Why We Remove Wisdom Teeth
- Dr. John
- Sep 23, 2021
- 3 min read
Updated: Nov 6
This is one of the questions we frequently hear. There are several reasons why we recommend (in most cases) removing wisdom teeth in young people.
1. Pericoronitis/Facial infection
This is a very common reason. Any tooth that is partially erupted has gum covering a part of it. Any time gum covers a part of the tooth, there is the potential for food or plaque to become trapped between the gum and the tooth, leading to an infection. Since most teeth other than wisdom teeth are erupted, this commonly happens only to wisdom teeth.
This infection is called pericoronitis because it happens around (peri) the crown (corona) of the tooth. This infection had the potential to become a raging infection, in some cases, life-threatening. Dr. John has treated patients with large facial infections that required incision and drainage in the operating room with recovery in the ICU for several days.
2. Prevention of Dental Disease
Insufficient oral care can lead to decay and periodontal disease over time. Caries in the second and third molars are responsible for the extraction of impacted third molars in approximately 15% of patients. (1)
3. Orthodontic Therapy
Wisdom teeth are removed for orthodontic reasons. These include crowding of the posterior teeth to provide space, sometimes crowding of even the anterior teeth, and before lower jaw (orthognathic) surgery.
4. Prevention of Cysts and Tumors
Wisdom teeth are notorious for being the focus of cysts and tumors in the mouth. Obviously, not every wisdom tooth leads to cysts and tumors. Yet, some pathologies are predominantly associated with third molars, also known as wisdom teeth. Some examples are: Dentigerous Cyst, Ameloblastoma, and Odontogenic Keratocyst. The general incidence of neoplastic change around impacted molars has been estimated to be approximately 3%. (2)
5. Prevention of Jaw Fracture
The wisdom teeth are located at a point in the lower jaw where the horizontal part, called the body of the mandible, meets the vertical part, called the ramus of the mandible. Having a large tooth in this region means that the lower jaw has tooth structure in this location rather than bone, thus weakening the bone in this location. Contact sports or freak accidents can result in a fracture of the mandible in this region. The risk of fracture is 2.8 times higher when a full bony impacted wisdom tooth is present in this region. An impacted third molar presents an area of lowered resistance to fracture in the mandible and is, therefore, a common site for fracture. (3)
6. Management of Unexplained Pain
For reasons unknown to us, vague pain of the jaw in this region that is not attributable to any other cause seems to resolve with the extraction of wisdom teeth. Approximately 1% to 2% of mandibular third molars that are extracted are removed for this reason. (4)
7. Decay of Adjacent Teeth
Often, an impacted wisdom tooth is tilted from the straight up and down position characteristic of all the other teeth. Depending on the angle of the wisdom tooth and its proximity to the second molar, the wisdom tooth can cause resorption of the root of the second molar. Sometimes it can also be the secondary cause of decay.
8. Pre-prosthetic Reasons
Wisdom teeth are removed when they interfere with denture placement.
Conclusion
There are many reasons to remove wisdom teeth. The best time to remove wisdom teeth is when the patient is in their late teens, as the bone is soft, the roots are small, and recovery is better and faster. This changes as we age.
REFERENCES:
Michael Miloro, GE Ghali, Peter Larsen, Peter Waite, Peterson's Principles of Oral & Maxillofacial Surgery, Third Edition - 2 Vol. Set (Hb) 3rd Edition, Pmph USA, 2011.
(1) Lysell L, Rohlin M. A study of indications used for removal of the mandibular third molar. Int J Oral Maxillofac Surg 1988; 17: 161- 164. Peterson, 101
(2) Guven 0, Keskin A, Akal UK. The incidence of cysts and tumors around impacted third molars. Int J Oral Maxillofac Surg 2000;29: 131- 135; Berge TI. Incidence of large third-molar- associated cystic lesions requiring hospitalization. Acta Odontol Scand 1996;54:327- 331. Peterson, 102
(3) Yamada T, Sawaki Y, Tohnai I, et al. A study of sports-related mandibular angle fracture: relation to the position of the third molars. Scand J Med Sci Sports 1998;8:116- 119; Safdar N, Meechan JG. Relationship between fractures of the mandibular angle and the presence and state of eruption of the lower 3rd molar. Oral Surg Oral Med Oral Pathol Oral Radio! Endod 1995;79:680-684; Tevepaugh DB, Dodson TB. Are mandibular third molars a risk factor for angle fractures? A retrospective cohort study. J Oral Maxillofac Surg 1995;53:646-649. Peterson, 102
(4) Nordenram A, Hultin M, Kjellman 0 , Ramstrom G. Indications for surgical removal of the mandibular third molar. Swed Dent J 1987;2:23- 29. Peterson, 102.
Pictures:
Edentulous: https://4.bp.blogspot.com/-4ft-F9hVIVA/TqegdJ6Gz7I/AAAAAAAADvI/B2dUAv9GB4E/s1600/Removal+of+unerupted+teeth+from+edentulous+ridge.png
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