The latest wisdom on wisdoms

Teeth: Dentists used to routinely extract those late-or never-blooming molars, but now they're thinking twice about it.

Health & Fitness

February 10, 2002|By Mariee McCullough | Mariee McCullough,KNIGHT RIDDER / TRIBUNE

Your dentist has just advised you to have your wisdom teeth removed, even though they are not causing any problems.

Is this a word to the wise, or jumping the, er, gum?

Wisdom teeth, of course, are the molars that sit farthest back in the mouth, two in the upper jaw and two in the lower. Technically called third molars, these are the last teeth to develop, usually appearing in the late teens or early 20s -- supposedly about the time wisdom shows up.

For decades, dentists and oral surgeons have urged young adults to get rid of wisdom teeth that are "impacted" -- below the gum and blocked from growing in normally -- to avoid trouble down the line.

But the wisdom of this practice has never been proven. In fact, in recent years some experts have argued that the cost and surgical risk of preemptive extraction outweigh the benefits of preventing problems that may never develop.

"Careful analyses of the published research show that routine removal of impacted or unerupted, disease-free third molars cannot be justified," E. Preston Hicks, professor of orthodontics at the University of Kentucky, wrote in the Journal of Oral and Maxillofacial Surgery in 1999.

Because existing research is limited and inconclusive, several studies are under way to try to resolve the controversy. The largest, sponsored by the American Association of Oral and Maxillofacial Surgeons, is following 1,000 young adults with impacted wisdom teeth to see how many of them develop problems over a five-year period. The study is in its fourth year.

Even without new data, many surgeons are taking a more conservative approach.

Mansoor Madani, an oral surgeon in Bala Cynwyd, Pa., compares this gradual shift to what happened with tonsillectomies. The annual number of people who have had their tonsils taken out has fallen from 1.2 million in the 1960s to 400,000 today because it has become clear that, given time, many patients outgrow sore throats and other tonsil-related problems.

"I think my advice to patients is: Just because they're impacted, you don't have to jump on it," Madani said. "Impacted teeth are not something to be afraid of, but to be looked at and evaluated."

For those who reach their 30s without pain, infection, gum disease or other wisdom-teeth woes, the expert consensus is clear. Leave well enough alone, but monitor the teeth for signs of change.

Until the advent of local anesthesia around the turn of the last century, impacted wisdom teeth were rarely pulled. Today, removal strictly for preventive reasons remains less common in countries with government-funded medical care than in the United States. Indeed, two years ago, an advisory group to Britain's National Health Service recommended it be discontinued.

The problem with wisdom teeth is that the modern jaw, unlike that of our prehistoric ancestors, tends to be too small to accommodate them. A lucky few people never get wisdom teeth or gain a bonus set of correctly aligned, properly functioning molars, but most people wind up with at least one blocked tooth. It may remain buried beneath the bone, or grow through the bone but not the gum, or erupt partially through the gum.

While removing impacted wisdom teeth in young adulthood is not pleasant (a few days of pain, swelling and oozing blood are almost inevitable), there are reasons why the surgery is theoretically a good idea:

Extraction becomes more difficult when the root is fully formed, a process that takes a few years. This can increase the risk of surgical complications such as infection, sinus trouble and damage to adjacent teeth or fillings.

"The roots get longer and they get nearer to the nerve in the jaw, so the incidence of injuring that nerve increases [in older patients]," said Louis K. Rafetto, an oral surgeon in Wilmington, Del.

Belated problems with impacted teeth are common -- no one knows precisely how common -- and likely to necessitate later extraction. Typical problems include decay, gum inflammation, infection and crowding of adjacent teeth.

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