First, let’s get the cliché out of the way. Writing this article was like pulling teeth. Literally. Which is to say, carefully thought out, methodically executed, and pretty easy. The subject is wisdom teeth, and what, if anything, to do about them. Like, for example, extracting them. Pulling wisdom teeth.
WHAT ARE WISDOM TEETH?
Wisdom teeth are the ones all the way in the back, top and bottom. Dental school professors and textbooks refer to them as third molars. They’re usually the last of the permanent teeth to erupt. There are normally four. One on each side on top, ditto on the bottom. Some people have three, two, one, or no wisdom teeth. A few others have more than four.
And why do we call these third molars “wisdom teeth”? Aristotle did, writing nearly 2,400 years ago. The great thinker reckoned 20 to be the normal age for these teeth to appear. In those days, a 20-year-old was already wise, it seems. At any rate, Aristotle referred to these in Latin as the dens sapientiae – in English, “wisdom teeth”. The name stuck, right up to now. Like much of Aristotle’s wisdom.
WISDOM TEETH: WHAT ARE THEY GOOD FOR?
Third molars are very, very handy for chewing raw meat, raw roots, raw leaves – see the pattern? Some kind of trendy “paleo” diet? In a sense. Wisdom teeth were essential to the humans who lived when everybody was on the paleo diet because cooking and farming hadn’t been invented yet. Perhaps not coincidentally, our distant ancestors’ jaws were larger than ours today are. Real crushers and grinders, they were.
Then, along came the (then) high technologies of farming and cooking. Nice, (relatively) tender chow. Over the generations, our jaws became smaller and less formidable. Those wisdom teeth, those third molars, became less essential. As a matter of fact, the other two molars in each quadrant began to act like “three’s a crowd”.
WHAT WENT WRONG
Well, those third molars just don’t neatly fit any longer in our sleek, compact modern jaws. That’s what lies at the root of many of the problems related to those teeth. When they try, late in the teenage years, to erupt, the way may not be fully open to them. They can bump into the neighboring second molars, for example, which are already erupted. The point of impact can even be below the gumline, in which case the wisdom tooth gets stuck inside the gum. Never appears. Hence, the people with fewer than four wisdom teeth – they may be in there, but stuck below the gum line. Can’t see them.
These are called impacted wisdom teeth. One of the more serious results of which can be cysts forming under the teeth. This, in turn, can cause loss of jaw bone, and also can damage nerves.
Even when wisdom teeth erupt without impacting the neighbors, there are certain difficulties with them. They are, after all, way in the back. This makes it hard to clean them properly. An open invitation to tooth decay, cavities, gum disease, or one thing after another. So. What to do about all this?
THIRD MOLAR OPTIONS
The three basic options for wisdom teeth are:
- Extract them
- Treat them
- Leave them alone
Dentists take several factors into account when deciding which to recommend. Three of the key considerations are:
- Age of the patient
- Position of the teeth
- Condition of the teeth
BEST CASE SCENARIO
The best-case scenarios lead to the third of the above options. Leave the wisdom teeth alone. Don’t treat them, don’t pull them. Their owner simply continues taking care of them just like all the other teeth. The owner also continues using them, just like all his or her other teeth.
We can think of the third molars, the wisdom teeth, as vestigal. Body features left over from the very old days. We humans have ten or so physical features that are vestigal. Perhaps the most notorious is the appendix. Doesn’t do anything that we know of, though there are some theories. The only time we get interested in our appendixes, in fact, is when they get infected or otherwise cause trouble. Then, we simply take them out. We seem to get along perfectly well without them. Some other examples of human vestigal features are the tailbone (coccyx), ear muscles that barely work or don’t work at all, and, of course, the wisdom teeth.
The wisdom teeth, however, can be very nice to have as long as they’re not causing any trouble. And when the Anderson Dental Lake Worth dentist judges they’re not going to, in the future. Hence, the ideal scenario is:
- Four normally-erupted wisdom teeth
- Normal tooth alignment throughout
- No signs of significant decay in the wisdom teeth
- All signs the patient’s cleaning of the wisdom teeth is effective.
- Patient reports no pain or discomfort
Such a patient might as well keep them. A tooth, after all, is a terrible thing to waste. Other things being equal, it’s better to have more of them than fewer of them.
Which brings us to the treatment option. If all the other ducks (adult patient, etc.) in the best-case scenario are in a row, but a minor carie has developed, filling it may be a good choice. The dentist would also want to see that the carie is in a position accessible to his or her tools. If so, there’s room for a conversation about placing a filling.
There are some other variants on the treat-them theme, which dentists sometimes find and discuss with patients.
PULLING WISDOM TEETH
Now we’ve come to consider the indications that extraction of wisdom teeth is the best option. That is, to all scenarios which are none-of-the-above. Not to treat ‘em, not to leave ‘em alone. When pulling wisdom teeth is the way to go. Thankfully, with modern anesthesia, sedation, and technology, extraction is generally painless and without issues.
Notice the adults-only feature of the scenarios in which wisdom teeth stay in place? Here’s why. Until wisdom teeth have fully erupted, and some time has passed, there’s a distinct possibility that they’ll cause orthodontic issues. Crowding and impacting are not at all good for alignment.
Hence, dentists keep a close eye on teenage patients’ wisdom tooth progress. As the age of “wisdom” approaches, he or she updates a judgment about the likelihood of problems of any kind developing. The strategy is of pulling wisdom teeth before they cause trouble. Sooner, rather than later. An ounce of prevention is, indeed, worth a pound of cure.
There are, moreover, changes in the risk profile for extractions as a patient gets older. For one thing, it’s an easier job extracting a wisdom tooth from a young person. Teenagers recover faster from sedation, and the extraction wound heals faster. With older patients, too, there’s an increased risk of damaging an important jaw nerve when extracting a wisdom tooth.
There you have it. The wise approach to wisdom teeth. We don’t need them. They’re fine to have, though, as long as they’re not going to cause trouble. We’ll fix minor problems and keep them, but otherwise – so long, wise guys. You were great to have when times were really tough, but this isn’t the Stone Age anymore.