What are wisdom teeth? Most of us will develop a third molar tooth in each quadrant of our mouths, upper left, upper right, lower left lower right. The molars are the large grinding teeth in back. The last molars in the line are called 3rd molars or more popularly wisdom teeth. These teeth usually erupt, break through the gum tissue after the age of 17. Some will only partially erupt and others will stay completely buried under the tissue. Many patients never develop 3rd molars although a few folks will get 4th molars. Fortunately, these are rare.

Should you have your 3rd molars removed? This question causes a great deal of controversy. There is some evidence that our jaws are getting smaller. However, the size of our teeth have not changed as much. Consequently, many of us do not have room for our 3rd molars. Mankind has evolved over the last half million years without having 3rd molars removed. It was only after the development of local anesthesia that dentists started routinely removing these teeth. I learned in dental school that all unerupted 3rd molars should be removed. However, the latest guidelines I have seen suggest that if you are 35 years old and they are not yet in your mouth, leave them alone but check them in x-ray every few years.

What can happen if I leave them? All teeth form in tissue sacks called follicles. Sometimes these sacks will enlarge becoming a cyst, a fluid filled sack, that can cause the loss of part of the jaw bone. If enough of the bone is lost it could lead to a weakened jaw that could fracture easily. The cyst could put pressure on the nerves of the jaw. If the 3rd molars are laying on their side, they can cause bone around the roots or the roots of adjacent teeth to be eaten away. There is some very very very slight chance the cyst could change to other types of tissue. The teeth may lead to infection later in life and need to be extracted. It can be dangerous for elderly patients with some medical problems to go through this surgery.

What is an impaction? If a tooth never comes through the gum tissue and is covered by tissue or bone it is referred as "being impacted." To remove impacted teeth, the tissue must first be opened and often bone must be removed to get to the tooth. In order to keep the hole as small as possible, the teeth may be cut into several small pieces so each piece can be removed more easily. After this type of extraction, there is usually swelling and moderate to sever pain requiring potent pain killers for a few days.

What are your options

Option #1- do nothing

pro - Take a wait and see attitude - if it is not broke; do not fix it. You can always have them removed it they cause problems. If the teeth are not uncomfortable or infected, this is a viable option. Many folks never have a problem. In fact, before local anesthesia, almost no one had them out.

con - They may have to come out in the future. This may happen at a inconvenient time, vacation, wedding, school, job etc.

If one of the teeth is infected or painful you will need to do something.

Option #2 - have them all out

pro - You will only have to go through it once. If you have all 4 out at once, you will not be 4 times as uncomfortable. You will not have to worry about them in the future. You will heal faster when you are young and healthy.

con - It will probably be painful. It will be more costly. There may have complications. You could have nerve damage leaving you lip or tongue nub, or partially numb, possibly for life. You could end up with a hole into you sinus or your tooth or root in the sinus. If you have general anesthesia, you could have complications to the anesthesia. While it is very rare, people can die due to anesthesia problems.

Option #3 - have the tooth removed that is bothering you

pro - If the tooth is a problem, something needs to be done about that tooth. However, the others may never bother. Upper teeth, in particular, if left alone will often will come in by themselves and be much easier and less costly to remove if it becomes necessary.

con - you may have to go through the procedure in the future if other 3rd molars start causing problems.

In general, I am opposed to removing teeth in youngsters prior to knowing if the teeth will come in by themselves. I have had surgeons suggest they should be removed in 12 year olds. At this age, the jaw is still growing and these teeth are buried deep in the bone making the surgery much more complicated. I am opposed to removing all impacted 3rd molars just because they are there. They may never cause a problem. If a tooth or the area around it becomes infected, if a cyst forms, if good bone or root is being lost, the tooth should be removed. This does not, however, mean that all of them should be removed at this time.

It is your mouth, you must make the decision to remove or not remove. I hope this newsletter will help you decide what makes sense for you. If you have any questions or need more information please feel free to ask. Back to newsletter index