Wisdom molars (teeth) extraction seems to be an initiation ritual for those with ages between 12 and 21. The name “wisdom teeth” implies the fact that between the age of 17 and 25 a person has acquired certain wisdom. The stomatology name for the wisdom tooth is “MOLAR THREE”.
REMAINS FREQUENTLY STUCH BEHIND MOLAR 2 – Most of the time, wisdom molars present atypical roots, are inclined and misplaced. They are often blocked behind the second molar, problem known as “inclusion”. Many persons feel pain and tumefaction around these molars at a young age.
CAUSES DENTAL DECAY AND PERIODONTAL DISEASE – Frequently, even if they erupt, wisdom molars develop decay or gingival disorders (periodontal disease) because they are positioned in an area difficult to clean through brushing, allowing bacterial plaque to accumulate. In any case, wisdom molars are associated with several issues.
HAS NO FUNCTIONAL PURPOSE – From a functional point of view, the wisdom molar plays an infinitesimal part or none in mastication. Normally, 4 wisdom molars are found (molars no. 18, 28, 38 and 48) but some patients can have more or less. Sometimes all are missing (fortunate situation) and are never formed (buds are missing).
WERE OF USE TO THE PRIMITIVE MAN – Wisdom molars are residual molars used by our ancestors to chew wood or raw food. A widespread theory states that our ancestors had skulls with larger maxillaries and more teeth, which is possible to have been used for leaf or raw meat chewing, for a more efficient digestion. As the human diet modified and became easier to be digested, maxillaries have also become smaller. However, molars number three or wisdom molars continue their development on human maxillaries.
Truth and fiction about wisdom tooth (wisdom molar)
- Often, wisdom molars cause localized inflammation, infection, dental decay and gingival disorders.
- Frequently, wisdom molars determine maxillary and adjacent (neighboring) teeth damage.
- Complications are extremely rare when extractions are performed with modern surgical techniques, advanced technology and by experienced specialists.
- The best treatment approach is early removal of all 4 wisdom molars, simultaneously or 2 by 2, between the ages of 15 and 20 (roots are incompletely developed and bone is still “elastic”).
- Alongside local anesthesia, for the patient’s total comfort, additional sedation methods are recommended – inhalosedation or intravenous drug sedation.
- Usually, recovery is fast, most of our patients going back to work or school in one or two days.
- Wisdom molar removal causes movement to the back of teeth already crowded. False: Teeth do not move to the back, and wisdom molar removal does not correct crowded teeth (eases the force action determined by the orthodontic device that straightens teeth).
- Teeth without any problems shouldn’t be removed. False: Remained intact wisdom molars can develop a series of issues because they are very hard to be reached with brushes, bacterial plaque builds up and develops dental decays and periodontal disorders.
- As wisdom teeth are close to a nerve, their removal could cause nerve damage. Unfounded: Normally, a space is found between the wisdom molar and nerve. It is ideal for the diagnosis to be performed on a three dimensional image (dental tomography), for advanced technology to exist within the equipment (laser or piezotome) and for the surgeon to have the necessary experience in such procedures. Nervous function issues are rare.
- Wisdom molars removal determines cheekbones fall. False: wisdom molars removal has absolutely no effect on the facial shape.
- If it doesn’t hurt, don’t intervene. Wrong reasoning: Decays, gingival disorders and other pathological forms can quickly develop in wisdom molars without any symptoms and can irreversibly affect the adjacent structures.
Most of the issues associated with wisdom molar are related to the difficult access for ensuring a proper hygiene and scale deposit, fact that determines inflammation and infection.
Why do wisdom molars need to be removed?
Frequently, wisdom molars are included or stuck behind molars number two and are extremely difficult to be cleaned. Scale along with limited access for oral hygiene, causes inflammation which can lead to infection, decay or gingival disorders.
Wisdom molars can also cause cysts in maxillary level.
They are at the same time involved in adjacent teeth migration.
The most common issues associated with wisdom molars are:
- Pain and tumefaction: These are the most common initial symptoms. Caused by inflammation (pericoronitis) or gingival tissue infection.
- Gingival disorder (periodontal disorder): Gingival disorder can develop between the second molar and the wisdom molar. These are found on the same bone and gingival tissue and when tissue is damaged, its restoration or regeneration becomes extremely difficult, if not impossible to treat. If a second molar develops a profound decay on a side it needs to be extracted.
- Caries: Cavities can appear on the wisdom molars or on the root surface of the second molars. These are difficult, if not impossible, to treat. If a second molar develops a profound cavity on one side, it often has to be extracted.
- Maxillary cysts: Cysts determine a significant destruction of bone and damage of surrounding structures (teeth, nerve, maxilla). Some of them can become quite large and weaken maxillary bones with the risk of fracture.
- Adjacent teeth migration: This isn’t a fully understood aspect by dentists, yet included wisdom molars can represent a factor that contributes in teeth overcrowding. Orthodontists often recommend wisdom molars removal to prevent migration.
Specialty literature and collective experience of several dentists support one thing: wisdom molars predictably cause problems for a large percentage of the population.
According to a comprehensive analysis of the specialty literature performed by The American Association of Oral and Maxillofacial Surgeons (AAOMS), it is stated that:
- Included wisdom molars negatively affect gingival tissue and adjacent teeth health
- Included wisdom molars can continue to shift position after the age of 23.
- Erupted wisdom molar (not included) don’t necessary indicate a good health status. They are associated with a higher incidence of gingival disorder (periodontal) or bone loss.
- Lack of symptomatology such as pain and tumefaction doesn’t indicate an absence of illness.
- There is a large number of bacteria surrounding molar number three (wisdom molar), many of them extremely pathogenic.
- Gingival disorder evolves even with a symptomatology absence and with aging.
- Postoperative complications incidence following molar number three removal is three times larger after the age of 25.
- Early removal is advised for included molars as well as not included ones, for both asymptomatic and symptomatic patients.
AAOMS specialty literature analysis concludes:
- Early removal of wisdom molars is recommended for preventing infection, pathology and surrounding teeth damage.
- The philosophy “If it doesn’t hurt, don’t intervene” is not sustained by the specialty literature.
- Risk of complications for wisdom teeth removal can increase with aging.
- Disorder development can occur in included wisdom molars as well as not included ones (erupted).
Specialty literature and oral surgery literature don’t support the philosophy “If it doesn’t hurt, don’t intervene”