Wisdom Teeth—“Pros” of Removal and “Cons” of watchful waiting

The debate about wisdom teeth has always centered around one major question: Do wisdom teeth need to be removed or not? It has long been established that wisdom teeth that have associated pathology (tooth decay, gum disease, infection, pathologic cysts or tumors enveloping the root) need to be removed. However the question has always remained whether pain free, erupted (in the mouth) or impacted (not in the mouth) wisdom teeth have to be removed? Does “pain-free” wisdom tooth also mean “disease-free” wisdom tooth?

Recently, the American Association of Oral and Maxillofacial Surgeons published the results of the “Third Molar Clinical Trials”. This was a major clinical study performed by “The Task Force for Third Molar”. The Task Force, which consisted of distinguished clinicians in the field of Oral and Maxillofacial Surgery from major US academic institutions, collected and interpreted clinical information relating to the management of third molar “wisdom” teeth over the period of fifteen years.

The results of their work are outlined below:

Part A: Frequency of disease involving the wisdom teeth in patients in whom wisdom teeth are asymptomatic (pain-free):

• 25% to 60% of patients, depending on their age or gender, had clinical evidence of inflammatory gum disease.
• 28% to 77% of patients with asymptomatic wisdom teeth will have tooth decay (caries).

Part B: What happens to wisdom teeth if they are retained (not removed)?

• Retained wisdom teeth change their position over time, but not in a predictable way. They may erupt into the mouth and subsequently develop decay and inflammatory gum disease.
• Among patients with pain-free wisdom teeth, who have no evidence of inflammatory gum disease 30% to 40% developed inflammatory gum disease after a period of 5 years.
• In 40% of patients with visible wisdom teeth and gum disease and bone loss present, the bone loss is expected to also involve the other molar teeth within 2 years.
• Young and adolescent patients with visible wisdom teeth have a greater risk of developing inflammatory gum disease compared with their peers without visible wisdom teeth.
• Only 75% of impacted, pain-free wisdom teeth are free of disease. So, if a patient has 4 impacted wisdom teeth, even though they are pain free, chances are at least one of them has either: decay, inflammatory gum disease, cyst or a tumor around it.
• Among patients with pain-free and disease-free wisdom teeth who chose to keep their wisdom teeth, at least one third of the wisdom teeth develop disease within 4 years and need removal.

Part C: Summary of outcomes after wisdom teeth removal:

• Removing wisdom teeth significantly improves the gum and bone health of adjacent teeth. Removal of wisdom teeth resulted in threefold reduction in the proportion of adjacent molar teeth with gum and bone disease.
• Most young, healthy adults may expect to have full recovery within 5 days or less after wisdom teeth removal.
• Increasing age (greater than 24 years), level of impaction of the wisdom tooth, and the need to remove bone are associated with delayed patient recovery after the surgery and delayed clinical healing. Not surprisingly, delayed clinical healing also increases the risk for delayed recovery of lifestyle (daily activity, recreation, social life), oral function (talking, chewing, resuming normal diet) and prolongs bad breath and discomfort in the mouth.

Conclusions:

• Pain-free Wisdom teeth does not mean disease-free wisdom teeth.
• Even if the wisdom teeth are not bothering you, you may still have wisdom tooth decay or inflammatory gum disease around your wisdom teeth.
• The older you are when you get your wisdom teeth out (after the age of 24), the more difficult the procedure, the longer the recovery, and the higher the risk for complications.
• If you choose to keep your wisdom teeth, make sure your dentist routinely monitors them for any evidence of pathology developing around them.

If you have any questions about your wisdom teeth and want to schedule a FREE consultation, please call Dr. Tsvetov’s office at ☎ Temecula Facial Oral Surgery Phone Number 951-302-9100 − we will be delighted to talk to you!