Written By: David Dara Yarmand DDS, MD.
North York Oral & Maxillofacial Surgery Centre
I do admit that I have a certain bias. I have seen many people wait until later years to remove their 3rd molars, usually as a result of pain or infection only to have a miserable post-op course. Granted, the vast majority of those patients were told to have their wisdom teeth out years ago, but the difference between then and now is enormous. Back then when they were teenagers they would have had a relatively easy recovery with almost no complications. Now, they will have a week of misery with a much higher complication rate especially when it comes to the nerve. My issue is not whether to remove 3rd molars in older patients – most asymptomatic teeth should be left alone – but rather with not removing them in younger patients.
After years of debating the wisdom of prophylactic removal of wisdom teeth the debate still persists and for no good reason. Why are we not having the same debate for prophylactic removal of tonsils? Because it became obvious that tonsils did not have to be removed. The evidence for keeping impacted wisdom teeth in teenagers is notably tenuous and underwhelming. The biggest study to date is conclusive (well, as conclusive as a study like this can be) and very much “proextraction” but it is questioned because of its source: The American Association of Oral & Maxillofacial Surgeons. But most of you know from your own patient pool that impacted 3rd molars, especially when they’re partially impacted, create problems down the line. I may be preaching to the choir but there have been some nonsense statements made by a certain orthodontist in a certain journal that may have you re-examining your recommendations.
The main question to ask yourself is this: What would be the acceptable threshold for your child having an issue with their wisdom teeth in the future? 10%? 20%? 30%? Personally, even a 10% lifetime risk is too high for me because I know that complication rates in teenagers is far less than 1%. The math is simple. My girls are going to have their wisdom teeth out. No question. Yes, I may be oversimplifying things to make a point but even with close nerves and sinuses, complications are STILL less than 1%. With adults, it’s a completely different story and wisdom teeth extractions are particularly sensitive to advancing age – I am not an advocate of prophylactic removal third molars in adults. Of all things, this is where clinical judgment/case-by-case basis comes into play. However, if you have a 17 year old with impacted 8s, it is pretty safe to say that those teeth should probably come out.
I will leave you with my weirdly ironic and unusual story. I have a very unique occlusion. My #15 and #25 were extracted for ortho reasons (I was 14) but I still have all my lower premolars so my upper 7s are in full occlusion with my lower 8s. I do have a pretty big Neanderthal jaw so my #38 and #48 erupted just fine. Except that now, in my mid 40s I’m having issues. I clench at night but only on my lower 8s and I have pain ONLY ON MY 8s! Of course no one in the world (including my prosthodontist dad) is suggesting that I remove them and I am half joking. But I’m guessing at some point that something’s going to give and my lower 8s will have to be extracted and I am not looking forward to having my giant teeth with my giant roots in my giant jaw, yanked out.