Article written by: Dr. Craig T. Ajmo DDS
The decision to extract wisdom is often thought of as a given, but frankly, that is old school philosophy based on attempts to prevent issues that are very likely never to happen.
A wisdom tooth, in humans, is any of the usually four third molars. Wisdom teeth usually appear between the ages of 17 and 25. Most adults have four wisdom teeth, but it is possible to have more, in which case they are called supernumerary teeth. A fair number of people are missing one or more wisdom teeth, or do not develop wisdom teeth at all.
There is a couple of situations where is would be important to get them out; this would include severe decay in the wisdom tooth, or if the wisdom tooth is creating decay or can potentially create decay in an adjacent tooth, based on its position.
Another important reason for taking out wisdom teeth would be if the tooth is only partially erupted (meaning it cannot fully come into the mouth), and there is a way for the saliva in your mouth (which is full of bacteria to help digestion) to get to your jawbone (which is basically sterile) and cause an infection.
Beyond that, wisdom teeth get a bad rap. Will they cause your teeth to get crowded? No. Will they become a problem if they are fully impacted? Probably not. In fact, giving them up may be giving up a valuable asset that can help you down the road, as explained below.
In 2006, the Cochrane Collaboration, a group dedicated to providing the public with information that allows them to make informed medical decisions, published a review of randomized controlled studies to study the effect of preventive removal of wisdom teeth that had no sypmtoms.
There was reliable evidence showing that preventative removal did not reduce or prevent front teeth crowding later in life. ClinicalEvidence, one of the world’s most authoritative medical resources for informing treatment decisions and improving patient care, published a summary that concluded that preventative extraction is “likely to be ineffective or harmful.” It advised against extracting asymptomatic, disease-free wisdom teeth because of the risk of damage to the nerve imbedded in the Jaw. The authors of the review suggested that the number of surgical procedures could be reduced by 60% or more.
The American Public Health Association recommends against preventative removal of asymptomatic, non-pathological wisdom teeth, including wisdom teeth that are impacted, on the basis that the removal of third molars (wisdom teeth), like the removal of any teeth, should be based on evidence of diagnosed pathology or demonstrable need, rather than anticipated future pathology. The APHA’s position is based on scientific research that documents the risks of injury to the nerves of the jaw that can cause permanent numbness of the lip and tongue, damage to the temporomandibular (jaw) joint and adjacent teeth.
Perhaps most imortant of all, in August 2008 it was revealed that scientists in Japan were able to successfully harvest stem cells from wisdom teeth. Although the dentally-derived cell lines varied in quality, the researchers, from Japan’s National Institute of Advanced Industrial Science and Technology said some their stem cells performed 100 times more efficiently than other cells taken from skin cells. The cells, they say, were able to differentiate into many other cell types, including cardiomyocytes (heart cells). This discovery is of great clinical importance, since you are essentially carrying a bank of stem cells right in your mouth.
While the research in stem cells is still very much at an early stage, I have personally met with a researcher is was able to create a functioning mouse heart with them. Studies are showing that stem cells can develop into various organs or nerves, and that using one’s own cells for that purpose greatly reduces the odds of rejection of the new tissues. There is also some potential of finding cures for cancer and diabetes with stem cells. While you may not be able to effectively use these stem cells today, as research progresses, the likelihood is pretty high that they can be useful to you in the future.
Post Operative swelling from Wisdom Tooth Surgery.
Beyond all of this, there is a certain line of thinking that says that it doesn’t make sense to do surgical procedures unless you really need it (duh!). The act of removing fully impacted wisdom teeth requires removal of bone that can potentially weaken the integrity of the jaw, making it easier to fracture. Post surgical complications can be a problem, and at the very least are uncomfortable.
In our office, once we have done a proper evaluation and are sure that there are no issues present, we have been recommending against the preventative removal of impacted third molars for these reasons alone. The stem cell issue only adds more importance to that concept.