What's the Deal with Wisdom Teeth? A dentist helps you decide whether to lop off these body parts for being so "extra"
What say ye wise man?
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Is the wise old man in the photo above on to something? Is it sage advice to remove your wisdom teeth, or not so much? This is a hotly debated issue within the dental community. It divides families and eviscerates friendships. You could lose a tooth getting walloped by a dentist if you blaspheme in the wrong company. Currently, most American oral surgeons strongly recommend the prophylactic (meaning pre-emptive strike; get it out of there before it causes a problem later) removal of wisdom teeth for the majority of patients. It’s sort of a right of passage in our culture. But should it be?
Why would I so recklessly risk my life by casually discussing this most taboo of topics? Am I not just carelessly throwing gasoline on a perfectly innocent campfire? Why ruin ghost storytime with my incessant questions? Sorry. I am what I am. I’m terribly curious. I like parsing through what’s true and what’s not. It’s a bit of an obsession of mine. I’m a big fan of Louis Brandeis’ and his attitude toward sunlight. I want more patients to understand what is going on with their healthcare. That’s why I write these posts. It’s why I make videos on my YouTube channel. I’m a big believer in having informed consumers participating in any free market.
If you want to read an argument by a dentist who thinks we’re crazy to be removing all the wisdom teeth that we are, check this out. He’s very passionate that we shouldn’t be chucking teeth left and right as standard practice, and he makes some very reasonable points. If you want to read a reasonable counterpoint from the American Association of Oral and Maxillofacial Surgeons,¹ check this shizz.
Personally, I have mixed feelings. I don’t take out many wisdom teeth, so I don’t have a financial incentive to recommend their removal. The only time I remove wisdom teeth is when a patient comes to me in significant pain and wants it out right away or can’t afford to see an oral surgeon. If it’s not an overly complicated extraction, I’ll take care of it for them, but that isn’t an everyday procedure for me. I’m not going to lose sleep over patients suddenly deciding to keep all their wisdom teeth.
Except, I kind of might. Why? Because again, I tend to see the cases of patients who didn’t get their wisdom teeth removed when they were young, and now they show up in my office in their 30’s or 40’s, and they are in pain. It’s less fun to get your wisdom teeth removed when you’re older. It’s a tougher procedure, and you don’t heal as easily.
This is an anecdotal bias of mine. I don’t see every healthy wisdom tooth walking around in peoples’ mouths out in the world.³ The majority of wisdom teeth that we don’t yank out in our teen years won’t cause major problems. Still, some of them will, and it’s not an exact science predicting which ones will be the trouble makers down the line. I ask for a dental prognosis crystal ball every year for Christmas, and Santa still hasn’t gotten me one. I even tried bribing the Tooth Fairy to put in a good, ahem, uh, “word” when Mrs. Claus was out of town. No dice.² Until Santa comes through, we’re stuck with best effort educated guesses about your wisdom tooth future.
I also should disclose that technically you could argue I do have a financial incentive to have more patients keep their wisdom teeth. If you hang onto these teeth and they get cavities, guess who has to treat the cavities? As a general dentist, that would be me. So, maintain a healthy skepticism about everything I say too.
The good news is you never have to get any cavities. Ever. You read that right. Watch this video, and this video, and this video, and this video, and this video, and you’ll be well on your way to never having to have me stick my hands in your mouth to fix any of your teeth. Ever.
Honestly, I don’t like working on wisdom teeth. They are very far back in a dark, wet hole, and it’s not easy to do my best work back there. Watch the videos. Stay healthy. Avoid me. At least in person. Instead, watch my videos so you can interact with a toxic, evil, big meanie person like me from a healthy distance. See what I did there? I switched up the incentives. I have a financial incentive to get you to watch a video. Is that better? I don’t know. I’m experimenting.
Wisdom teeth require the same level of care and attention as the rest of your teeth, but they can be a little harder to reach. If you’re going to keep them, you need to put in the extra effort.
What Problems Can Wisdom Teeth Cause and How Often Do They Cause Them?
In the 2007 American Journal of Public Health article I linked to above, Dr. Friedman (a dentist with a masters degree in public health) points out:
“Not more than 12% of impacted teeth have associated pathology. This incidence is the same as for appendicitis (10%) and cholecystitis (12%), yet prophylactic appendectomies and cholecystectomies are not the standard of care. Why then prophylactic third-molar extractions?”
Basically, not everyone has their appendix or gall bladder removed just because it might cause a problem. How can us dental folk justify such a completely different approach to a very similar problem?
