West Los Angeles Molar Extraction with Dr. J
“Extract third molars or not?” “Do you really need your wisdom teeth?” “They don’t hurt; why should I take them out?” “I can’t even see them - where are my wisdom teeth?” “The other dentist told me it would be fine to leave them in; I don’t want to take them out now!” These thoughts, questions and remarks have gone through everyone’s mind when they are told that it is time to remove the 3rd molars. So why are there so many different opinions out there and why has the public not been informed of how they are supposed to deal with wisdom teeth? The answer is that there is no definitive answer on what to do, and each individual has a unique set of circumstances that makes the decision to remove 3rd molars a case-by-case situation.
The American Association of Oral and Maxillofacial Surgeons states that about 85% of third molars will eventually need to be removed*, and while this paints a grim picture, it does not explain when and why they may need to be removed.
*Wisdom teeth [pamphlet]. Rose-mont, Ill: American Association of Oral and Maxillofacial Surgery; 2005.
Third molars usually begin developing within the upper and lower jaw bones around ten years of age. At this time, a tooth bud is beginning to calcify into a hardened tooth. The development begins from the top of the crown (chewing surface) and grows towards the tip of the root. By the age of 16-18, the crown has completed its development and the root development stage begins. For reference, as the roots of other teeth grow, that is usually when they erupt into the mouth. The inherent problem with 3rd molars is that they grow in the back of the jaws, which, due to the shape of the bone, can sometimes force a tooth growing there to be pointed in the wrong direction (slightly forward instead of straight up). So, if we connect the dots, 3rd molars often are pointed in the wrong direction and at about 16 years of age when the roots of the 3rd molars are beginning to develop, the tooth starts moving towards the inside of the mouth. With other teeth in the way, or a strong part of the bone holding it back, the third molar can cause a wide range of symptoms. Most of these are unpleasant and in the case of any of them, tooth extraction is suggested. Signs and symptoms can include:
- Pain in the area
- Inflammation of gums in the area
- Shifting of teeth
- Jaw pain, face soreness
- TMJ pain
- Ringing in ears
- Cavities on neighboring teeth (https://www.ncbi.nlm.nih.gov/pubmed/27659630 (https://www.ncbi.nlm.nih.gov/pubmed/27659630))
Other times, the tooth is totally turned in the bone resulting in “impaction” which literally means “physical blockage.” For most people, horizontal impactions occur. This means that the tooth has turned 90 degrees, so that instead of “standing straight up,” the tooth is going “head-first down a slide.” These teeth never have a chance of making it into the mouth and many times lay dormant in the jaw. This position can also lead to the same signs and symptoms as a partially impacted 3rd molar. In the more advanced scenario, a retained impacted 3rd molar can lead to something called a “dentigerous cyst,” which can cause bone expansion and tooth movement. Lower impacted 3rd molars are at an elevated risk for “ameloblastoma,” which is a tumor arising from the tooth bud that was left in the socket with the tooth. (https://www.ncbi.nlm.nih.gov/pubmed/17052585)
The risk for all potential problems significantly arises after the age of 20. The pain management and recovery of removing the 3rd molars is also more difficult as we age, so many doctors suggest taking them out prophylactically, which will prevent any problem from occurring in the future. The truth is that studies have not shown cause-effect relationships; many patients have fully functioning, very healthy 3rd molars which never need to be extracted. The problem is that we only know they are healthy when they don’t cause signs and symptoms to show up. At that point, it is too late and we must address the visible problem (crowding, pain, decay) and then also address the source of the problem (the 3rd molars). However, because so many patients live well with 3rd molars, no standard has been set. Instead it boils down to the individual.
*Statements by the American Association of Oral and Maxillofacial Surgeons Concerning the Management of Selected Clinical Conditions and Associated Clinical Procedures: The Management of Impacted Third Molar Teeth. Rosemont, Ill: American Association of Oral and Maxillofacial Surgeons; 2007.
Think of it like this:
- You have a tooth that could cause a problem in the future
- If you take the tooth out now, you will 100% avoid that problem
- If you take the tooth out now, there will be some cost (physical, emotional and financial)
- Is the cost of removing 3rd molars worth GUARANTEEING that you will not have those problems in the future?
If the cost is too much, just wait it out and hope it works out. You may also have to deal with the problems that the 3rd molars cause. Make sure to have your dentist monitor the health of the 3rd molars at routine dental appointments.
If the cost is not too much, get them out. You are much better off taking the 3rd molars out and knowing you will not have extra decay, infection, tooth movement or the possibility of tumors.