to have your tonsils out in grade school. Now is generally requires far more medical proof before a patient is subjected to the discomfort, risks, and expense of such a procedure.
Historically, wisdom teeth have been blamed as the cause of lower incisor crowding. However, we have known in the orthodontic literature for over 20 years that when comparing people born without wisdom teeth with those who've had them removed and with a third group of patients who still "own" theirs have the same average amount of shifting with the passage of time.
Therefore, tooth shifting is an age-related problem. This is why the orthodontic community switched recommendations with respect to retainer wear. Rather than asking each patient to wear retainers "for two years," or "until you are 18," or "until you get your wisdom teeth removed," for at least the past 25 years we in the profession state in our informed-consent forms that you must use your retainers both consistently AND for the rest of your life. This usually means night-times only and as the years go by, less and less nights per week.
Probably the best summary on the topic that I have found discussing the myths surrounding wisdom teeth was written by Jay Friedman, DDS, MPH (Master of Public Health) in the September 2007 issue of the American Journal of Public Health (vol 97, No 9). He has 28 citations if you are interested in seeing some of the original research. His concluding paragraph reflects my feelings on the subject:
"The evidence is compelling that prophylactic extraction of third molars is a significant public health hazard. It is a silent epidemic of iatrogenic injury that warrants avoidance of the extraction of any third molar in the absence of a pathologic condition or a specific problem."Another interesting observation was made by Dr. Lindauer in the July 2007 issue of the American Journal of Orthodontics and Dentofacial Orthopedics. He stated:
"Opinions about the role of third molars in causing crowding of the anterior dentition were significantly related to year of graduation for both orthodontists and oral/maxillofacial surgeons. Generally, orthodontist became less likely to believe that third molars caused crowding and were less likely to recommend their removal prophylactically when they graduated more recently from orthodontic programs. This agrees with most recent literature on the topic that suggests little association between the eruption of third molars and crowding of the anterior teeth. Surgeons were more likely to believe that third molars caused crowding and more likely to recommend their removal to prevent crowding if they graduated in the 1970s or 1980s than earlier or later graduates."It may be another two generations of dentists and oral surgeons before this becomes our universally acknowledged societal and professional perspective. Meanwhile, I will continue to do my part to let those patients under my care know that the presence of third molars does NOT necessarily mean that they will HAVE to be removed!
Julia's gone
Julia is my oldest child of two. She left for college four years ago and this is the painting I did for her to display in her dorm room. She chose against bringing her teddy bear to college since its arm had nearly worn off over the years. I included books by two of her favorite authors from then, Mercedes Lakey and J.K.Rowling.She graduated this past May from Duke and is currently working on her Master's in Business Systems at the Fuqua School of Business at Duke University. We talk frequently, but I still miss her presence in my daily life.
About six years ago I took a beginners drawing class at The Drawing Studio here in Tucson anticipating the day when the kids would be gone. I knew that I would need something more than golf and practicing orthodontics to keep active and "engaged" in my life without them around. About a year later I started taking oil painting classes and I have enjoyed "most" of the hours I've spent painting since. I will include photos of more of my work in future posts.
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