I’m not a physician, so I don’t really know how difficult it is to properly evaluate risk levels for problems with an appendix⁴ or gall bladder. However, as dentists, we do have the distinct advantage of often being able to evaluate wisdom teeth directly. We say “open wide” and looky there, a direct view of the situation. A simple and relatively inexpensive x-ray also reveals lots of information about the positioning of the wisdom teeth and the likelihood of future problems.
Considering that the appendix and gall bladder are soft tissue organs, I’m guessing a quick x-ray is not quite as informative. I’m going to take a shot in the dark and say they likely use an MRI? I could be wrong, though. Sometimes I can be kind of an idiot, but I like to think I’m rather well adjusted to that reality. In any case, a quick Google search told me an MRI costs around $2,600. That’s quite a bit more than it costs to get your wisdom teeth out at many dental offices. A panoramic x-ray to evaluate wisdom teeth at a dental office probably costs about $130.
Also, I don’t think taking an MRI will give you a lot of valuable information as to who might develop appendicitis or gall bladder issues.⁵ Again, I’m not a physician, but some quick googling told me that we don’t have good methods as of yet to predict who is going to develop appendicitis. If you could predict whether you were going to develop appendicitis, you might consider doing something about it before developing a searing pain in your abdomen. Then again, maybe you wouldn’t. I’m not you. Everyone has different priorities. I get it. That’s cool.
So problems may come up with your wisdom teeth if you let them run wild and go buck buck in the back of your mouth. You’ve heard of buck teeth. I’m talking about buck buck teeth.⁶ What sorts of problems are involved with wisdom teeth goin’ buck buck?
1. Gum Tissue Infection
When wisdom teeth are erupting, and there isn’t quite enough room for them to come all the way into the mouth, patients can develop pericoronitis. A flap of loose gum tissue lays on top of the partially erupted tooth. Food and bacteria camp out in there. It makes a painful nastiness. Sometimes the opposing wisdom tooth bites down on this gum tissue and adds injury to insult. A little salt in the wound, as they say.
Will you survive your brush with pericoronitis? Sure. You can get the gunk rinsed out with an antibacterial mouthwash called chlorhexidine. Your dentist will likely scrape the gunk out for you too. Your ole’ dental pal will also probably show you how to clean and rinse out the area at home. Severe cases may require antibiotics. Once things calm down, you may have to have the excess gum tissue cut away (or consider removing the wisdom tooth). Sometimes pericoronitis is limited to an acute one-time episode. Sometimes it becomes a recurrent issue if the tooth stays where it is trapped under that stubborn flabby gum tissue.
2. Gum Disease and Bone Loss
Wisdom teeth are way in the back there, which means they are tougher to floss. You need to floss all of your teeth, despite what you may have read in the New York Times back in 2016. If you don’t floss, you are inviting gum disease. You wouldn’t invite a vampire into your house, so why would you invite periodontal disease? Periodontal disease is a vampire. The only difference is you can’t fight it with garlic. That will only add to the stinky breath.
If you’re trying to keep those wisdom teeth flossed up and you can’t reach your giant ham hands into the back of your mouth to do it because your intolerable sausage fingers keep bumping into the sides of your claptrap box, try out these floss tools with handles.
Gum disease does not hurt, even when it is causing damage, so you should have your wisdom teeth evaluated periodically to make sure the gums are healthy.
The wisdom teeth tend to have deeper gum tissue pockets around them because of the limited space between them and the 2nd molars. If you don’t have enough space between teeth, then bone cannot develop between them. If the right amount of bone doesn’t develop between teeth, then a healthy and stable amount of gum tissue doesn’t develop between teeth. If healthy gum tissue doesn’t develop between teeth, it is more susceptible to worsening gum disease over time. What a cluster-cluck.
The cluster-cluck is a slow-growing phenomenon. Usually doesn’t cause a major issue until years down the line. I had a patient in their 70’s who developed a chronic draining infection around a wisdom tooth. Basically, pus was flowing into their mouth on a continual basis from the infected tissue that was too hard to keep clean. Luckily, there wasn’t any pain associated with this problem, but it did leave a consistent bad taste in the patient’s mouth. I sent the patient to an oral surgeon, but based on the patient’s age, it was determined the potential complications of the procedure would be worse than monitoring the infection and hoping it doesn’t progress at this point—one of those situations when the cure would have been worse than the disease.
Could I have perfectly predicted this development 50 years down the line by looking at the patient’s wisdom teeth at age 20? Of course not. But I could have said that there was an increased likelihood based on the horizontal position of the tooth bumping up against the tooth in front of it that this was more likely than if the tooth was upright. Then you as a patient have to make the final decision as to what you want to do.
