Wisdom Teeth?

[wolingfeng]

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Is it controversial to remove all wisdom teeth? What's the conditions to remove wisdom teeth? What if wisdom teet are not interfering? Are wisdom teeth going to benefit patients in future?

I am just curious about it.

So what's really pro&con?

 

[Rezdawg]

If the wisdom teeth erupt without disrupting the rest of the dentition then it is not a necessity to remove them. However, having those 3rd molars back there makes it more difficult to reach into the back of your mouth and truly get those surfaces clean...As a result, many may get caries back there...which would lead to a restoration...which could lead to recurrent caries...which isnt really worth all the trouble and costs since you dont need 3rd molars to begin with.

 

[wolingfeng]

Thank you for the answer.
Someone messaged me for saying my thread as "the dumbest fcuking question". As I am not a dentist, nor wants to pursue dentistry, I just want to know some reasons most dentists recommended to do so.

 

[armorshell]

Thank you for the answer.
Someone messaged me for saying my thread as "the dumbest fcuking question". As I am not a dentist, nor wants to pursue dentistry, I just want to know some reasons most dentists recommended to do so.

That's not a dumb question at all; there's still some dissent even within the field as to whether prophylactic 3rd molar removal is wise. You probably just got the best of some freshman pre-dent.

 

[rals]

sometimes they come in impacted which means they are not aligned properly and can then start problems including inflammation and disruption of the surrounding dentition, etc. If not though, I don't think they should generally be removed. I only know this much from what I've discussed with my dentist and what I've read as a pre-dent so keep that in mind.

I think it is controversial, even though many dentists seem to prefer to just get rid of them at the slightest sign of imperfection/trouble.

 

[ktcook83]

Wizzies can also be trouble if they are partially erupted as you can get pseudo-pocketing and caries below the gums because you have a warm moist bacteria party going on down there where the TB can't access

 

[BeetleMama]

I wish it had been common practice to remove them here, when mine came in they pushed my front teeth out of line, top and bottom.

I had to have a back top tooth out a few years ago, so my top row was spared the big push and have straightened back out, but the gap that missing tooth left is almost entirely closed up now, so they must have needed the room. On the bottom, one is almost sideways now. I wish I'd had at least one out on the bottom to keep my previously straight line.

 

[rals]

one out screws up the symmetry, but worst of all, it could really do a number on your bite. if you have good contact and occlusion now, then a good orthodontist should advise you to hold onto your teeth rather than take some out for cosmetic purposes.

 

[DrJeff]

I wish it had been common practice to remove them here, when mine came in they pushed my front teeth out of line, top and bottom.

I had to have a back top tooth out a few years ago, so my top row was spared the big push and have straightened back out, but the gap that missing tooth left is almost entirely closed up now, so they must have needed the room. On the bottom, one is almost sideways now. I wish I'd had at least one out on the bottom to keep my previously straight line.

Big myth about wizzies and those movements you're referring too. Look into something called "mesial drift" for why it would have happened to you independently of the presence/abscence of your wizzies!

 

[DrJeff]

Short version of my theory of wizzies

If you've got enough room for them to fully errupt AND you can keep them clean, they stay, otherwise you get to become a few ounces lighter!

 

[ktcook83]

Short version of my theory of wizzies

If you've got enough room for them to fully errupt AND you can keep them clean, they stay, otherwise you get to become a few ounces lighter!

and less wise 😉

 

[OceanDMD]

Big myth about wizzies and those movements you're referring too. Look into something called "mesial drift" for why it would have happened to you independently of the presence/abscence of your wizzies!

Its amazing how many people blame crowding on "wizzies". Ive seen so many patients who have lost 1st or 2nds, and because of this mesial drift their retained 3rds are now functional and in acceptable occlusion. Why cant people understand you will need some form of retention forever after ortho. Regardless, I probably recommend extraction of thirds over 50% of the time. It seems the younger patients rarely have room.

 

[BeetleMama]

Big myth about wizzies and those movements you're referring too. Look into something called "mesial drift" for why it would have happened to you independently of the presence/abscence of your wizzies!

So I have blamed them all these years and it's not their fault? poor old things, I almost feel bad for them

I think the reason people don't understand is because dentists say things like "they are being pushed out of line" it does tend to imply that something new has occured that is "pushing" them.

