Generally a tooth is extracted when it is too badly damaged to be repaired. This can be the result of an accident, abuse or neglect. Teeth should not be used to open bottles, tear open packages or crack nuts. This type of abuse will eventually crack the teeth. Poor dental hygiene will result in periodontal disease, which can cause enough bone loss that teeth need to be extracted.
The exception is wisdom teeth. Your wisdom teeth, or third molars, are the last teeth to emerge from your gums during your late teens, or “age of wisdom”, which gives them their name. But wisdom teeth are not really so wise. They often become impacted or trapped in the jaw bone and gums and fail to erupt as straight and fully functioning teeth. Impacted wisdom teeth nearly always have to be removed. Example of impacted wisdom teeth can be seen in the following graphics.
Why do we have wisdom teeth at all if they have to be removed so often? Human beings once had tougher diets. As our diets became softer and more refined, we no longer needed jaws for strenuous chewing. The jaws failed to develop, leaving little room for third molars. In addition, due to mixing of gene pools, some adults never develop wisdom teeth at all and some end up with more teeth than jaw. Perhaps in the distant future, we won’t have to worry about them at all. Today, most people experience at least one impacted wisdom tooth.
Why remove wisdom teeth? Wisdom teeth that are not painful seem harmless enough. But if they are not removed early, they often cause problems such as:
- INFECTION (PERICORONITIS): The mouth is full of bacteria that normally do not get past the protective layer of gums. But when an impacted tooth breaks through the gum surface, bacteria can get in causing an infection in the gums around the crown of the tooth. This infection can cause severe pain, swelling, jaw stiffness, and even general illness.
- DESTRUCTION OF THE NEXT TOOTH: An impacted tooth may still try to grow where it has no room, eroding the tooth next to it. This is called resorption. Eventually, this could lead to the loss of both teeth.
- PAIN: Infection in a decayed wisdom tooth or in the gum around an impacted tooth can cause pain. If a decayed wisdom tooth is not situated in a healthy position, or if it is not restorable, we may recommend its removal. An impacted tooth can also cause pain if it presses against a nerve or the next tooth.
- CROWDING: An impacted tooth can crowd nearby molars out of alignment. If you are undergoing orthodontic care, we may recommend that your impacted wisdom teeth be removed.
- CYSTS: When a tooth is impacted, the sac of tissue around the crown remains in the bone. Occasionally, the sac fills with fluid forming a cyst that can readily destroy or enlarge the bone and endanger surrounding structures.
Why early removal? Before you reach adulthood, the roots of your teeth are not totally formed and the surrounding bone is softer. Therefore, there is less chance of damaging nerves and other nearby structures during surgery. The operation itself may be more difficult as you get older. The risks are greater and the healing is slower. If you wait until your wisdom teeth cause you trouble, you may have to be treated for complications such as infection, before they can be removed. In short, early removal of your wisdom teeth is likely to prevent problems later on. In addition, we may recommend that opposing healthy wisdom teeth be removed at the same time if they are impending on the opposing jaw. A recently completed clinical study of more than 9,500 patients reveals that the optimal time for extraction is between the ages of 12 and 24 years. In general, difficulties increase with age.