Third molars (AKA wisdom teeth) are very likely to remain impacted within the jawbone. An impacted tooth simply means that the tooth grows inside the jaw due to lack of space. On occasion there is enough space for the tooth to partially erupt, but eruption does not imply a state of good health. When wisdom teeth do erupt, they often cause acute infection (pericoronitis) due to difficulty in maintaining oral hygiene and due to inadequate soft tissue support leading to periodontal deterioration. A visible wisdom tooth and adjacent teeth have a higher incidence of periodontal (gum) disease.
“The presence of impacted third molars adversely affects the periodontium of adjacent second molars as reflected in disruption of the periodontal ligament, root resorption, and pocket depth associated with loss of attachment.” (1)
Periodontal disease has been shown to be progressive even in the presence of asymptomatic third molars. The incidence of dental decay (dental cavity) is also much higher in third molars that are retained into adulthood.
Many clinicians believe third molars may cause dental crowding and recommend their removal to prevent crowding. Dental crowding is multi-factorial and a cause and effect relationship between third molars and dental crowding is difficult to establish and is only one factor in the decision making process for their removal.
Due to the high incidence of problems that develop from maintaining wisdom teeth, oral surgeons recommend that third molars be removed early before the development of problems. Typically, younger patients (< 25 years of age) have an easier recovery with fewer complications from surgery. Younger patients tend to heal faster and have better prognosis if complications occur. Also, younger patients usually are able to allocate adequate time off for recovery. Most adults that maintain their wisdom teeth end up at some point in their adulthood having to undergo wisdom teeth extraction due to development of pathology such as cysts, periodontal disease, or decay. For the best possible outcome extraction of wisdom teeth is recommended around ages 15-18 (or younger), depending on tooth development. As a matter of fact, removing lower third molars with less than 1/3 root development has the lowest incidence of morbidity.
Unfortunately surgery is not without associated possible risks. The most common sequelae from removal of third molars include: loss of periodontal support distal to the second molar, paresthesia (numbness) of the lip, chin and tongue, and infection. Loss of periodontal support distal to the second molar depends on the age of the patient, plaque control and on the pre-exiting bone defect prior to surgery. Older patients (>25) are more likely to have periodontal support loss distal to the second molar. No single surgical technique has been shown to yield increased bone level distal to the second molar after removal of third molars. Bone grafting may increase attachment level post-operatively in cases where pre-operative bone loss is present distal to the second molar, although additional studies are necessary.
“The position and disposition of unerupted teeth has been found to be dynamic and unpredictable. Therefore, the ultimate decision regarding the management of such teeth is best made by an expert clinician after clinical examination and review of factors such as the age of the patient, position of the tooth, anticipated difficulty of removal, type of overlying prosthesis, and risks associated with removal”. (1)
Reference: 1. AAOMS White Paper on Third Molar Data
For patient information regarding Wisdom teeth removal, visit AAOMS.org