 

[mmasurf]

its always better to have a tooth than not to have one, so if they erupt without any problems then there shouldn't be a need to remove them. Also wisdom teeth can be taken out and transplanted into the missing 2nd or 1rst molars. read up on the topic here

http://www.dochemp.com/transplant.html

 

[DrJeff]

its always better to have a tooth than not to have one, so if they erupt without any problems then there shouldn't be a need to remove them. Also wisdom teeth can be taken out and transplanted into the missing 2nd or 1rst molars. read up on the topic here

http://www.dochemp.com/transplant.html

Much, much, much more predicatable if your looking for 1st or 2nd molar replacement to use an implant. After all, more often than not, that person that lost the 1st or 2nd molar lost it due to caries. Just makes more sense to give them a more predictable, CARIES PROOF restoration, the implant

 

[DrJeff]

So I have blamed them all these years and it's not their fault? poor old things, I almost feel bad for them

I think the reason people don't understand is because dentists say things like "they are being pushed out of line" it does tend to imply that something new has occured that is "pushing" them.

What I'll tell my patients when the hit me with the old standard line "my front teeth are crooked because of my wisdom teeth", I'll give a basic explanation of mesial drift in simple terms, and explain how the movement of those front teeth is do to the "pushing" of the entire mass of the often lateral incisor back on through the 2nd molar working on that very small root of the central incisor(I have a typodont in my operatories where the teeth aren't rigidly screwed in, but held in a silcone socket so you can really wiggle and move them around to demonstrate things to patients that helps alot with explaning things like this.

 

[BeetleMama]

...in simple terms, and explain how the movement of those front teeth is do to the "pushing" of the entire mass of the often lateral incisor back on through the 2nd molar working on that very small root of the central incisor

erm, you might want to make it more simple then that, maybe just give them the model to play with....

 

[JavadiCavity]

Regardless of the amount of room, I'm in favor of yanking wisdom teeth sooner than later. Much easier to get them out when the patient is younger. Less risk for intra- or post-op complications. Even if there is enough room, I say pull 'em...unless the patient is already matured with very dense bone. Then I'd leave em. But, if the patient is a teenager or in their twenties, with that nice soft, expandable bone, I'd yank em.

 

[DrJeff]

Regardless of the amount of room, I'm in favor of yanking wisdom teeth sooner than later. Much easier to get them out when the patient is younger. Less risk for intra- or post-op complications. Even if there is enough room, I say pull 'em...unless the patient is already matured with very dense bone. Then I'd leave em. But, if the patient is a teenager or in their twenties, with that nice soft, expandable bone, I'd yank em.

To play a little devil's advocate with you for a minute. Let's say that 20 year old with 4 fully errupted wizzies that are cleansible and in occlussion has elective wizzie removal on your advice and they suffer permanent parasthesia on one side of the mandible due to the proceedure😱 It happens.

Sometimes the best dentistry we can do is none at all. Plus, I've never once heard a patient complain when I tell them that as long as they can continue to keep their fully errupted wizzies clean that they can stay😀

That being said, I'm seeing that between 2/3rds and 3/4ths of my patients needing wizzie removal due to lack of space, and especially this time of year, that makes my local oral surgeons very happy (the 2 big wizzy ext times a year for oral surgeons are right after the college age crowd gets home for the summer, and when the college age crowd comes home for x-mas break)

 

[JavadiCavity]

True, parathesia is a risk. But, I purposely left out complicating factors like roots impinging on the IA or an aberrant lingual nerve hiding on top of the retromolar pad. Under those circumstances, I'd elect to leave the teeth (assuming enough room, etc.).

That being said, in younger patients, 3rd molar roots aren't fully formed and shouldn't be close to the IA nerve. I suspect the real risk is accidentally damaging the lingual nerve. And, there's no way that I've learned to know the location of the lingual nerve before surgery. It's a tiny, stringy little nerve too, if I remember from gross anatomy, so it would be hard to see anyway. Maybe, just keep your flap and window far to the buccal. You might severe the long buccal nerve, but no one seems to be bothered by that.

Good discussion.🙂

 

[DrJeff]

True, parathesia is a risk. But, I purposely left out complicating factors like roots impinging on the IA or an aberrant lingual nerve hiding on top of the retromolar pad. Under those circumstances, I'd elect to leave the teeth (assuming enough room, etc.).

