• Dr. John

Why We Remove Wisdom Teeth

Updated: Oct 22, 2021

This is one of the questions we hear a lot. There are several reasons why we recommend (in most cases) to remove 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 get stuck between the gum and the tooth causing 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 becoming 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

There are many reasons to remove wisdom teeth. The best time to remove wisdom teeth is DRAFTJS_BLOCK_KEY:ae2hlwhen the patient is in their late teens - the bone is soft, the roots are small, the recovery is better and faster. This changes as we age. can lead to decay and periodontal disease over time. caries in the second and third molars are responsible for 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 prior to 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 pathology are predominantly associated with 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 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 more with the presence of a full bony impacted wisdom tooth 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 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

Many times an impacted wisdom tooth is turned from the straight up and down position that is 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 casue 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 - the bone is soft, the roots are small, the 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:

Facial infection: https://image.slidesharecdn.com/abscessandphlegmoninmaxillofacialregion-odontogenicinfections-101114100301-phpapp01/95/abscess-and-phlegmon-in-maxillofacial-region-odontogenic-infections-66-638.jpg?cb=1422663883

Decayed wisdom tooth: https://images.fineartamerica.com/images-medium-large-5/tooth-decay-dr-armen-taranyan--science-photo-library.jpg

Causing decay: http://tmjtreatment.com.au/wp-content/uploads/2013/07/wisdom-tooth-decay.jpg



Cyst: http://www.orofacialsurgery.com.sg/wp-content/uploads/2016/09/32.jpg

Edentulous: https://4.bp.blogspot.com/-4ft-F9hVIVA/TqegdJ6Gz7I/AAAAAAAADvI/B2dUAv9GB4E/s1600/Removal+of+unerupted+teeth+from+edentulous+ridge.png





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