There is nothing wise about the way people view wisdom teeth, according to many experts.
“Removal of affected teeth where there is no disease is controversial.”
Wisdom teeth, or a person’s third and last set of back molars, are the last teeth to grow in one’s mouth. As early as the 4th century BC, the Greek philosopher and polymath Aristotle dated how these teeth usually erupt around the age of twenty, although he noted cases of wisdom teeth erupting in people as young as eighty. Humans evolved wisdom teeth to better grind tough foods such as raw plants, tough meats and nuts, but as our diet became softer and our brains larger, our species evolved larger skulls and smaller jaws.
This leaves wisdom teeth as unwanted tenants in our mouths, taking up valuable space and causing pain because they haven’t gotten the hint that they’re no longer welcome. They can crowd into a person’s jaws, causing chronic pain. If they become impacted (pressing on a gum or other tooth), they can cause health problems such as tooth decay and infection. People with gum disease often struggle with chewing and develop halitosis (bad breath).
As a result, dentectomies – that is, tooth removal surgery – are quite common. For decades, people around the world often choose to have their wisdom teeth surgically removed because they serve no other purpose and can lead to so many health problems.
However, some experts say the procedure is overused. One of those experts is Dr. Edmund Bailey — an oral surgeon, the head of globalization for dentistry at the Institute of Dentistry and a faculty member teaching medicine and dentistry at Queen Mary University of London.
“We know that a large percentage of young adults are suffering from problems with their wisdom teeth,” Bailey said, estimating that about 70 percent of the population undergoes tooth extraction for their wisdom teeth. If there is already pain and infection, Bailey believes this surgery is necessary, but worries that the procedure is often done preventively rather than because symptoms are present.
“Removing affected teeth where there is no disease is controversial,” Bailey said. “Some surgeons will remove teeth to prevent future problems; however, the side effects can be significant. These side effects include [not only] pain, but long-term problems including numbness of the lip, chin and tongue can also occur.’
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“Some surgeons will remove teeth to prevent future problems, however, the side effects can be significant.”
Part of the problem is that people assume wisdom teeth are always bad for the mouth, but Bailey said that’s not true. Some of the “crowding” caused by wisdom teeth occurs because the jaw changes shape in adulthood. for people who do not experience these changes in their jaws, wisdom teeth could occupy space in their mouth for long periods without incident.
“People are often very anxious about having their wisdom teeth removed. This may be because they hear from people who have had bad experiences with their own wisdom teeth,” Bailey said. “Some people also believe that the crowding of their front teeth as adults is due to their wisdom teeth ‘pushing’ on them. Evidence shows that this is not the case – instead, it appears that the jaw changes shape in adulthood causing the crowding.”
Because this science is not widely understood, experts struggle to understand the true extent to which wisdom teeth are needlessly removed. ONE study 2021 in the Annals of Medicine and Surgery (London) studied 106 patients who underwent wisdom tooth extractions in the year 2020. They found that only slightly more than three in four people (76.4%) had their wisdom teeth extracted for medically legitimate reasons. The others were removed as a precaution even when the patients were not experiencing health problems.
“Surveillance of asymptomatic periodontal disease appears to be an appropriate strategy,” the authors write. “Regarding retention versus prophylactic extraction of asymptomatic wisdom teeth, decision-making should be based on the best evidence combined with clinical experience.”
Unfortunately for the general public, the medical and dental industry has a financial incentive to continue wisdom teeth removal regardless of whether it is wiser for their patient to do so. The dentist Dr. Jay Friedman, a longtime crusader against wisdom tooth extraction, pointed this out in a article 2007 in the American Journal of Public Health. He wrote at the time that 50% of upper third molars classified as impacted were actually normally developing teeth that would otherwise erupt with minimal discomfort, while only 12% were actually related to pathological conditions such as tooth decay and cysts.
While preventive surgery could still be justified if it were harmless, Friedman wrote that patients often suffer short-term side effects such as pain, swelling, bruising and discomfort as well as possible long-term conditions such as permanent paresthesia or numbness of the lips, tongue and cheek.
“Third molar surgery is a multibillion-dollar industry that generates significant income for the dental profession, particularly oral and maxillofacial surgeons,” Friedman writes. “It is driven by misinformation and myths that have been exposed in the past but continue to be propagated by the profession.”
Ultimately, perhaps the wisest practice for people who still have their wisdom teeth is to make sure they choose their doctors and dentists wisely. Because every human mouth is different, only a skilled and honest surgeon can assess whether a particular patient should have theirs removed.
“The success of the operation is linked to the experience of the surgeon,” Bailey said. “So choose your surgeon carefully!”
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