Wisdom teeth removal = Con Game?

[mile_26]

(I am posting this for a friend):
In a group discussion this subject came up: Is it really necessary that we have our wisdom teeth extracted? Is it part of a "con-game" for the dentist or oral surgeon to get a better boat or airplane? Of course there can be complications for a minority if they are not removed. (There are also risks for those who have them removed). How important is it?

This friend has 2 impacted and the other 2 that his dentist said will need to be surgically removed before school this fall (to avoid any "future problems"). He is 25. His parents both still have their wisdom teeth with no complications.

1.Does anyone know how necessary this is--if there are not any problems at this time? (considering cost and the pain involved).
2. Anyone choosing to KEEP their wisdom teeth?
3. Should he keep his appointment in 2 weeks or wait and see if he has problems down the road?
4. Pros/Cons?
Thanks!

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[markymarky]

impacted wisdom teeth may contribute to the crowding of teeth. as for wisdom teeth in general, they are hard to clean and may accumulate plaque and calculus, possibly leading to periodontal disease in the posterior areas of the mouth.

 

[Big_Poppa DDS]

how about contribute to the formation of odontogenic cysts like dentigerous cysts, and caries on the distal of second molars.

 

[compudentist]

hi,
a normaly erupted 3rd molar can be retained , if it is in proper occlusion with the antagonist.its extraction is must only if it is impacted , abnormaly erupted (lingual, buccal , palatal) etc , or if it is caried (can be retained if properly restored ),if it is impinging on soft tissues or neighbouring tooth structure or when it is causing crowding.
if u feel it causes any problem like diffficulty maintaning the area clean ,then u can think about extraction.

 

[DrJeff]

Originally posted by markymarky
impacted wisdom teeth may contribute to the crowding of teeth. as for wisdom teeth in general, they are hard to clean and may accumulate plaque and calculus, possibly leading to periodontal disease in the posterior areas of the mouth.

The two largest misconceptions by the lay public about dentistry are 1) people have "soft" teeth and 2) wisdom teeth cause lower anterior crowding. Wisdom teeth will not cause lower anterior crowding, ask any competent orthodontist, or just think about it from a logical standpoint. Realistically can a tooth the size of a wisdom tooth(generally not that large) be expected to "push" all of the root structure of the 5 to 7 teeth mesial to it to "move" the lower anteriors?? It just doesn't happen. However, occlussal irregularities, forces of the tongue pushing out, the facial muscles "pulling" in and vertical erruption forces can cause crowding. This interm with the inherrant tendencies for a mesial drift of teeth as we age can, and often will cause lower anterior crowding as we age(due to the larger root structure of maxiallry anterior teeth it is often not seen, or much less pronounced in the maxilla)

Now, is having wisdom teeth removed a "scam" that the dental community runs?? I will admit that some dentists and oral surgeons may be a bit quick to reccomend wisdom tooth removal. The criteria that I use is as follows: Is the wisdom tooth fully errupted(i.e. fully through the gum)? Does the patient demonstrate the ability to keep the wisdom tooth clean? Is the periodontal(gum) situation the same around the wisdom tooth as all the adjacent teeth? If any of these questions is a "no" I reccommend extraction. The most common problem with wisdom teeth is something called pericoronitis, which is a PAINFULL infection that from time to time can occur around a wisdom tooth that isn't fully errupted through the gum. If the tooth is impacted, hey the worst thing that can happen is if the impacted tooth is pushing on the tooth infront of it. This can cause extensive decay to the infront of the wisdom tooth in an area that is unrestorable and then not only will the wisdom tooth need to come out at a later date, but also the tooth infront of it

Now, nobody likes the concept of having their wisdom teeth removed, but it is very likely that if your dentist has reccommended it that it is for good reason. Think of it this way, if your dermatologist reccomends an "interesting" looking freckle be removed because of a future risk, you'd do it in a moment. This is the same type of situation!

 

[markymarky]

oops my bad. i just checked some abstracts on the effects of third molars on anterior crowding. i wouldn't go so far as to say that they will NOT affect crowding, but they, along with other factors may contribute (minimally, however) to anterior crowding (as i've stated originally).

Dr. Jeff,
although your logical reasoning does sound nice, when coupled with teeth's natural tendencies to drift mesially, couldn't impacted third molars have a slight probability of causing crowding?

by the way, what are "soft" teeth?

