To Pull or Not to Pull…

Are wisdom teeth expendable? – that is the question.  Pros and cons appeared in an article “Prudence of Having That Tooth Removed” in the September 6, 2011 New York Times at http://www.nytimes.com/2011/09/06/health/06consumer.html.  The article advises against routine extraction of wisdom teeth (third molars) as scientific evidence supporting routine preventive extraction is lacking.  The author notes that “Each year, despite the risks of any surgical procedure, millions of healthy, asymptomatic wisdom teeth are extracted from young patients in the United States, often as they prepare to leave for college.”  I don’t know how she came up with the figure of “millions” but it seems excessive.  I don’t know of any oral surgeon who routinely extracts “healthy, asymptomatic” wisdom teeth nor would I routinely refer such teeth to a surgeon for extraction.  I only recommend extraction if there is a reason to do so.

However I think that the author underestimates the percentage of problems we see related to wisdom teeth.  If I see a problematic tooth then I would discuss extraction with the patient and guardian.  Sometimes there is a problem that is not obvious to the untrained eye.  There might be pathology evident on a radiograph but not visible to the patient.  The tooth might be decayed.  It might be impinging on the second molar, affecting the  prognosis of the second molar.  The tooth might have soft tissue impaction and recurring infections.  These are all good reasons for extraction, and all of the above do occur quite frequently.  People are often concerned that their third molars are causing crowding of the lower front teeth – but there is no evidence that this is the case.

An issue not discussed in the article is the prevalence of periodontal disease among adults, possibly affecting 60% or more of the adult population in the U.S.  If the patient is not adept at removing plaque from hard to reach third molars, it might be prudent to extract them, for the health of the rest of the dentition.

Nevertheless, surgery always carries a risk, including possible nerve damage and complications from the anesthesia.  If you do opt for extraction, ask for local anesthesia, which is generally safer than general anesthesia.  Follow post-op instructions: soft food for a couple of days, ice on the area, and analgesics if necessary.

Whether or not to extract wisdom teeth, like everything else in dentistry,  is a matter of judgment.  Your dentist needs to have good judgment and experience and have your best interest at heart.

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