3. Cavities
Wisdom teeth are hard to floss. They are also hard to brush. Do you have a gag reflex? I’m sorry. Use a children’s toothbrush with a small brush head. I know you’re a grown ace adult, but sometimes we have to brush our wickle wisdom teefers with a brush that has cartoon giraffes on it if we want to stay healthy.
As much as I am not a fan of doing fillings on wisdom teeth, it can be done. If you would rather not worry about periodic maintenance with fillings of your wisdom teeth, consider getting them out when you find out they have a cavity. Staying cavity-free by not introducing sugar and enriched wheat flour at snacking intervals in your diet in the first place? You’re killing it. You’re a rock star. Don’t let me hold you down.
Cavities also do not hurt most of the time until they get deep into a tooth. If you eat risky foods that can lead to cavities, make sure you get your teeth professionally evaluated at least once a year. The better solution? Don’t snack on the risky foods, and then I really don’t care when you show up to have your teeth evaluated. If you’re brushing and flossing well, too, you’ll probably be fine.
4. Damage to Adjacent Teeth
Sometimes wisdom teeth ram into the backside of your 2nd molars and cause something called “resorption.” This involves the cells of your own body deciding that they don’t like other cells from your body, so they break them down in an uncontrolled manner. It’s sort of the opposite of cancer, which is when cells in your body multiply uncontrollably. I probably shouldn’t have just brought up cancer. It’s not anywhere close to as bad as cancer. I’m sorry. It just seemed like an apt comparison that popped into my head just now. Sometimes I’m a bit careless. I’m only human. Yeesh.
Resorption is not cancer. It can cause you to lose a tooth, though. External root resorption was responsible for me losing one of my front two teeth when I was in dental school. I haven’t been through much in my privileged life, but that counts as one of my war stories, I suppose.
Don’t want your wisdom teeth to ram into the back of your 2nd molars and damage them with resorption? Maybe get an x-ray of the wisdom teeth to show their position so a dentist or oral surgeon can help you reasonably assess the risk of whether or not this could happen.
5. Cysts
Have I seen plenty of people that have kept their wisdom teeth without problems? Sure. Have I seen occasional patients who develop cysts in their 50’s or 60’s? Sure have. Why does a cyst matter? There’s a bunch of different types. The most common one that develops around an impacted wisdom tooth is called a dentigerous cyst. Basically, it’s a fluid-filled sac in your jaws that grows over time and can erode bone and shove teeth around. In rare cases, these actually can transform into more malignant tissues (aka cancer).
Cysts associated with impacted third molars are relatively rare. They occur around 3% of the time with impacted wisdom teeth, according to this study here and that study there. Impacted means that the tooth hasn’t erupted into a normal position in the mouth. The tooth is stuck buried down in the bone and gum tissue. That’s impacted, ya dig?
Now, while 97% of impacted wisdom teeth won’t develop cysts, that does mean that about 3% of impacted wisdom teeth will develop cysts. If you go searching for accurate data on the incidence of impaction of wisdom teeth, you’ll have a hard time finding it. I have seen studies with estimates ranging from around 25%-75%. Lower wisdom teeth are more likely to be impacted than upper wisdom teeth.
I think it’s fair to say that if you develop four wisdom teeth (not everyone does), on average, somewhere between one and two of the wisdom teeth will be impacted. So, the risk of a cyst that could cause problems for you years to decades in your future is somewhere between 3–6%. A little less than 1 in 20, probably.
Is that an acceptable level of risk for you? That’s up to you to decide. It may mean a more involved surgical procedure later in your life. Then again, in all likelihood, it won’t mean that. Are you the type of person that likes to wear a seatbelt and drive with a mouthguard in place, or are you the type of person who likes to do a handstand on a motorcycle buck-ace necked while shotgunning a four loco?⁷
More than likely, you’re somewhere in between. If you’re flush with cash and would rather plan to have a potential problem taken care of before it becomes a problem, you’ll likely pop those suckers out. If the doctor tells you that you might wind up with permanent numbness if he tries to remove one of your wisdom teeth, you’ll probably let sleeping dogs lie and roll the dice on a problem that may rear its head in 20–30 years. Besides, you might die in a necked motorcycle accident before that ever comes to be.
Do most dentists have time to have this in-depth conversation I’m having with you in this article in their offices during consultations. Unfortunately, no. That’s one of the major problems with our current healthcare system. The people most well-equipped to have discussions with patients about informed consent also don’t have time to have those conversations because everyone is demanding faster, cheaper, better healthcare.
