Thank you for all the recent questions around the safety and risks of having wisdom teeth removed.
In response to our recent article, titled “The Common, Unknown Risk of Having Wisdom Teeth Removed” where we share our story about a cavitation surgery, we received many questions like “Is it safe to have wisdom teeth removed?” and “What are the risks associated with having wisdom teeth removed?” among many others.
As with so many subjects in dentistry and medicine, there is no black and white/ right and wrong answer. It can be challenging to see clearly through the cultural stories around wisdom teeth removal as well as to review the scientific literature on the subject.
So, it’s in this spirit that we write to help you sort through the data to determine if having wisdom teeth removed for you or your children is the wise decision.
Wisdom teeth are routinely removed regardless of whether the tooth is infected or healthy.
But is this really necessary? Are there dangerous risks associated with this common procedure?
In order to do this subject any justice, let’s lay down a few terms so we can all be on the same page.
Impacted wisdom tooth: An impacted tooth is simply a tooth that hasn’t fully erupted into the mouth. This most commonly happens due to space limitations in the jaw. Wisdom teeth can be impacted in many different angles. Some wisdom teeth can even grow in fully sideways (strange but true).
Erupted tooth: When a tooth breaks through the surface of the gum tissue, it is erupting into the mouth. Think a child teething. Their teeth are erupting into the mouth. Wisdom teeth do the same thing and the associated slight fevers and teething pain can occur.
Dry socket: The common term for Alveolar osteitis, inflammation of the jaw bone. Dry socket most commonly occurs when the body fails to create a blood clot in the open wound after a tooth extraction. When a dry socket happens, the jaw bone is exposed to the mouth environment because the body’s ability to knit gum tissue over the gap to close the wound has been compromised. Dry sockets are very slow to heal and can be rather painful.
Paresthesia: Damage to the nerve. The mandibular nerve is very close to the roots on lower wisdom teeth. Removing impacted lower wisdom teeth can unfortunately cause permanent damage to the nerve resulting in frequent drooling, loss of sensation on the lip (which can cause frequent biting of the cheek) and diminished ability to taste (and enjoyment of kissing 🙁 )
With these in place, let’s take a closer look at the main cultural stories we have around wisdom teeth.
Myth 1: Wisdom teeth have a greater tendency to become diseased.
It makes sense that the dental profession would come to this conclusion. After all, they are seeing a portion of the public who make appointments with them to get their help with stressed teeth.
However, the stats say that only 12% of impacted wisdom teeth become diseased. While 12% may seem high, if we consider that 10% of appendix become diseased and we as a culture don’t remove healthy appendix just to avoid the risk of the 10% that become diseased, why should we remove healthy wisdom teeth? Clearly, not because there a huge risk of the wisdom teeth becoming infected.
Myth 2: It’s easier on the body to take wisdom teeth out earlier in life.
I can understand the rationale behind this myth. After all, it makes sense that an 18 year old would bounce back easier and faster than a 48 year old to having some surgeries in the mouth. And in a way, we agree with this given the 18 year old’s immune system has, in theory, had to deal with less stress so may have an easier time bouncing back.
However, again the research falls short of backing up this myth. In fact, risks of secondary infection, paresthesia and developing a dry socket are higher among patients aged 12 to 24 than patients 35 to 83 years old. The highest risk of secondary problems from having wisdom teeth removed lies in the age group from 25 to 34 years old. (1)
Myth 3: Leaving wisdom teeth intact will cause your teeth to shift and get misaligned
We find that this ‘reason’ is the most common myth about leaving wisdom teeth in the mouth. In fact, a quick scan on the net for reasons to have wisdom teeth removed found an article on WebMD which states crowding other teeth as the #1 reason to have wisdom teeth removed. “Damage to other teeth: That extra set of molars can push your other teeth around, causing mouth pain and bite problems.” (3)
Again, research trumps cultural myth…
To quote Dr Jay Friedman, “Third molars do not possess sufficient force to move other teeth. They cannot cause crowding and overlapping of the incisors”. (2)
To add to this, other studies have been conducted to determine whether wisdom teeth really can cause our teeth to become crooked. Authors state, “There are valid reasons for extracting third molars. But extraction for the exclusive purpose of relieving interdental pressure and thereby preventing incisor crowding is unwarranted.” (4)
Myth 4: You increase the risk of disease if you wait to have them removed.
They are way back there in the mouth. You can’t clean them as easily. Of course they are going to become infected and be a breeding ground for disease throughout the mouth, right? 🙂
“There is no evidence of a significant increase in third-molar pathology with age.” (5)
That sums it up I think…
Myth 5: There’s little risk removing them.
Little risk? This article is dedicated to a recent sad statistic of a 17 year old young woman who is nearly dead after going into cardiac arrest toward the end of having her wisdom teeth removed.
Unfortunately, the above recent event isn’t unique. Here’s a story about another 17 year old young woman who died from this ‘not risky’ procedure.
Less ‘serious’ risks of having wisdom teeth removed range from dry socket, damage to the jaw joint, and jaw fractures to permanent paresthesia. In fact, in some types of impacted wisdom teeth (namely when the wisdom tooth is tilted toward the second molar), the risk of nerve damage is as high as 6%.
Now, 6% may not seem like a very high number, but would you risk drooling for the rest of your life due to nerve damage if you actually knew the statistics? I know I wouldn’t put any children in my care at risk of this unless I was given a very good reason (backed by science not myth).
Dr Friedman puts it rather matter of factly, “There can be no excuse for tolerating so many unnecessary extractions on millions of unsuspecting and misled people and putting them at risk of so much iatrogenic [dentist induced] nerve injury. This is a public health hazard.”[emphasis mine] (2)
So when is it a wise consideration to have them out?
If the tooth/teeth give you regular challenge, then the benefit to have it/them removed may outweigh the risks. However, what we hope this article has helped you realize is the folly to have healthy wisdom teeth removed to ‘save us’ from the damage that invariably will happen.
This notion simply isn’t based in reality. If your dentist tries to pitch these unsubstantiated claims as reasons to have wisdom teeth removed, vote with your dollars and find another dentist who is willing to work with you and stick to the science.
Let’s wrap this subject up with a couple quotes. “The fact is that most third molars, impacted or not, do not become diseased and that the risk of iatrogenic injury [dentist induced injury] from such surgery is greater than the risk of leaving asymptomatic, nonpathologic teeth alone” [emphasis mine] Jay Friedman, DDS, MPH”
Bottom line, if the tooth isn’t bothering you, best to leave it alone. To quote our long time mentor and friend, Dr David Kennedy, “God gave us 32 teeth for a reason”. Maybe we shouldn’t mess with that unless really necessary?
What about you? Do you still have your wisdom teeth? If so, have they given you any trouble? Did you have yours out? Has that given you any trouble?
Helpful, related resources:
1. Osborn TP, Frederickson G, Small IA, Torgerson TS. A prospective study of complications related to mandibular third molar surgery. J Oral Maxillofac Surg. 1985;43:767–769.
2. Friedman J. The Prophylactic Extraction of Third Molars: A Public Health Hazard. Am J Public Health. 2007 September; 97(9): 1554–1559.
4. Southard TE. Third molars and incisor crowding: when removal is unwarranted. J Am Dent Assoc. 1992;123: 75–79
5. Stanley HR, Alattar M, Collett WK, Stringfellow HR, Spiegel EH. Pathological sequelae of “neglected” impacted third molars. J Oral Pathol. 1988;17:113–117.