 

[mpp]

I've moved a lot so I've had many different dentists. So when I go for dental work, I often get a second opinion which was to my benefit.

Once a dentist insisted that I needed two root canals, with two crowns, and all four of my wisdon teeth removed (to the tune of about $7,500 which he was more than willing to offer on his payment plan O.A.C). Obviously, in this case I got a second opinon and the next dentist had no problems just giving me fillings on those teeth and left the wisdom teeth intact. That was six years ago and still no problem with any of those teeth.

So, if you feel that perhaps the dentist is trying to pull one over on you, get a second opinion just to satisfy yourself. I doubt that this is a common occurence, but the extra $65 exam fee (or whatever it might cost) is worth the comfort of knowing that you are not having any unnecessary procedures being performed (both on your teeth and on your wallet).

 

[DrJeff]

Originally posted by markymarky
oops my bad. i just checked some abstracts on the effects of third molars on anterior crowding. i wouldn't go so far as to say that they will NOT affect crowding, but they, along with other factors may contribute (minimally, however) to anterior crowding (as i've stated originally).

Dr. Jeff,
although your logical reasoning does sound nice, when coupled with teeth's natural tendencies to drift mesially, couldn't impacted third molars have a slight probability of causing crowding?

by the way, what are "soft" teeth?

If wisdom teeth were going to cause anterior crowding, wouldn't we see a whole lot of folks in their late teens/early 20's with generalized anterior crowding(especially amongnst the post ortho treatment folks) when the "active" erruption of the wisdom teeth is typically occurring? It's because the wisdom teeth can't "push" the teeth mesial to them out of the way that they will become impacted(typically either under the ascending ramus or mesio-angularly impacted against the 2nd molar). I'd bet that if some poor orthodontic graduate student did a retrospective analysis of anterior crowding in 30+ year old that have their wisdom teeth verses those that had them extracted that the difference would be statistically insignificant.

Now "soft teeth". This is a phrase that you will hear literally thousands of times over your career from your patients as they attempt to rationalize why they keep having multiple areas of decay at every recall(cleaning visit). These folks will typically set down their extra large, extra sweet cup of coffee in the operatory (generally 1 of 4 or 5 cups/day), and then ask for a towel so that they can spit out the Altoid that they constantly have in their mouth. They will generally also have kids who at their recall visit have tongues that are vivid neon shades due to the Kool-aid that they just finished drinking and also have large quantities of fruit roll-up wedge interproximally and into the occlussal grooves. The will then insist that when you tell them to set up a couple of apointments to take care of the areas of decay that they have "soft teeth" just like my _____ (insert mother/father/parents in the blank) had. This is also after you've explained to them a half dozen times the role of sugar and strep mutans in the decay equation. The "good" thing though is that these folks will ensure that your practice will economically thrive for years to come!

 

[Centrum]

Dr. Jeff is the man!

 

[markymarky]

Originally posted by DrJeff


If wisdom teeth were going to cause anterior crowding, wouldn't we see a whole lot of folks in their late teens/early 20's with generalized anterior crowding(especially amongnst the post ortho treatment folks) when the "active" erruption of the wisdom teeth is typically occurring? It's because the wisdom teeth can't "push" the teeth mesial to them out of the way that they will become impacted(typically either under the ascending ramus or mesio-angularly impacted against the 2nd molar). I'd bet that if some poor orthodontic graduate student did a retrospective analysis of anterior crowding in 30+ year old that have their wisdom teeth verses those that had them extracted that the difference would be statistically insignificant.

Now "soft teeth". This is a phrase that you will hear literally thousands of times over your career from your patients as they attempt to rationalize why they keep having multiple areas of decay at every recall(cleaning visit). These folks will typically set down their extra large, extra sweet cup of coffee in the operatory (generally 1 of 4 or 5 cups/day), and then ask for a towel so that they can spit out the Altoid that they constantly have in their mouth. They will generally also have kids who at their recall visit have tongues that are vivid neon shades due to the Kool-aid that they just finished drinking and also have large quantities of fruit roll-up wedge interproximally and into the occlussal grooves. The will then insist that when you tell them to set up a couple of apointments to take care of the areas of decay that they have "soft teeth" just like my _____ (insert mother/father/parents in the blank) had. This is also after you've explained to them a half dozen times the role of sugar and strep mutans in the decay equation. The "good" thing though is that these folks will ensure that your practice will economically thrive for years to come!

lol!

