Wisdom teeth extraction in Wheaton, Il
We are of the believe that with the advent of CBCT, prophylactic extraction of wisdom teeth is very wise as long as the risk for nerve damage is low and spacing is going to be an issue. CBCT can give the surgeon excellent information as to what the risk level is (not perfect but much better than before). A coronectomy of lower wisdom teeth is also being done more often, as the research points to it being successful. We do believe that those with small teeth and/or large jaws can easily maintain wisdom teeth and should not have them prophylactically removed. We know that those people are in the minority but we do not have an exact percentage as the term “small teeth” and “large jaws” is subjective.
Not sure where this quote is from but we like it and feel the same way.
“Get your wisdom teeth (third molars) out while you are young and healthy. The bone is soft, the teeth will come out easily, and you will heal more rapidly than if you wait until there is a problem in 30 years. While it is true that you may be lucky and never develop a problem, if you wait, you may be risking a more difficult and painful recovery with irreversible damage to your other teeth.”
Why prophylactic third molar extraction?
Seems we have to continually learn the same things. NIH reduced number of third molars extracted initially by setting more strict guidelines (under the belief that they were being done unnecessarily). Unfortunately, the number of third molars being extracted soon returned to normal with the average age just increasing. The increased age means there is a significant increase in morbidity from the surgical removal of these teeth. This is not a good result. 1
A counter argument would be that the doctors have learned to “work” the system over the years. That is also possible but it is my believe the program just delayed the inevitable with poor results. What ever the reason, the experiment has been an utter failure for the patients of Britain and we should learn from it.
To put this in perspective a MPH usually does not practice dentistry and is more of a bureaucrat. I prefer to listen to those in the trenches than those in ivory towers. So I will tackle his myths one at a time.
Myth Number 1—Third Molars Have a High Incidence of Pathology
When using a term like “High Incidence of pathology” it’s important to understand what one is comparing it to. Comparing pathology of teeth makes sense to compare it to other teeth; hence at 12%, third molars have a high incidence. Especially since when they develop pathology they require extraction, whereas other teeth can be successfully treated with root canals. To compare it to invasive surgeries as they mention is ridiculous. To answer the question of, “Why then prophylactic third-molar extractions?” Because they are easily accessible and can be accomplished without any form of sedation.
Myth Number 2—Early Removal of Third Molars Is Less Traumatic.
Um, as someone that has done both many times I will attest to the fact that, that is entirely accurate. Comparing it to not having anything done is ridiculous unless you compare it to all the work that maintaining these teeth throughout a lifetime will require (fillings, crowns, 12% previously mentioned extractions). Wisdom teeth are the most difficult for patients to clean properly because of their position and get plenty of dental issues even when in good position.
Myth Number 3—Pressure of Erupting Third Molars Causes Crowding of Anterior Teeth
Research is inconclusive on this.
Myth Number 4—The Risk of Pathology in Impacted Third Molars Increases With Age
This is just a statement of fact. If 2% of people have x medical problem by age 20 and 2.1% have it by age 60; that is an increase with age. This point is valid though; which is why you never hear of oral surgeons or dentists recommending extraction of asymptomatic wisdom teeth after the age of about 20, unless there is some sort of issue. If we don’t get to them in the age window we like then you are better off rolling the dice.
Myth Number 5—There is Little Risk of Harm in the Removal of Third Molars
Again to compare it to doing nothing negates all the things I mention in myth number 2. Also with the CBCT quickly becoming the standard of care, fewer nerve complications should be seen.
Risks of wisdom teeth extraction
Alveolar osteitis (dry socket)
There is a 6% overall risk for dry socket when extracting a tooth. This is certainty higher for wisdom teeth, up to 30% for impacted lower molars. Risk also increases with following Congiusta EBD 2013.
- Previous surgical site infection (odds ratio [OR], 3.3; 95% CI, 1.4 to 7.7)
- Traumatic extraction (OR, 13.1; 95% CI, 5.4 to 31.7)
- Smoking of tobacco after extraction (OR, 3.5; 95% CI, 1.3 to 9.0)
The risk of dry socket will be lower if patient uses CHX. Canullo JOMI 2020
Partial or complete paresthesia.
Wisdom teeth that are at higher risk for causing can have the following characteristics on 2D imaging. Matzen DMFR 2015 When the roots overproject the mandibular canal in the PAN image and if one or more of the following are present, take a CBCT.
- Interruption of the radiopaque borders of the canal
- Diversion of the canal
- Darkening or shadowing of the tooth root
Wisdom teeth extraction incision line
This is a nice video on instagram showing the incision plan and extraction method.
Wisdom tooth extraction tips
The example below shows a case that you can section at the red angle and rotate out.
Horizontal wisdom tooth extraction
Great video showing the steps.
Wisdom teeth extraction RESEARCH
IANB given to young children may stop the development of immature third molars on that side. Swee JADA 2013 found a strong relationship between history of IANB and lack of wisdom teeth.