Hint: faster, cheaper, AND better DON’T ever go together well in combination without either 1.Exploitation of someone somewhere in the chain of service/good delivery OR 2. Innovation. Writing these articles and making these videos is my attempt at innovation. Hopefully, you don’t feel exploited.
6. Crowding of Front Teeth?
Can buck buck teeth lead to buck teeth? Nah son. This one is a myth. A fairy tale. A bunch of codswallop and silly billy nonsense. Apparently, there are still a fair number of dentists out there telling patients that wisdom teeth coming in can cause crowding of your front teeth. Many patients who have had braces or clear aligners show up and ask me if their teeth will become crooked again because of the wisdom teeth.
Yes, your teeth can become crooked again. No, it is NOT because of your wisdom teeth. If you like the position your teeth are in, you should get a bar retainer permanently fixed to the back of your front teeth to hold them in place, OR you need to wear a plastic retainer at night to hold the teeth in place. If you don’t do one of those two things, your teeth will naturally drift and shift over time due to pressure from your lips and tongue. Only teeth rigidly held in place by your bite interlocking will avoid this.
If you don’t believe me, consider this: When an orthodontist needs to move a tooth, they have to tie that tooth to multiple other teeth located in the direction they want the tooth in question to move toward. The group of teeth have to work together to pull the single tooth along. Intuitively, doesn’t that make sense? So, explain to me how a single tooth coming in the back of your mouth is somehow mighty enough to shove an entire row of teeth forward simply by bumping into the furthest back tooth? Hint: It’s not. Your wisdom teeth aren’t The Incredible Hulk. If you still don’t believe me, here’s an article, and here’s an article. Another study that casts doubt on this most spurious of ideas. Look at the economic incentives at play and how those may affect an honest opinion. Here’s an even more in-depth article discussing the role of third molars in orthodontics.
7. Weakening of the Jaw?
There is a little truth to this one, but it’s not often that it would become a practical problem. If you have a tooth sitting in the back of your jaw taking up space, that means there is not any bone developed in that area. You have a tooth-shaped hole holding a tooth back there. If that space were instead filled with bone tissue, it would be stronger. If you take a blow to the jaw right where that wisdom tooth is, there is an increased likelihood of fracture with a wisdom tooth riding shotgun. Solution? Don’t put yourself in situations where you are likely to get punched in the face, and you’ll make out alright.
8. Interference with Future Dental Work?
Another sort of weird one, but it does happen. Let’s say you leave your wisdom teeth in place. Years have gone by, and you’ve lost some of your other teeth. You want to replace those missing teeth. You get a denture or removable partial denture made. That new appliance tippity taps on the bone above the wisdom teeth and wakes up the sleeping bear (there needs to be at least a couple millimeters of bone overlying the wisdom tooth to keep this from happening). Sometimes the bear will decide it’s time to erupt into the mouth. Now your new appliance doesn’t fit so well anymore, and you have to have the tooth removed and the appliance modified. Not an everyday occurrence, but it happens.
Solutions? Remove the bear while it’s still sleeping when you’re young (or at least before you have the appliance made) OR take excellent care of the rest of your teeth, so you don’t have to have them removed and replaced by an appliance.
So, now you have an idea of what can and can’t go wrong with wisdom teeth. How do you take this information and make a decision that is relevant to you or your child?
Is that an acceptable level of risk for you? That’s up to you to decide. Are you the type of person that likes to wear a seatbelt and drive with a mouthguard in place, or are you the type of person who likes to do a handstand on a motorcycle buck-ace necked while shotgunning a four loco?
When Should You Get Your Wisdom Teeth Removed?
Let’s start with your kid (I’m going to assume there aren’t that many high school and college students reading this, but maybe I’m dumb for thinking that. I don’t know what the demographics look like for the average Medium reader.). Ideally, if you’re going to pull the plug on a wisdom tooth, you want to make that decision by age 25 at the latest. Ideal timing is probably more around the ages of 17–20. I’ve seen kids need them out as early as age 14 due to complications, but that’s rare.
Also, if your kid is 18, technically, it’s their decision what to do, so maybe you will have to have them read this article for them to make up their mind. If they are closing in on age 25, they have to decide whether or not to remove their wisdom teeth just as their prefrontal cortex is finally becoming fully developed. It’s their first big decision as a fully neurologically capable and online adult person!⁸ Unless you as a parent decided for them back before they were legally emancipated from your iron-fisted rule. Hopefully, you’re a good parent. And yes, all parents should be judged on the accuracy of their decisions about the ideal timing of wisdom tooth treatment or non-treatment for their children. No other criteria should be used to evaluate parenting ability or success. Period. Full stop.
