Removing wisdom teeth is a rite of passage of sorts, something almost every high school or college student experiences. A good dentist will prepare the teen for what’s to come, providing updates on how their wisdom teeth are coming in and advising when to have them removed. But is removal really necessary?
Wisdom teeth, also known as third molars, are located at the back corners of the mouth. These four permanent teeth (two on the top and two on the bottom) typically break through the gum (erupt) around 18. But the challenge with wisdom teeth is a twofold problem – space and necessity.
Most present-day mouths are not large enough to accommodate these teeth. Therefore the majority do not erupt properly. Thus, many wisdom teeth come in sideways or with roots that are twisted or in the shape of a corkscrew. Our caveman ancestors needed wisdom teeth as they ate a diet primarily consisting of raw foods – including meat. Their mandibles (jawbone) were also larger, allowing for space to accommodate the teeth. But today, our diets consist of mostly cooked foods that are primarily cut into manageable pieces to make eating easier, and we have smaller mandibles.
Yet, these teeth continue to be a part of our existence. And even if wisdom teeth come in straight and pain-free, the risk of infection and cavities – because it is hard to clean teeth that are so far back in the mouth – has around 90% of people seeking removal.
Enter the dentist.
Dr. Andy Engel of Living Dental Health has been removing wisdom teeth for almost 25 years. Like most of the things he does in his practice, he looks at the removal of wisdom teeth strategically. He considers physics, not brute force.
Are you envisioning the scene with Steve Martin getting his teeth yanked out in Little Shop of Horrors right now?
Dr. Engel’s wisdom teeth removal procedures are nothing like what was depicted in that movie. He assures us he never puts his knees on a patient for leverage, and he anesthetizes every patient before getting started. He even provides around 75% of patients oral sedation via a pill called Halcion, so they are happy as a clam to be in his chair.
But all kidding aside, Dr. Engel does his homework on each patient before surgery. For example, when the tooth’s roots are not going in the same direction, which comprises around a third of his cases, he will remove the tooth in sections. Doing so reduces the chance of a dry socket, pain, and infection. If his 2D panorama imaging isn’t providing enough information, he uses his 3D scanner to see precisely where the roots are. But sometimes, he needs to refer to an oral surgeon, such as when a root is wrapped around a nerve or if a patient has a rare blood condition.
Most patients wait until their wisdom teeth become a problem before having them removed. Therefore, time becomes a significant factor.
Dr. Engel says putting off the removal of wisdom teeth is a bad idea. The best time to remove wisdom teeth is when they are still developing, around age 15-17, when the roots aren’t fully grown. Dr. Engel feels the prime time for wisdom teeth removal is when a patient has a full crown and the roots are around ⅓ to ½ developed. Removal at this point is easier, with less pain and swelling. His patients typically have a downtime of just two days. Dr. Engel does many of his wisdom teeth removals on Fridays, so it doesn’t impact the weekday schedule. And summer break is one of the most popular times for these extractions. Did we mention that it is summer right now?