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Posted on October 15, 2014
Should wisdom teeth be removed on my teenager? Short answer: YES.

Well it’s definitely Fall with temps dropping and Halloween décor going up. Want to hear a tale of gore and fright? Let’s talk about Wisdom teeth!

As a pediatric dentist, I don’t often get patients complaining of wisdom teeth related problems. But, starting around 15 or 16 years, the wisdom teeth or third molars will begin to form roots. Root formation is what drives teeth to move into the mouth or “erupt.” For most teeth it’s a minor discomfort, but for wisdom teeth symptoms can run the gamut. Vague pain at the corner of the jaw, sensitivity around the gum, pain with biting are all part of a NORMAL eruption process. The trouble is, wisdom teeth becoming functional teeth is usually NOT normal!

A recent review article by Dr. Martin Steed of the University of South Carolina in the Journal of the American Dental Association, really turned my head and changed my thinking in regards to wisdom teeth. To paraphrase Dr. Steed, wisdom teeth rarely behave themselves and stay inert under the bone if they don’t have room to come in (only 11.6%). Rarely do they ever cause a bone tumor or cyst (I remember the incidence is 0.059%). But over 88% of the time, wisdom teeth will become infected with cavities or more often periodontal disease. Getting them taken out is not fun and not cheap, but only treating them when they are symptomatic may the wrong long term decision.

To go into more detail, a Dr. Dodson published a rating system for wisdom teeth in 2012 that aided in following wisdom teeth over time and tracked the incidence of disease. From there, his group could make predictions on the number of wisdom teeth that would “jump categories” and become problematic. What he found is most wisdom teeth that are asymptomatic now will become symptomatic over time. This change, if not monitored, may actually seed the mouth for long term problems in adulthood such as chronic periodontal disease. In most cases, un-erupted wisdom teeth butted up against the second molars. In that area, a pocket or communication formed that allowed bacteria or track down between the teeth and bone and grow without being cleansable. For asymptomatic teeth, one study of 329 young adults found 25% had pockets formed. Another study suggested that wisdom teeth “supported the concept that clinical and microbial changes associated with the initiation of periodontitis may manifest in the third-molar regions of young adults.” If that is not scary enough (chronic disease of the gums starting in teenagers), Dr. Steed also reminds us that “retained third molars frequently and unpredictably change their periodontal status.”

What that boils down to: it is serious matter to consider whether wisdom teeth should be removed. If you decide to leave them in, monitoring needs to be done every six months with examination, history and probing, not every few years with an xray. For my kids, I think taking wisdom teeth out at age 15 or 16 is a very good idea. Removal at that age reduces the chance of surgical complications and makes recovery very fast compared to having them out even in the early twenties. This may very well be the first decision parents and young adults face when they transition from a pediatric dentist to an adult dentist. Don’t let that decision slip by you, or you may be ignoring a “little monster” who can turn into a real nightmare! Happy Halloween everyone! For more questions on this or any other children’s dentist topic, contact me at my new email greg@gobiggrins.com. Check out our new website too!