What about if you’re past age 25 and you’re not having any problems with your wisdom teeth? When should you have them removed then? In a nutshell: when they start causing a problem. I would suggest having a dentist evaluate them periodically to make sure they aren’t developing an issue. As I outlined earlier in the article, just because the tooth doesn’t hurt (yet) doesn’t mean there isn’t trouble brewing back there. As long as things are holding steady at your checkups, just keep chilling. No need to rush in there and poke the sleeping bear. Do all wisdom teeth cause problems as you get older? No, they do not.
Let’s say you’ve made up your mind that you or your kiddo ought to have those wisdom suckers pluckered on outta there. What’s involved with that? What are the relevant risks of the procedure itself that may influence your decision?
My goal is to give you more information so you can have a better discussion with your dental care provider about what is best for you. That’s it. I hope I’ve given you an appreciation for the idea that, as with almost all healthcare decisions, there is no one size fits all solution for every patient.
Tripping Inception style.
What to Expect/Risks When You Get Your Wisdom Teeth Removed
If you do decide to have your wisdom teeth removed, I would recommend seeing a dentist or surgeon with plenty of experience in removing wisdom teeth. I realize not everyone can afford to do that, and that’s why general dentists like me (I tend to focus on other procedures that are a lot more common in my practice, but that is not to say there aren’t excellent general dentists out there who are very proficient in removing wisdom teeth.) end up taking out wisdom teeth sometimes when we would prefer not to, but the reality is that a less experienced dentist like me who will take it out for a lower fee is better than you trying to knock it out with an ice skate in your garage.
What can go wrong? Well, no matter what, you’re going to be a bit sore and have some pain. Everyone’s pain tolerance and healing varies, but I’d block off a few days to take it easy and recover. What doesn’t kill you makes you stronger, right? Hopefully, you don’t have any restrictions against taking ibuprofen because ibuprofen will be your best friend to manage the inflammation, swelling, and discomfort brought on by the procedure. Swelling will typically peak around the 2–3 day mark post-surgery, so don’t be surprised by that.
You’ve probably heard that you need to avoid smoking, using straws, and spitting. Essentially, don’t do anything that would create a vacuum in your mouth. I trust none of us have that insatiable of a libido. Give it a few days. If you dislodge the blood clots protecting the sockets, you expose bone and can get a dry socket. Those hurt. A lot. As in, more than toothaches hurt. Toothaches also hurt a lot. Dry sockets hurt more. Follow the rules. Don’t get a dry socket.
There is also evidence that hormonal levels can influence the likelihood of developing a dry socket. This is particularly relevant if you are taking birth control,⁹ but apparently, you can time the procedure so that this is less likely to be an issue.
Regardless of how you heal, unless something goes really wonky (you shouldn’t have teeth taken out if you have recently had radiation therapy to the head/neck area, or if you have taken certain meds to help treat cancer or for bone problems — particularly in IV form), you should heal up completely within 2–3 weeks. The first few days are when you will need to take ibuprofen and acetaminophen most consistently. After that, you may still have some swelling, limited jaw movement, and mild discomfort, but you made it through the tough part.
None of that sounds so bad. Easy peasy. So, what is the one risk that would lead me to seriously consider not removing a wisdom tooth if it were me? Paresthesia. Para-who-ha? Permanent numbness.¹⁰ Your lower jaw feeling numb forever. How likely is that to happen? Not that likely, especially if you are working with an experienced dentist or surgeon who took appropriate imaging and evaluated the position of your tooth in relation to the nerve in your lower jaw before recommending the procedure.
It’s not actually always forever. Sometimes you will have numbness after the procedure that goes away within 6 months. All I’m saying is that if my surgeon told me there was a significant risk of permanent numbness in my lower jaw if I had my wisdom tooth removed, and that wisdom tooth was not causing any problems, AND the surgeon didn’t see any signs of disease associated with the tooth, I’m not gonna poke that sleepy bear. If my surgeon tells me that the tooth's roots are nowhere near the nerve in my jaw and I’m not at risk for a nerve injury, then I say full steam ahead. Get that bear outta there. I never liked him anyway.
Perhaps now you’ve changed your mind again? Forget surgery, you say. “I’m keeping my teeth. Over my cold dead body will anyone be plucking my wise enamel outta the back of my clam. Those are pearls back there!” Cool. If that’s the right choice for you, spectacular. Guess what though? You still have to take care of them if you want them to behave and not hurt like the Dickens down the line. Those teefers are your responsibility now, bucko.