 

[mile_26]

Thank you for all of your comments. DrJeff, I especially appreciate your insightful details. However,

Originally posted by DrJeff
The "good" thing though is that these folks will ensure that your practice will economically thrive for years to come!

The above quote makes me wonder, still, if the surgical removal of wisdom teeth may be an economical benefit, also. I am not quite sure of the dental terms...impacted= If the teeth are impacted can they just stay that way for many years (for life) without causing troubles? OR, do they ALWAYS cause trouble? Is it beneficial to "wait-and-see" if those future troubles occur? OR-is it best to have them taken out early--even if there will not be any future complications?

 

[DrJeff]

Impacted is a term that refers to something that is preventing the wisdom tooth(or any tooth for that matter) from fully errupting into the mouth. The most common types of impactions are bony and soft tissue. There are also further defining terms used such as "full" (i.e. completely impacted by bone or gum tissue) and "partial" (i.e. only a portion of the tooth is impacted in either bone or soft tissue). The partial impactions are generally the moost troublesome(interms of future potential problems) since they generally will have SOME exposure of the tooth into the oral cavity which will greatly increase the chance that some debris will at one time or another get wedged into the pocket around this tooth which can lead to a painfull infection. These type of impactions should almost always be removed. Full impactions be it by bone or gum tissue are a bit more controversial in their removal. If the tooth is completely encased by bone or soft tissue and doesn't have communication with the oral cavity then the infection risk is low, and its removal may not be needed. If this impaction is in an unfavorable location (i.e. lodged against the adjacent tooth) it may be wise to have it removed(see may above posts about potentially having to have the wisdom tooth and and adjacent tooth extracted in the worst case scenario. The other thing to consider if you decide to leave the wisdom teeth in place is that they have a developmental sac around them which in rare instances can have tumor growth associated with them(generally a benign tumor, but often aggressive in its bone destruction).

On a personal note, I have 1 impacted wisdom tooth (my upper left wisdom tooth) that basically is located closer to my left ear than my oral cavity. I have chosen to leave it there and every two years I have a panoramic radiograph taken to evaluate it for potential tumor development. 8 different oral surgeons have seen my radiograph, and not a single 1 has even hinted at having it extracted, and 1 oral surgeon last week after seeing my radiograph said "you really want to have that tooth until the day you die".

Like I said before, most dentists will make recomendations out of your best dental health interest, not out of their wallet's interest. And my comment about the patients that will provide future economic interest for the practice was in reference to the patients who after repeatedly having the cause of decay(i.e high frequency sugar consumption) explained to them, don;t change their habits and continue to have multiple new areas of decay.

 

[UBTom]

to Mile_26:

Impacted wisdom teeth often look something like this:

The Mandibular 3rd molar is growing horizontally and its crown is butting into the distal side of the 2nd molar. More often than not this situation will cause all the chronic problems others have mentioned and pre-emptive extraction is usually a good idea.

Me, my lower 3rd molars weren't impacted but were lingually tilted and kept lacerating my tongue. I'm glad I had them pulled.

 

[mile_26]

I will pass your info on...
i appreciate everyone's comments!
Thanks!!

 

[mile_26]

Just to clarify...
If the person would NOT have the impacted wisdom teeth removed at this time, what chance is there that he will never have complications from these teeth?

Thanks again.

 

[compudentist]

cannot predict exactly , it may remain asymtomatic for a long time or may even cause problem suddenly .
depends on how the tooth is impacted.

 

[DrJeff]

Not having seen their x-ray, it's tough to speculate, but here goes. Assuming that the teeth are completly impacted and submerged in either bone or soft tissue with no communication with the oral cavity and not encroaching on the adjacent tooth, the risk of future complication is extremely low(less than 5%). If the wisdom tooth is encroaching on the adjacent tooth, you're probably looking at a 1 in 3 chance of having a problem requiring extraction of booth the wisdom tooth and the adjacent tooth (the second molar). If the wisdom tooth has any communication with the oral cavity, the chance that there will be atleast 1, if not multiple occurrances of the tissue and developmental sack surrounding the wisdom tooth becoming painfully infected (called pericoronitis) is better than 75%.

