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What To Do About Wisdom Teeth

Posted Feb 10 2009 11:04am
Wisdom teeth shown in red.

Bottom wisdom teeth in red.

By CK Wilde for 3GenFamily Blog

Is it a new fad or good health care?

US dentists are recommending that teens and young adults, from ages 17 to 26, have their wisdom teeth removed in record numbers. Dentists call it a “preventive” measure so the teeth, also know as the third molars, won’t be a problem in later life.

My wisdom teeth never came in, so I was unaware that these could cause any problem until our first born son reached his teen years. My husband still has all of his wisdom teeth.

His four wisdom teeth have never given him a problem a day in his life.

Even so, just about every dentist my husband has seen, has wanted to remove those third molars “as a precaution.”  He has declined to do so because there just wasn’t any justification for it.

Who would want to go through the considerable pain and expense of oral surgery (not to mention the possibility of complications) if the procedure wasn’t necessary? It’s like having your appendix out because it might be a problem sometime in the future.

Back in the 1950’s it was common for young children to have their tonsils removed if they were prone to infection. I was one of those who had the surgery.

In 1959, 1.4 million tonsillectomies were performed in the United States. This number had dropped to 260,000 by 1987. The primary reason for removing the tonsils is no longer recurring infections. Instead, doctors suggest removing the tonsils only if they are blocking the air passages.

(The real source of my infections, by the way, was the cigarette smoke in our house. My Dad quit smoking a number of years after I left home for college.)

Preventive Surgery?

Many US dentists are focusing on getting those third molars out of teens mouths before they have caused any problem. For the dentist, it is easier to remove the wisdom teeth when the bony structures of your child’s jaw are still developing and somewhat soft.

During his senior year in high school, our older son mentioned that a large number of his classmates were having this surgery done. It was an extremely painful rite of passage.

We know from talking with the parents that some of these students had real problems, like wisdom teeth coming in sideways (impacted) and actually pushing on other teeth. These students had had braces when they were younger. Those wisdom teeth were threatening to disrupt thousands of dollars of dental work paid to straighten the originally crooked teeth. The best solution seemed to be surgery to remove the wayward third molars.

But, if the wisdom teeth aren’t directly impacting  your child’s other teeth or causing gum infection, is this surgery necessary? Any surgery carries risks. No caring parent wants to expose a child to these risks without a good reason.

We faced this question two years ago when we moved to a new dentist. During our older son’s first visit, the dentist gave him a referral slip to an oral surgeon to “review having wisdom teeth extracted.”

I asked to see my son’s x-rays. Yes, there were the beginnings of third molars below the gum line, but they looked like they were growing in straight.  I asked the dentist to explain the reason he was making this referral. After talking in vague terms, he finally suggested that I look it up on the web. What I found was enlightening!

Controversy Over Teeth

In 1979, the National Institute of Health held a conference to attempt to resolve the question of what to do with wisdom teeth. These dental experts were able to agree that straight, healthy wisdom teeth should be left alone. Those that were diseased or causing trouble should be removed. But the distinguished panel was never able to agree on the proper treatment for impacted but otherwise healthy wisdom teeth.

In 2006, the Cochrane Collaboration published a review of studies designed to  evaluate the effect of preventative removal of wisdom teeth that were not causing problems. The authors found no evidence to either support or refute this practice. There were no scientific studies to be found.

However, there was reliable evidence showing that preventative removal did not reduce or prevent late incisor crowding. (It is a common belief among dentists that wisdom teeth will cause crowding in the mouth and push front teeth out of alignment.) The authors of the review suggested that the number of surgicalprocedures could be reduced by 60 percent or more.(emphasis is mine)

“Watchful monitoring” of  wisdom teeth not showing problems may be a better approach, suggest review authors led by Dr. Dirk Mettes of Radboud University Medical Centre Nijmegen in the Netherlands.

‘The third molar controversy is still ongoing,’ concludes Mettes. ‘As with all surgical procedures, the surgeon wants to do surgery, it is his or her profession. However, systematic prophylactic removal of impacted third molars is not evidence-based but only practice-based and usual care. From a patient point of view, nonsurgical treatment should be the first option in an asymptomatic environment.’

Mettes TG, et al. Interventions for treating asymptomatic impacted wisdom teeth in adolescents and adults (Review). The Cochrane Database of Systematic Reviews 2005, Issue 2

We adopted this wait and see policy for our son’s wisdom teeth. It has been two years now — still no problems. Our family has found another dentist who agrees with our wait and see approach. We think this makes the most sense for our situation.

But yours may be different. I would encourage any parent of a teen to ask your dentist lots of questions and look carefully at your child’s x-rays before sending your son or daughter for this surgery.

And, if surgery seems appropriate, you may want to talk to the oral surgeon about preserving those teeth. Researchers in Japan have just announced that the dental pulp from wisdom teeth could be a new source of therpeutic stem cells.

The researchers were able to program cells cultured from the center of a wisdom tooth into adult stem cells. The tooth they used had been in a freezer for three years.

We are still years away from actual therapies using wisdom tooth stem cells. But, if your son or daughter must have this surgery, you might as well try to save those teeth. They are usually just thrown away.

What do you think about this post? Leave us a comment!

© 2009 CK Wilde. All Rights Reserved. Please feel free to link to this post but you must have prior written permission (please use the comments) to reproduce this post either whole or in part.

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