Wisdom Teeth Evaluation
I recently had a 22-year-old patient who developed a small cavity on the biting surface of one of his lower wisdom teeth. The tooth didn’t have much room. The gum tissue runs high near the biting surface of the tooth. So, I referred him to an oral surgeon for an evaluation. After the evaluation, the patient’s father indicated that this oral surgeon didn’t think that extraction was necessary. This was a bit surprising for me. Taking out wisdom teeth is a large part of any oral surgeon’s practice. But I have no problem doing a filling for this tooth and see how it goes.
Wisdom Teeth Extraction
But what are the consideration for extracting wisdom teeth? If a wisdom tooth is impacted, then it depends on where it is located. It it’s near the mandibular nerve and there could be permanent paresthesia (numb) in the area, then best to leave it alone. If it is butting up against the second molar, it can cause a problem for the second molar. In that case, it’s best to take it out. If a cyst is noticed where the tooth bud is, removal should be considered.
For teeth that have erupted the location of the lower nerve is still important to consider. I usually recommend removal, if there is a lot of decay, with or without pain. If the gum tissue around the tooth gets inflamed and swollen regularly, that’s usually a sign that the tooth should come out. If there is the probability that the wisdom tooth will move the tooth in front of it and cause a misalignment, then the tooth should go. I do rely on recommendations of my specialists, namely my orthodontist and my oral surgeon.
I am in favor of patients of college age having a wisdom teeth evaluation. If there is a large jaw that can accommodate 32 teeth, I just leave it alone. Otherwise, I frequently recommend removal.
I personally had my wisdom teeth taken out at different times in my life. I think that is not the best way to do it. If the opposing wisdom teeth (upper and lower) are not taken out at the same time, the remaining tooth tends to super- erupt over time and will eventually hit the opposing gum tissue. That’s not desirable. I wish I had mine removed at the same time and been done with it in one sitting.