Wisdom Teeth

The most common issues that oral and maxillofacial surgeons deal with are wisdom teeth and the problems arising from them. Given their advanced, surgical training, oral and maxillofacial surgeons are the ones best-suited to counsel patients regarding wisdom teeth and their proper treatment.

Surgical removal of wisdom teeth is frequently necessary. In fact, recent research has shown that the vast majority of wisdom teeth should be removed and that they are best removed, between the ages of 15 and 25.

Being the last teeth to erupt, the wisdom teeth (a.k.a. third molars), frequently do not fit into the mouth and bite. This is because our other teeth have already nearly filled the available space. This causes the wisdom teeth to force themselves into strange positions, in their quest to “come in” to the mouth. By the time the wisdom teeth come in damage has likely, already occurred. Additionally, delaying the removal of wisdom teeth allows their roots to grow longer and more curved, so that they are harder to remove, as the patient ages.

With the x-ray technologies we have available, it is easy to predict, at an early age, which teeth need removal. Our office recommends a screening x-ray (“Panorex”) be taken at age 14-16.

In the uncommon case that it is decided to leave any wisdom teeth in place, they should be monitored, over the patient’s lifetime, with periodic “Panorex” x-rays, to make sure that no cavities, bone loss, gum disease, cysts, and/or tumors are developing. A.O.S.D.I. would be happy to perform these x-rays for you and counsel you regarding the proper treatment of your wisdom teeth.

Some people are born without one, or even all, of their wisdom teeth! In fact, wisdom teeth are the most common teeth to be missing from birth. This suggests to us that even Mother Nature is trying to eliminate wisdom teeth. For the majority of us who are not lucky enough to benefit from Mother Nature’s “phase out”, our wisdom teeth need removal.

Studies of human skulls, from over the last 4,000 years have shown that the size of the jaws is slowly decreasing. A softer, modern diet does not stimulate jaw growth, like ancient diets did. Because of this, the human race has been having progressively less space in the jaws to accommodate the wisdom teeth as well asother teeth. As a result, many of us have wisdom teeth (and other teeth) that are doomed to be impacted, likely in strange positions.

Not uncommonly, these strange positions leave the wisdom teeth trapped, partially in the jaw, and partially in the mouth. The result is food and bacteria being trapped around the wisdom teeth, while proper brushing and flossing of the malpositioned teeth is prevented. This then leads to the development of cavities, gum disease, and bone loss, in the region, as well as creating a nest around the wisdom teeth for the bacteria that cause this damage.

Outdated philosophies commonly held that patients should wait, until the wisdom teeth “came in” or, worse yet, started troublesome before they were removed. We now know that such a delay in removing the wisdom teeth is very counterproductive. Just like a young, short-rooted weed is easier to pull than a large, old dandelion, so is a young, short-rooted wisdom tooth easier to remove compared to an older, fully formed one. Removing wisdom teeth, beyond the age of 25, is significantly more difficult, requires more extensive surgery, and leads to a longer, more difficult recovery, than if the surgery is done in the teenage years.

Frequently, the small x-rays taken at the dentist’s office do not reach far enough back in the mouth to properly image the wisdom teeth. Only the special “Panorex” type x-ray is adequate to image most wisdom teeth. Everyone should have at least one “Panorex” x-ray in their lifetime, preferably in the middle teenage years. If this film shows that the wisdom teeth are ready for removal, then their removal should be performed immediately. If the wisdom teeth are not positioned for reasonable removal on the initial x-ray, another film is taken, in two to three years, and usually then indicates that it is time for the wisdom teeth to be removed.

As we age, removing wisdom teeth becomes more difficult; therefore, surgical recovery involving time away from school and work is prolonged. Additionally, an adult’s ability to “bounce back” from surgery is far slower than in the teenage years. Usually teenagers can schedule surgery during a vacation break, from high school or college. As we enter the work force, finding the time to have surgery (and accommodate its recovery) become much more onerous.

Given that removal of wisdom teeth after the mid twenties is notably more difficult, the frequency and severity of the surgical complications also rises proportionately with age. The younger the patient, the faster they recover, and the less short- and long-term complications there are. In the older age group, patients having wisdom teeth out are not uncommonly forced to have the adjacent molars removed as well, due to the long-term damage caused by the wisdom teeth.

Wisdom teeth have been cited as causing crowding of the front teeth as they try to “come in”. However, this has never actually been proven or disproven to occur, though. Others note that wisdom teeth can be the source of large, destructive tumors and cysts of the jaws. While this is true, these cysts and tumors arise in a very small number of people. The bottom line is that failing to remove wisdom teeth can be the cause of painful infections, cavities, gum disease and bone loss, as well as damage to adjacent teeth. The most prudent course of action is a Panorex x-ray and evaluation by an oral surgeon, beginning in the mid-teenage years.

Our Office

Our office is conveniently located one block west of Rangeline on 29th Street. We are on the second floor of the Wells Fargo Building next to Oasis Day Spa.

  • Address:   2819 E. 29th St. Suite 2 Joplin, MO
  • Phone:      (417) 623-2000
  • Fax:          (417) 623-7948
  • Hours:      Open Monday-Friday 8am to 5pm