I grew up in a time when everyone got their tonsils out – well, almost everybody because I never did. I remember feeling that in keeping my tonsils, I had actually missed something – especially all of the ice cream, ginger ale, and attention. When my own children were growing up we practically had to threaten our physician to have our son’s tonsils removed – it was like he was going to have to pay for it if we went to the ENT and they actually did the surgery. Maybe he did have to – I never read much of the fine print in our medical insurance plans.
What I learned was that it was not right to always remove them, and it was not right to never remove them. I’m really not certain where the pendulum is now about tonsils as there are only one set left in my family and I’m hangin’ on to ‘em. I’m a little closer to the question about WISDOM TEETH.
In Pemberville, I scheduled one Friday per month for third molar surgery and it was one of my favorite days. A cocktail of Demerol, Seconal, and Promethazine and those happy patients would let me do anything I wanted. That feeling was rekindled recently (except for the doing anything I wanted part) when I had a request from a colleague to perform third molar removal surgery for a friend. I borrowed appropriate equipment from one of the Faculty Club members, Doug Benting (thanks, Doug!), and removed four teeth on each of two patients. Once the word was out that I had an elevator, a pair of forceps, some 3-0 suture and the willingness to use them, they practically lined up at the door! I really enjoyed the procedure and both patients are doing very well.
This experience brought me back to thinking about thirds and wondering what the current pendulum position is – SO I’M ASKING ALL OF YOU:
Do you routinely recommend removal of third molars?
Why or Why not?
I already put some time in on PubMed to investigate the current thoughts but I really believe the best source will be all of you. I can’t wait to hear what you think.
Yes..I generally recommend that my patients have their third molars removed – but- this recommend is based on questions of future predictions:
1 Do I believe that they can keep them clean?
2 Will they interfere latteral or protrusive function?
3 If lower thirds are impacted,will they ditch into the distal roots of lower seconds and cause problems?
4 Is there a cyst present.
If I believe that anyone of these factors will occur,I will recommend removal.
according to me any tooth which is not creating any problem and not involved with any lesion shoud be saved removing 3rd molar without a reason is not always a wise decision post surgery complications can be problematic for patients but considering a matter of fact that chances of complaints related to 3 rd molar are comparatively more… because
of it position — impaction , difficulty in maintaining good hygiene ,
many cyst and lesions related to it..
So WISDOM TOOTH should be kept IN if its not encountered by any of these factors
thank you.
I routinely leave them in if they are not causing a problem. That’s assuming that none of the major issues listed by Chris Wilson are present.
However, I do tell the patient that wisdom teeth are more likely to have problems. If they show a desire to have them removed, I’m happy to oblige their concern.
I like them out. I have many of the same indicators as mentioned above…position, cleansability, function. I have developed this philosophy after having purchased a dental practice 2 1/2 years ago where my average patient age is 72 y/o. I have a great mix of ages and even “generations of dental philosophy” that I get to see every day. And honestly, I see very little positive from a retained 3rd molar and conversely, am faced with many of the negatives every single day.
I see uncleansable and decayed 2nds created by poorly positioned 3rds, occlusal interferences that result in gross bite changes, etc. Yet the next patient can be a 55 year old with 20+ year extracted 3rds, similarly poor hygiene and parafunctional habits and he avoids a lot of the issues that many times my elderly patients are facing from retained wisdom teeth. These observations have helped shape my philosophy that wizzies need to come out. Of course there is the <5% exception where positioning is perfect, etc. But in my office if you've got 'em you probably won't for long.
High percentage of teenage patient I do refer to oral surgeon for extraction of wisdom teeth age 15 and older. To my knowledge is least traumatic to have them removed early and higher chance of bone fill around the distal root of second molars. Of course if teeth are deeply impacted and covered with solid bone I usually leave them. As Nikki mentioned I do have elderly patients developing abscesses and having surgery done when overall health is compromised.
Hello Everyone,
I am a take em’ out most of the time guy.
My rule of thumb is that if you are below 25 and they don’t have room to erupt fully we take them out.
If you are over 25 and they are all the way in and cleansable we leave them.
If you are over 25 and the are completely under the gingiva then we leave them.
If you are over 25 and they are partially erupted we take them out.
Thanks,
Steven
Only about 5% of the population has adequate jaw space for properly positioned third molars. The rest would probably benefit from removal. I like the recent trend of taking the lowers out before the roots form. That is a much easier and less risky procedure for both the doctor and the patient. I like Steven Kendrick’s guidelines posted above. I also think that many children would benefit from tonsil removal. As in most things, there is a balance.
As a board certified oral and maxillofacial surgeon the above comments and guidelines are excellent.
Ideally, impacted wisdom teeth are treatment planned for removal when the root is 1/2 to 2/3 complete. In patients of this age treatment proceeds smoothly and predictably with few complications and rapid healing. As patients and their teeth mature and complete root development removal requires more surgery with resultant increasing complication rate (nerve and sinus) combined with slower healing and longer recovery.
In our practice, after age 40, We carefully weigh the risk/benefit ratio for removal vs. retention and radiographic monitoring for asymptomatic impacted wisdom teeth. The presence of pain or pathology changes that, with removal typically recommended. In these situations, the pathologic tooth/teeth are removed and many times the asymptomatic tooth/teeth monitored with radiographs. The ultimate decision to extract vs. retain asymptomatic wisdom teeth in the adult is the patient’s following a complete informed consent discussion. Some patients prefer to take care of the treatment at one visit, not having to worry about it again. Other patients prefer to retain the teeth that are “not hurting”, understanding that they may require extraction in the future should they become pathologic or symptomatic.
Cone beam imaging has greatly assisted in accurately assessing the proximity of wisdom tooth roots to the maxillary sinus floor and inferior alveolar canal. These visual images make it easy for patients to understand the risks of treatment.
It is very important that the patient understands that the TREATMENT for the retained impacted teeth IS RADIOGRAPHIC MONITORING. We communicate this to the referring dentist as well.
Finally, should there ever be a question about the timing or need for wisdom tooth removal, I am confident your oral surgeon colleague would be happy to see your patient for consultation and assist with the treatment decision.
Hope this is helpful to the discussion.
I recommend almost all of my young patients to have their 3rds removed. Ideally it would be as root formation starts (14-17 years old). In 27 years of practice I have very rarely seen erupted 3rds that weren’t a challenge to clean or that didn’t interfere excursively. To allow them to erupt to see if they would someday be in the extremely small minority of no caries, no perio, no occlusal disease involving 3rds is not in my patient’s best interest.