Could I have perfectly predicted this development 50 years down the line by looking at the patient’s wisdom teeth at age 20? Of course not.
How to Take Care of Your Wisdom Teeth if You Decide to Keep Them
This has already been a long article. I’m not going to make it much longer. Wisdom teeth require the same level of care and attention as the rest of your teeth, but they can be a little harder to reach. If you’re going to keep them, you need to put in the extra effort.
Here’s a series of videos you can watch over the coming weeks to get your act together and wisely avoid problems with your wizzies:¹¹
How to Stop Acid from Making Your Teeth Yellow
Why Dentists are so into Fluoride
Fresh Ideas to Help You Quit Smoking Before It Destroys Your Teeth
If you watch and understand those videos and follow the advice, which will require some effort and discipline, you will be well on your way to a successful, healthy dental life. Heck, maybe you won’t have to deal with smelly breath anymore either. You can do it. If you doubt yourself along the way, check out this book and this book and this book. Eye of the tiger. You got this.
Summary
Here’s a relevant question that should probably be considered: Do we even use our wisdom teeth for anything?
Teeth are relevant to life for three main reasons:
1. Facilitate chewing of food.
2. Facilitate proper speech noises.
3. Make us look purty so the rest of society doesn’t reject us for not measuring up to beauty standards.
How relevant are wisdom teeth to any of those purposes? If the rest of your teeth are healthy, then they really don’t matter, to be honest. Nobody misses their third molars when they are gone. That doesn’t mean their removal is free and easy, and you shouldn’t appropriately consider all the pros and cons as outlined above. Still, the Tooth Fairy isn’t paying top dollar for wisdom teeth. They just aren’t that valuable most of the time.
I hope I have given you a clearer understanding of “what the deal with wisdom teeth” actually is. There are legitimate reasons to have them taken out for some patients. There are legitimate reasons to save a procedure and hang on to them for other patients. It depends on a lot of factors. If you want to review those factors in the future and don’t want to reread this article (because, let’s face it, I’m not THAT entertaining in written form), You could also watch this video.
Off the top of my head, what are the ideal circumstances in which you should have your wisdom teeth removed?
You have an active problem with one or more of your wisdom teeth (pain, tooth decay, gum disease, interference with needed dental treatment, causing problems with a tooth in front of it).
You are younger in age.
You (or your parents) can afford the procedure without it being a serious financial strain.
You can take it easy for several days after the procedure to properly recover and heal.
The roots of your wisdom teeth are nowhere near the nerve in your lower jaw, so you aren’t at risk for permanent numbness.
You’re NOT using this as an opportunity to trick your parents into allowing you to experiment with harmful drugs.
If you don’t meet those criteria, you’ll just have to weigh your individual pros and cons and make a decision along with your dentist or oral surgeon about the right course of action for you. If Santa ever gives me that dental prognosis crystal ball, I promise I’ll let you borrow it.
If you’re really studious and motivated like me, you can also check out the “Additional Resources” links at the bottom of this article. If you think I’m a biased ninny who doesn’t know what I’m talking about, you’re welcome to check out the first link from the American Academy of Oral and Maxillofacial Surgeons. They have put together a really nice set of resources and learning materials about wisdom teeth (aka 3rd molars) on their website. Oral surgeons are dentists who go through an additional 5–6 year residency program AFTER 4 years of dental school, which happens AFTER 4 years of college. They are a pretty well-educated bunch, so it won’t hurt you to understand their point of view and the logic behind their recommendations.
Has anyone experimented with keeping more of their wisdom teeth and lived to tell the tale? Actually, yes. The British do things a little differently than us rebellious ‘Mericans, and they seem to be getting by ok. Granted, the British are also not exactly known for having the best teeth, so maybe I just shot myself in the foot by mentioning that. Oh well. Here’s some research from the Brits about only removing wisdom teeth if they fit the criteria for those likely to cause a problem.
This difference in approach between America and Britain actually came up when I was in dental school, but the oral surgery faculty was very quick to dismiss it and said essentially, “Patients should have their wisdom teeth removed. That’s not in question.” The issue being so quickly dismissed without further discussion piqued my ever-vigilant curiosity, so I started doing a bit of research independently, and this article is what I came up with.