One other thing to remember, the younger you have the wisdom teeth extracted (if you're going to), the quicker you'll heal.

Good luck with your friend making the choice about what to do.

 

[oudds]

The standard percentage that floats around the dental community is that 15-20% of wisdom teeth will become problematic. The catch is that you can't predictably determine which will cause problems. These problems include dentigerous cysts that often remain asymptomatic until they have expanded the mandible and in effect hollowed it out. In addition, the proximity of the mandibular molars to the inferior alveolar canal and nerve can cause future problems that become increasingly more difficult and risk laden to address.

The removal of wisdom teeth are not a scam but worthy of consideration and usually extraction. In addition, these teeth (as posted earlier) are hard to clean, hard to restore and can cause the loss of the 2nd molars in front of them. If your friend doesn't trust his dentist or think he needs them to be removed, he has been informed, tell him to make up his own mind about the risks. God bless informed consent.


seeyou

 

[mile_26]

How is an airway maintained during this surgery?
Is there usually a lot of blood in the mouth during the surgery?
How can the dentist deliver the anesthetic agents, monitor the patient, and do the surgery if the patient isn't intubated?

Also, How do you avoid "dry sockets"?

Thanks, you are all the best!

 

[oudds]

When wisdom teeth are extracted there are a number of factors that determine the desired level of sedation necessary.

Most oral surgery related to tooth extraction is completed simply under local anethesia with the patient fully aware of his/her senses. The doctor may or may not elect to use a disassociative drug (Halcion) or gas (nitrous oxide).

If general anesthesia is a part of treatment the level of sedation needed is not deep enought to warrant intubation. The surgical field is maintained by the surgical assistant with the use of a throat pack and suction. The patient's breathing is not suppressed and is only monitored via a pulse oximiter and visual confirmation.

Dry sockets are caused by the presence of infection as well as any oral habit that may dry the mouth or dissolve a clot.

As for the presence of blood, the mouth is highly vascular and bleeds. All oral surgeons and staff deal with this on a daily basis. The only significance on your behalf would to review what medications may extend bleeding and could cause problems. Usually these medicines can be avoided a few days prior to surgery. As always, you would consult the oral surgeon prior to stopping any medicines.

seeyou



seeyou

 

[mile_26]

Do dentists ever receive a "kick-back" referral fee for sending their patient to the oral surgeon? or, is $$ not a part of the deal?
Thanks, again.

 

[UBTom]

A referral fee is a definite no-no. If a dentist was found out to receive referral fees he would face disciplinary action from either the dental society or the state licensing board (forgot which exactly).

 

[gryffindor]

So the general dentist doesn't get a referral fee, but the oral surgeon's office will probably periodically send bagels/chocolates/plants and other stuff throughout the year to thank the dentist and his/her staff for the referrals.

 

[Centrum]

And will hook the dentist and his family up with free services!

 

[DrJeff]

The general dentist/specialist relationship.....

There are no $$ per specific patient kick backs, end of story.

Do specialists send gifts to general dentists? Yes and no. Some of the specialists that I refer to will send thank you gifts to the office (typically at Christmas time), and these generally are a fruit cake, a box of chocolates or a pointsettia. Some specialists will not send anything. One specialist that I refer to sends a gift certificate to a local restaurant at Christmas time. This is fairly common. The specialist do this as a way to say thank you for sending them patients. Have I ever seen actual money coming my way from a specialist as a thank you, no!

The other "thank yous" that specialists will typically do is take the general dentist out to lunch once or twice a year. This is generally done if a specific patients case needs to be discussed, or if the specialist has acquired a new piece of equipment that they want folks to know about. Occasionally if I hear back from one of my patients that they felt that they had a bad experience at the specialists office, I'll call them up and take them out to lunch to discuss this.

The other thing that specialist will typically do is any work that the general dentist needs is generally done free of charge (or materials fees at most) and the specialist will also often treat members of my staff at either no charge or at a "courtesy discount" of generally 50%.

The only things that cross my mind when I'm filling out referral slips for my patients is my patients best interest, and occasionally which specialists personality will mesh best with my patients, and lastly and occasionally is there a geographically preferable specialist to send my patient to(this last one is much less of a factor in urban settings than in a rural setting like mine).