Our Philosophy Regarding Wisdom Teeth

We have over 30 years of experience in caring for patients of all ages and you know we have always placed excellence in care and excellence in delivery of our services first.

  • Like orthodontic care, we can remove wisdom teeth at any age – it is however, like orthodontic care, much easier, better for the patient, and less risky to perform the care on a younger patient.
  • Early evaluation and removal is best. Age 15 is a great time for evaluation and often is a very nice time for treatment.
  • Delaying treatment often leads to increased risks and dental problems.
  • Tooth/root formation; risks to the nerves, sinuses, and adjacent teeth; difficulty with surgery; social difficulty (lost time from school/work, etc.). All of these risks increase with age.
  • Life is less complicated on the younger patient. They are often under the care and provision of their parents.
  • We are careful and gentle. At any age, I feel it is proper preventive practice to remove third molars that have a likelihood of becoming a problem.

The American Association of Oral and Maxillofacial Surgeons (AAOMS) has published a white paper on third molar extractions. This is a scientific fact sheet that backs up the information presented here.

WISDOM TOOTH CARE PHILOSOPHY

  • If there is adequate arch length (room) and position of the third molars is favorable (basically vertical in position) it is reasonable to watch them and guide them toward eruption.
  • For patients with inadequate arch length or abnormal angulation the mid-teen years are ideal for removal of wisdom teeth. Waiting and watching is generally not a good plan. I support this philosophy below.

BENEFITS OF MID – TEEN WISDOM TOOTH REMOVAL

    • * We can easily screen for arch space and angulation with a panoramic scan.
    • * There is minimal root development. (less discomfort, low risks)
    • * Periodontal problems are minimal.
    • * Risks are minimal.
    • * Surgery is uncomplicated.
    • * Patients are healthy.
    • * Lives are less complicated.
    • * Patients are often under their parents’ care and provision.
  • At any given age, the risks are lower when you are younger.
    • * Teens – as above, much less complication, discomfort, and risk.
    • * Twenties:
    • * Teeth are developed, but still more flexible in the bone.
    • * Periodontium and bone (support structures) are more elastic than older patients.
    • * As the decades advance:
    • * Teeth become more anchored in the bone.
    • * Bone and teeth are less elastic.
    • * Risks to the adjacent vital structures are greater.
    • * Overall health diminishes with age.
    • * Risk of developing cysts, growths, and tumors from the tooth follicles.
  • Finances are always a variable. If removal is elective, it is certainly reasonable to stage treatment over a period of time as part of a comprehensive care plan. Keep in mind the increased risks with development and age.
  • In my hands, I have had few complications with removal of third molars, even in advanced, difficult cases. Gentle, careful technique goes a long way for improved safety and outcome.
  • At any age, I feel it is proper practice to remove third molars that have a likelihood of becoming a problem (preventive care). Waiting and watching are not a good plan.

SIGNS TO WATCH FOR IN THE OLDER PATIENT

  • Teeth with a continuity defect – any discontinuity in the follicle with possible communication to the overlying bone or the adjacent tooth are more likely to become a problem.
  • Teeth with an active or enlarged follicle – possibility of becoming cystic.
  • Teeth with abnormal positions and angles – which would make future removal more difficult with complicating factors such as ankylosis, cysts, nerve or adjacent tooth damage.

I disagree with the idea of “waiting and watching” third molars with any of theses concerns. Time is most often our enemy, increasing the risks and difficulties.

RISKS WITH KEEPING WISDOM TEETH

  • Periodontal problems, particularly on the adjacent second molar tooth.
  • Decay which may often affect the root structure of the adjacent second molar.
  • Crowding or abnormal angulation of the teeth.
  • Formation of odontogenic cysts or tumors which can be very destructive.
  • Pain, disability, time away from work.
  • Health risks as we treat older patients.
  • Increased risks with treatment as age increases.

The person removing third molars is the best person to evaluate the appropriateness of keeping them. The treating surgeon shares in the risks and concerns with the patient.

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