Unfortunately, things did not go as planned. Leavey developed a post-surgery infection, which was treated, but it cost her extra time off from school. Even so, her mother was glad she did.
“At least he won’t have to deal with it later,” says Becky Leavey.
Many parents choose to have their teens’ wisdom teeth removed, often before they go to college and often even before the teeth start to cause problems—and while the child is still covered by parental health insurance.
Experts say that teeth should come out when they come in at an odd angle, causing pain, tooth decay, inflammation, damage to neighboring teeth or other signs of disease. But no one agrees on whether it is good medicine to extract them prophylactically when there are no such issues.
“The oral surgeon needs to survey the area and make an informed decision based on a clinical exam and radiographs,” says Dena Fisher, director of the Center for Clinical Research at the National Institute of Dental and Craniofacial Research. “There may be dentists who make their decisions differently, but hopefully most make them based on clinical evidence.”
Wisdom teeth, also known as third molars, are the four teeth that come in last—usually in a child’s late teens—and are furthest back in the mouth, one on the upper and lower jaws behind the second molars. Experts say there are no reliable statistics on how many wisdom teeth come out each year, although some newspaper articles estimate about 10 million teeth from 5 million patients annually.
Those who favor early extraction say it’s generally easier, safer and results in a faster recovery when patients are young, between 15 and 25 years old, although, as with all surgery — as the Leaveys discovered — there can be risks. When patients are young, the roots of the teeth are small and easier to remove, they say.
“Think of a tree,” says Louis Rafetto, a spokesman for the American Dental Association. “It is better to remove or uproot the tree before the roots are fully formed. Roots grow into things – nerves, sinuses. You want to get the teeth out before the roots reach full maturity,” usually by the mid-20s.
Rivals – including the American Public Health Association — consider such prophylactic extractions unnecessary surgeries. At least one paper says there are no scientifically proven health benefits to removing non-problematic wisdom teeth. A consensus conference of the National Institutes of Health urged against the practice as early as 1980, and many recent studies I suggest there is no compelling reason to do so.
“I think sometimes in dentistry we also fall into that trap of, well, ‘If one needs to come out, let’s take them all out.’ If there’s a problem with one, they predict there will be problems with the others,” says William Love, director of dental services at the University of California, Davis Health Medical Center. The reason is often because general anesthesia is involved, making it more effective to remove all four at once, he says. “That’s an okay approach, but if medicine is based on diagnosis, you shouldn’t remove the other three based on the diagnosis of one,” says Love. “And when all four are asymptomatic, I think it’s fair to ask, ‘Why are we doing this?’
But “no symptoms does not mean there are no problemssays Raymond White Jr., the Dalton L. McMichael Distinguished Professor of Oral and Maxillofacial Surgery at the University of North Carolina Adams School of Dentistry and its former dean.
Most people “will have problems and need to get them out,” says White, who has conducted more than 100 peer-reviewed studies on wisdom teeth. “Older patients will take longer to return to their normal lifestyle than younger patients. It will take longer for them to be able to open their mouths and eat their usual foods.”
The ODA agreed in 2014 paper that asymptomatic wisdom teeth were not necessarily free of disease or problems, but added that there was insufficient evidence to conclude that prophylactic removal was better than continued monitoring.
A 2016 white paper on the management of wisdom teeth from the American Association of Oral and Maxillofacial Surgeons (AAOMS) was equally ambivalent. He said not all wisdom teeth needed extraction, but warned that the longer patients wait, the more difficult it becomes to remove and recover if a problem occurs. But he also acknowledged the possibility that patients who maintain disease-free wisdom teeth “could live their entire lives” without episodes.
“I think it’s fair to say that not everyone needs to remove them, but everyone needs to evaluate them,” says Rafetto, also a past president of AAOMS. “There should always be a discussion between the patient and the doctor about the risks and benefits of taking them. Many people in the United States will get it sooner or later, the question is: When is the most random time?’
Faisal A. Quereshy, a professor at Case Western Reserve University School of Dentistry, believes the time is when patients are young. “This summer, we’ll be doing almost 24 surgeries a week, all the kids home from college or home on break, which is the perfect time to do it,” says Quereshy, who is also president-elect of American College of Oral and Maxillofacial Surgeons.
He and other experts point out that the human jaw has shrunk over thousands of years, leaving less room for wisdom teeth. Also, thanks to fluoride, there is less tooth decay, so people don’t lose as many teeth as they did years ago, another reason the mouth can be full.
“We still grow the same number of teeth in our jaw, but our jaws have changed,” says Quereshy. “If they get through, they’re way to the back of the mouth in a very difficult area to keep clean. Often, people come with infection and rot. The infection can travel to the neck and throat. This can lead to a real medical emergency.”
However, risks may arise even when extraction is clearly necessary.
The most serious is possible damage to inferior alveolar nerve, “that gives you a feel,” says Love. “The lower third molar is often close to this nerve. If it happens, you may have what is known as paraesthesia [a burning, prickly or numbing sensation, often like pins and needles]. It’s much more likely to be temporary the younger you are. When you’re older, it’s more likely to be permanent.”
Joana Cunha-Cruz, a professor at the University of Alabama at Birmingham School of Dentistry, reports a 2020 study which found “a small but increased risk of complications associated with prophylactic removal, such as bleeding, infection, and dry reception,” he says, the latter referring to a painful condition when a blood clot necessary for healing after a tooth extraction does not form or dissolves too soon, leaving bones and nerves exposed to the air.
Experts say parents and clinicians need to consider many factors before deciding what to do and, if the teeth remain, monitor closely.
It is important to assess the position and condition of the teeth, determine how often the patient visits a dentist, and how well the patient practices home care, i.e. regular brushing and flossing.
If a patient is careless with dental care, cavities can form, not only in the wisdom teeth but also in the adjacent teeth, a reason why it may be better to have them removed. But if they brush twice a day, morning and night, floss before bed, and the position of the teeth is aligned with the mouth, it’s good to stop extracting them, they say.
Yes, some third molars will need to be removed, says Cunha-Cruz, who is also assistant director for the South Central region of National Dental Research Network. “However, it also seems possible that in some individuals third molars may have enough space and exist for life as healthy, functioning teeth.”
Carol Rogers, 79, of DC is among them. She lost one of her wisdom teeth last year due to a hard-to-fill cavity in one, but the others are fine. “One or two dentists over the years suggested I take them out, but I resisted,” he says. “I have never regretted my decision to leave them alone.”
