3rd molars out?

[aphistis]

D3's & D4's, I'm looking at you here

I've been putting it off, but I'm afraid the time has come to get my wisdom teeth removed. #17 & 32 are both impacted, but there's no pain/inflammation/etc associated with them; the only problem is they're starting to cause crowding (25 is getting displaced labially, 22 lingually). Those two are definitely coming out.

My question is about 1 and 16. There appears to be enough room for them, so is there any compelling reason to get them taken out? Getting 3rds removed is painful, and past victims tell me getting all four at once is misery

What I'd like to know: A) In y'all's expert opinions, should I get all four out, or just the two causing problems? B) Is this something I could have done at the school, or should I have my dentist/OMS do it?

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[drPheta]

I say take out 1 and 16 as well. They're most distal, so you won't have to worry about any mesial movement of teeth beyond that point. In addition, the maxillary 3rd's may irritate the retromolar pad when chewing. It probably won't be pathelogic, but just uncomfortable. Furthermore, I always feel that my molars are harder to clean because of the gums that crowd around back there (not to mention the cheeks). So, you may end up having to work a lot harder to keep those 3rd's clean.

This is the same exact advice I got from my general practitioner and my oral surgeon when I took mine out.

Any others want to chime in?

EDIT:
Oh yeah, if your insurance covers a private OMFS, go for that. But you'll save a heck of a lot of money at the school. Plus, you help your upperclassmates get some experience!

 

[Meggs]

Originally posted by aphistis
.....My question is about 1 and 16. There appears to be enough room for them, so is there any compelling reason to get them taken out? Getting 3rds removed is painful, and past victims tell me getting all four at once is misery

What I'd like to know: A) In y'all's expert opinions, should I get all four out, or just the two causing problems? B) Is this something I could have done at the school, or should I have my dentist/OMS do it?

Yeah, it can be misery, but at least is only one misery, compared to two (if go by left side surgery and then right side). And you'll find yourself a justification for a diet composed of ice cream, shakes, smothies, etc...

You better get all four extracted.
First, because 1 and 16 will be nonfunctional. All they will do there is to cause plaque retention. And they will still cause presure towards their mesial side.

Second , when a tooth looses one of its "neighbors", it'll start to get displaced by moving towards there's no pressure holding it; in this case loosing an antagonist will cause them to move towards occlusal, which will make them look like if they are "falling" out from their sockets.

Third, superio third molars are rather easy to extract, compared with inferior ones. So most of the pain, swelling, etc. will come from the mandible anyway, so......you might as well get the upper ones too.

About getting it done at school, it'll be cheaper, as long as you find youself an skilled D4 for those impacted inferiors.

Good luck.

 

[UBTom]

Heya Bill,

If your molars have hard-tissue impaction and might require sectioning or surgical exo, it would be the oral surgery residents or the OMFS instructors at your dental school who would do the procedure, so you should be in good hands. Lots of dental schools wouldn't let a 3rd-year touch a Hall drill or a Stryker, LOL..

Anyway, my assessment would be the same as drPheta's.

HTH!

 

[ItsGavinC]

Bill,

I had mine removed back in 97, and ALL of them were impacted. The hours right after the surgery were a bit painful, but overall it just wasn't a bad experience.

Don't let the fear of pain deter you in your decision. It just isn't THAT bad. Besides, you outta know what YOUR patients will feel like, right?

 

[no2thdk999]

Bill I doubt your crowding is due to your wisdom teeth. This is a popular misconception amongst patients and even dentists.

Dr. Proffit who wrote the ortho book you will probably use tells a lengthy story about his friend who drove his '73 Cadillac El Dorado in to a ditch one evening. Try as he might his friend could not budge the 6300 lbs of Detroit steel. He likens your 3rd molar to his friend and the rest of your mesial dentition is the Cadillac. It just aint gonna budge.

What is probably going on is you're having your late mandibular growth. As your mandible continues to grow forward the lower anterior teeth have to recline in order to stay behind the maxillary teeth. This reclining decreases the radius of the arch and lessens the amount of space you have for these teeth causing them to get jumbled up.

This usually happens in the mid to late twenties. Ask your orthodontist how long you have to wear your retainer. The answer is as long as you want straight teeth. If you look at anyone over 40 their lower anteriors will have some sort of crowding.

All this to say your teeth will continue to crowd whether your 3rds find sunlight or not.

If they are impacted I would still recommend getting them out. An impacted tooth can cause trouble down the road and it's much easier to get them out as a healthy 25 yo than as a 65 yo (or even 35 yo)

As for the top 3rds if they are impacted I would send them packing as well. If they are fully erupted and will be in occlusion once 17/32 are gone; you can keep them if you can keep them clean.

It's about the same amount of misery to get 4 out as 2 so do it all at once unless you have some other complication like one is wrapped around the IAN or way high in the sinus, etc....

I would try to be friends with one of the OMFS residents who could sedate you and save you some cash. If you were a female this being friendly would involve showing them the pan and batting your eyes. You might have to buy them a 6 pack (import not domestic)

 

[grimace]

the only problem is they're starting to cause crowding (25 is getting displaced labially, 22 lingually

Hey, just wanted to let you know that this is a common misconception among students and the general public alike. It has been proven that 3 molars (or any posterior tooth) does not have enough force to cause crowding in the anterior. It is similar to a person trying to push a car (that is the analogy an instructor used). There is simply no way the 3rd molars could cause shifting that many teeth away.

Instead, the more likely explanation to your crowding is called late mandibular growth. It is a common occurrance, and I'm assuming you are in your mid-20s or so, which is the prime time for this to occur. This late mandibular growth is the reason people experience lower crowding in the anterior.

Just thought you would find that interesting; it is definitely counter-intuitive and I was surprised to learn that myself.

All of this, by the way, is what is taught by UNC's Ortho Dept at present.

Good luck with your removal

 

[grimace]

wow, we must have been writing the same thoughts at the same time no2thdk...didn't see your post until i submitted.

Oh yeah, and that professor that told me the car analogy was none other than Dr. Proffit himself.

 

[ItsGavinC]

(off-topic post)

Grimace,

Have you had courses by Dr. Montgomery? He's teaching us currently. Opinions?

 

[grimace]

Gavin-

Dr. Montgomery taught Gross Anatomy here at UNC for like 30 years. I don't know too much about him, but the one thing I do know is that my class was VERY lucky to be the 1st class after his retirement at our school. Supposedly he is very hard, doesn't give the best notes and his exams are tough. That's all second-hand, but I've heard this from a lot of people.

(You are talking about Royce Montgomery, correct?? Word was he was very ill, and that is why he stopped teaching. I thought he was done for good).

 

[aphistis]

Thanks for the input, everybody--the information about late mandibular growth was especially interesting.

I'm still going in to get the teeth removed, but while I'm getting my initial exam I'm definitely going to ask about some options; maybe this will turn out to be nothing, but if it doesn't I want to get it taken care of early (yay for preventative treatment) before anything gets too out of hand. The last thing I'll need as a dentist is a mouth full of crooked teeth, after all Thanks again.