I don’t have the final word on any of this. Please don’t storm into your dentist’s office and yell that the internet man told you that you have been being lied to and you want to march him or her to the guillotine. There’s a reason I write these posts on Medium instead of on Twitter. I assume you all are capable of a bit more rationality here than in other online spaces. It’s not a good idea to “cancel” dentists. We need them. Dentistry is an exceedingly stressful occupation, and the last thing I want to do is make things harder on my colleagues. (make this a pull quote)
My goal is to give you more information so you can have a better discussion with your dental care provider about what is best for you. That’s it. I hope I’ve given you an appreciation for the idea that, as with almost all healthcare decisions, there is no one size fits all solution for every patient.¹² You need to work in concert with healthcare providers you trust if you want any chance of improving and maximizing your health.¹³ I’m not trying to start any revolutions here. Those are seldom very helpful. Usually, it’s a lot of bloodshed and guillotining, and then we end up right back where we started: terribly confused and not any closer to utopia.¹⁴
Hopefully, this was mildly entertaining and helpful. I wish you and your teeth the best.
Thanks for reading.
Additional Resources:
The American Association of Oral and Maxillofacial Surgeons Wisdom Teeth (3rd Molars) Resources Page
British National Health Service Guidance on Wisdom Teeth
The American Dental Association Patient Guidance on Wisdom Teeth
2016 Reuters Article
2016 Cochrane Review
2011 New York Times Article. But realize I don’t always think the Times is crushing it when it comes to dental wisdom. See my take on flossing here.
Terribly confused and not any closer to utopia.
Footnotes:
¹ What a name, huh? If I ever find a woman crazy enough to let me put a baby in her, I think I’m going to name our firstborn “The American Association of Oral and Maxillofacial Surgeons.” Ok. You’re right. That could be a bit much. His or her teachers may not appreciate that during roll call. Maybe “and Maxillofacial Surgeons” will be the middle name? “The American Association of Oral” is a pretty wild first name. That kid’s going places. May not be good places. But they’ll end up somewhere interesting. If you’re thinking, “What woman is crazy enough to allow that kind of a name for her child?” you are correct. I have not yet found her. Next month I will be banging trash can lids together in the middle of a desert in Nova Scotia in the hopes of attracting such a person.
² Dr. Friedman addresses this in his 2007 article for the American Journal of Public Health:
“Many dentists confuse the incidence of pathology as it shows up in their offices with its prevalence in the population. Advocacy of prophylactic extractions that is based on anecdotal experience (i.e., patients with diseased third molars who make dental appointments) exaggerates the problem and exposes millions of people to the risk of iatrogenic injury. Considering the low prevalence of third-molar pathology in the population, removal of asymptomatic, nonpathologic third molars does not meet the standard of evidence-based practice.”
If you’re not sure what that quoted paragraph above means, you can always take a statistics class and read up on epidemiology.
³ Don’t hate me for this. My understanding is that the Clauses are in an open relationship. The Mrs. has a thing for elves. Also, that kind of stuff is totally legal up at the North Pole. No governments have any jurisdiction up there. Who do you think is making laws, penguins? Nope. They don’t even live there. Also, polar bears can’t write, so they aren’t making laws to restrict the Claus either.
⁴ Although I have gotten reasonably good at determining which appendices are worth reading at the ends of books. Aren’t you glad you read this footnote now? Probably not. That’s understandable. Most of the footnotes are just silly nonsense. It’s my way of lightly teasing you. You shouldn’t trust me so easily. I put a little superscript next to a word, and you think you need to go rushing off to the bottom of the page or else? Or else what?
I’m being harsh. I’m no different than you. I read all the footnotes. I forage through the appendices. I can’t help it. If you’re still here, likely neither can you. What I’m really curious about are the people who read ONLY the footnotes and skip everything else. Do such people exist? What’s going on with their brain chemistry? I want to study them. Sorry for being a creep, but it’s true. Such a person could arguably be even stranger than me, and that’s saying something.
⁵ If you’ve noticed, I don’t know the proper name for gall bladder issues. Gall bladderitis? That sounds dumb and incorrect. I didn’t take Latin in high school. I took Spanish. I forgot most of it, but I’m trying to relearn using Duolingo. I think I’m making progress. If you’ve never tried it, you should totally try Duolingo.
I think I’m going to try to learn Swedish next. In my mind, if I can stumble through a few sentences of Swedish, that gives me a chance with a Swedish lady. I’ve been hopelessly attracted to Swedish ladies ever since I was on a swim team trip to Florida in college and the Swedish national team happened to be training at the same pool as our team for some bizarre reason. Why Fort Lauderdale? Maybe it wasn’t the Swedish national team. Maybe it was just a bunch of beautiful Swedish people that all decided to go to the same college. I’m not sure. But they weren’t speaking English, and they were far too attractive to be native Fort Lauderdalians. Yea. That’s right Fort Lauderdale. Boom. Roasted.