That being said, in younger patients, 3rd molar roots aren't fully formed and shouldn't be close to the IA nerve. I suspect the real risk is accidentally damaging the lingual nerve. And, there's no way that I've learned to know the location of the lingual nerve before surgery. It's a tiny, stringy little nerve too, if I remember from gross anatomy, so it would be hard to see anyway. Maybe, just keep your flap and window far to the buccal. You might severe the long buccal nerve, but no one seems to be bothered by that.

Good discussion.🙂

The big thing to consider, isn't the successful case that will happen 99% of the time, but that 1% case where something goes not according to plan (i.e. parasthesia, etc). Elective wizzie removal on a young patient with immature root formation (typically that 14 to 17 year old population) if something goes wrong, you could very well have to face the question about why you were taking them out BEFORE complete mandibular growth has occurred. If it's a close spacing situation, and a complication arises, that question may come back to bite you in the behind. For most folks, waiting until the early 20's (college age) for wizzy removal can allow for a good compromise between bone density and jaw growth. Plus from a healing standpoint, the less you need to cut, the greater the patient comfort post surgery, and having to "dig out" a fully submerged wizzie with immature roots may very well have a greater degree of post op pain associated with it than a wizzie with fully mature roots, but is atleast partially errupted.

Just things to consider/debate, and thats why this is such a cool forum👍

 

[scalpel2008]

It's a tiny, stringy little nerve too, if I remember from gross anatomy, so it would be hard to see anyway. Maybe, just keep your flap and window far to the buccal. You might severe the long buccal nerve, but no one seems to be bothered by that.

Good discussion.🙂

The lingual nerve is actually pretty thick (>3mm). Its thicker than the IAN.

 

[JavadiCavity]

Hmmm...well, it seems like it was around 1 to 2 mm...to me...which was smaller than the IAN that I looked at. Ah well.

 

[MrVagus]

Pray tell just how many IAN's have you looked at......and under what circumstances...

Hmmm...well, it seems like it was around 1 to 2 mm...to me...which was smaller than the IAN that I looked at. Ah well.

 

[OceanDMD]

Pray tell just how many IAN's have you looked at......and under what circumstances...

 

[JavadiCavity]

Pray tell just how many IAN's have you looked at......and under what circumstances...

Wow...are you kidding? Everyday in clinic. I dissect it out so I can make sure I place the needle right next to it. Patients don't mind at all.

Or, maybe just the one time I dissected it out in Gross Anatomy, like I mentioned above.🙂

 

[BeetleMama]

...while we're talking about extractions and things that might just possibly go wrong, I would like it noted that when you are removing a back tooth, using the most common method (brute force and wiggling it in a pair of pliers), when there is a loud crack and the tooth comes out with three quarters of an inch of bone attached to the side, saying "Oh that sometimes happens" is not very reasuring for the patient.

If it indeed does "happen" on a regular basis, a little heads-up before hand would have been nice, and if it does not happen regularly, a little more concern would have been appreciated, after all, it was my jaw bone, not hers, and while it may "happen" to you (the general populace of dentists), it has never happened to me and I was shocked and appalled and really very grossed out by seeing her remove what I considered a significant section of my bone.

Just remember we don't do this every day, it's very expensive and we didn't want to come in the first place. I'm not asking for a cup of coffee and a tv show of my choice, just that you look like you care 🙁

 

[Midoc]

...while we're talking about extractions and things that might just possibly go wrong, I would like it noted that when you are removing a back tooth, using the most common method (brute force and wiggling it in a pair of pliers), when there is a loud crack and the tooth comes out with three quarters of an inch of bone attached to the side, saying "Oh that sometimes happens" is not very reasuring for the patient.

If it indeed does "happen" on a regular basis, a little heads-up before hand would have been nice, and if it does not happen regularly, a little more concern would have been appreciated, after all, it was my jaw bone, not hers, and while it may "happen" to you (the general populace of dentists), it has never happened to me and I was shocked and appalled and really very grossed out by seeing her remove what I considered a significant section of my bone.

Just remember we don't do this every day, it's very expensive and we didn't want to come in the first place. I'm not asking for a cup of coffee and a tv show of my choice, just that you look like you care 🙁

Thats not bad advice but it is given in a very condescending manner and not appropriate for this forum.