A Guide to Wisdom Teeth

The following is a patient’s guide to wisdom teeth:

Wisdom teeth appear as the last teeth in the mouth and begin to erupt around the age of 16 years. In generations past, this was called the age of wisdom and it’s believed that this coincidence is how wisdom teeth got their name.

A commonly asked question is, “Why do we have wisdom teeth if there isn’t enough room in the jaws for them to erupt and be functional?” The commonly accepted answer is the evolutionary change in our diets. According to the British Journal of Oral and Maxillofacial Surgery, in an article entitled, “Management of Asymptomatic Impacted Wisdom Teeth”, Vol. 34 October 1996, the author notes that in the Neolithic man, the highly abrasive diet caused wear of the teeth resulting in a reduction in the size of the molars from front to back. This decrease in size from the abrasive nature of the food allowed for the forward migration of the teeth and adequate space for the eruption of the wisdom teeth. With the arrival of processed foods and a reduction in the amount of chewing necessary for swallowing, less wear occurs. This, coupled with a decrease in the loss of teeth from a decrease in cavities, requires modern man to remove impacted and partially impacted wisdom teeth.

When wisdom teeth cannot fully erupt into the mouth they can’t be effectively cleaned. As a result, painful and dangerous infection occurs. The potential for infection to spread to other teeth and other structures in the neck and chest motivates patients to have the wisdom teeth removed. Other commonly sighted justifications for the removal of wisdom teeth include the potential for them to cause cysts, tumors, or crowding and shifting of other teeth in the mouth. Although many believe that wisdom teeth cause crowding, this has never been definitively proven by any well-controlled scientific study. Infections do occur frequently and cysts and tumors, while quite uncommon, can be devastating for the patient.

Wisdom teeth are removed primarily to eliminate the potential for infection and damage to adjacent teeth. Remember, the jaws of most individuals are not large enough to accommodate the wisdom teeth and they remain either under the gum tissue (where they have a three to five percent chance of becoming cystic) or they become partially exposed where they have a much greater potential for becoming infected. The infection causes bone loss, damage to adjacent teeth and PAIN. Once symptoms of pocketing, swelling, food impaction or pain begin, removal is the most prudent course since the symptoms will not abate until the teeth are removed.

Should the patient have only symptomatic wisdom teeth removed and leave other asymptomatic wisdom teeth in the mouth until later? This depends on the relative position of the other wisdom teeth and whether or not the patient wants to be operated on more than once. Most dentists agree that one surgery is best and that multiple trips to the oral surgeon for the removal of wisdom teeth are not in the best interest of the patient, as it raises the potential for complications from multiple procedures and anesthetics.