So yea, you should try Duolingo. If nothing else, when you fail miserably at learning a new language, it should give you an appreciation for how incredible immigrants are that come to America and make it here. If you put me in Sweden right now, I think I would probably get my ass kicked. You have to be tough as nails to make it in a new culture when you don’t even speak the language. We should all struggle with Duolingo so that we can properly appreciate that reality.
As I was saying: gall bladder issues. I’m too lazy to look it up right now. I think I’ve made the relevant points as to why wisdom teeth and these other similar issues are still slightly different. If you want to look it up and send me an email, more power to ya.
⁶ Not all wisdom teeth will go buck buck. Some wisdom teeth are pretty mild-mannered and milquetoast.
⁷ I’ve had plenty of patients with active infections draining out of teeth who have refused dental care. I can’t touch you without your permission, even when I think any rational person would decide to treat the problem. Not all people think the same way. That’s life. My opinion as a care provider CANNOT and SHOULD NOT ultimately supersede your own as an autonomous human being. If you have a problem with that, then I order you to make me a sandwich. Right now. It’s what’s best for society as a whole. I’m hungry.
⁸ If you dig neurology and/or developmental psychology, you should check out Robert Sapolsky’s excellent book Behave. Chapter 6: Dude, Where’s My Frontal Cortex? is particularly relevant in this context.
⁹ Side note, if you want to listen to a fascinating podcast episode about the development of the birth control pill, check this out. In fact, you should probably just listen to all of Malcolm Gladwell’s Revisionist History podcast. It’s so good—one of my favorites. Also, if you’re looking for a way to help your irritable baby fall asleep at night, might I suggest Malcolm Gladwell’s Revisionist History podcast? It’s so soothing. Can you lotion your vocal cords? It’s as if he was somehow lotioning his vocal cords. That’s how soothing the man’s voice is.
¹⁰ If you want to read more about this, you can check the “Paresthesia” section of Dr. Friedman’s article cited earlier in this post.
¹¹ Wizzies is an adorable nickname dentists have given to wisdom teeth. For example: “I just whipped out a set of wizzies. I’m going to celebrate by having a beer and going polka dancing!” There ya go, now you’ve seen behind the curtain. You know who the wizard is. You know our jargon. The emperor has no clothes.
¹² This is why I typically loathe insurance companies and administrators, both private and public, who try to “regulate” and impose strict definitions on what healthcare providers and patients can decide is best for the patient. If you want a more nuanced breakdown of my opinions in this regard, I would recommend reading Richard Thaler and Cass Sunstein’s excellent book, Nudge. I’m a libertarian paternalist through and through. I believe in nudging people toward choices they would make in their own best interest, but I’m not for shoving or handcuffing. If you work in insurance and you’re reading this, sorry, not sorry. I probably loathe you. Probably. It’s not your fault, though. You’re just caught up in a poor solution for a recalcitrant problem. Read Nudge. Be better. If you read Nudge and are resistant to what is written on those pages, you might also try Michael Pollan’s How to Change Your Mind.
¹³ How about this quote from The American Association of Oral and Maxillofacial Surgeons White Paper on the Management of Third Molar Teeth:
“Uncertainty is more explicit in the case of patients who have asymptomatic, disease-free third molars. Given that we cannot confidently predict what the future holds for all patients with asymptomatic, disease-free teeth, we must rely on the clinician’s experience and expertise in recognizing the likelihood that pathology will develop and his or her ability to communicate this in realistic terms to the patient.”
Basically, as I’ve been saying this whole time: me no have no magic crystal predictify the future ball. Also, I have no idea if I’m communicating what I do know to you as a layperson in realistic or understandable terms. This is an early effort. I’ll refine my elevator speech over time. Suffice it to say, regardless of where you lie on the spectrum of third molar/wisdom tooth ideology; there are some sincere people out there trying to do the right thing as best they understand it.
¹⁴ If I had any musical talent and the wherewithal to start a band, I think I would call my band Terribly Confused and Not Any Closer to Utopia. I love that as a band name. If anyone wants to start a band and call it that, I’ll be first in line to listen to your EP. Just think about how fun that would be to shout out to a crowd: “We are Terribly Confused and Not Any Closer to Utopia, and we are here to rock your brains!” There’s not actually a crowd. It’s just you and a couple friends from high school having a midlife crisis at a local dive bar. But the enthusiasm is there, and you’re having a good time. That’s what matters.