Your family dentist has recommended you take your teenaged son to an oral and maxillofacial surgeon (OMS) for removal of his third molars, or wisdom teeth. Your son is not experiencing any problems with his teeth right now; what should you do?
The results of an ongoing study sponsored by the American Association of Oral and Maxillofacial Surgeons (AAOMS) and the Oral and Maxillofacial Surgery Foundation (OMSF) and published in the November 2002 Journal of Oral and Maxillofacial Surgery (JOMS) strongly suggest you heed your doctor's advice and have an oral and maxillofacial surgeon remove those teeth no later than the patient's early 20s to prevent future disease problems in the second and third molar regions of the mouth.
Investigators led by Raymond P. White, Jr, DDS, PhD, Dalton L. McMichael Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, University of North Carolina, and Richard H. Haug, DDS, professor and chair, Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Kentucky, conducted the 30-month institutional review board-approved longitudinal clinical trial. They examined the health of the tissues supporting teeth throughout the mouth, including the third molars of more than 300 healthy patients between the ages of 14 and 45, who had four, symptom-free third molars with adjacent second molars. They used standard methods of evaluating the tissues that surround and support the teeth, including probing depth analysis, calculation of a gingival index and x-ray examination.
They also took dental plaque samples and determined the presence and levels of bacteria in these samples. If the probing depth analysis measured a depth of 5 mm or greater, which is an accepted determining sign of disease (periodontitis), they observed that:
* 25% of all study-enrolled patients, and 34% of African American patients, had at least one probing depth equal to or greater than 5 mm behind a second molar and around a third molar.
* A higher proportion of patients 25 years old or older (33%) had a probing depth equal to or greater than 5 mm behind a second molar and around a third molar compared with patients younger then 25 (17%).
* Complexes of bacteria previously shown in scientifically-designed clinical studies to be associated with periodontitis, were detected at higher levels in plaque samples of patients who had at least one probing depth equal to or greater than 5 mm behind a second molar and around a third molar.
The results of these investigations further indicate that patients who do not have their third molars removed prior to age 25 may be at greater risk for the development of disease affecting the tissues surrounding the second and third molars, and that early stages of such incipient disease (periodontitis) may present first in the third molar regions in young adults.
The investigators note that disease behind second molars or around third molars may be attributable in part to the patient's inability to keep the area clean. This would, in turn, allow infectious bacteria to grow and begin the disease process, which could worsen over time. Additionally, third molars that have broken through the tissue and erupted into the mouth in a normal, upright position are as likely to exhibit disease as those third molars that remain impacted or buried.
This research challenges two long-held beliefs; that third molars which have broken through the tissue and erupted into the mouth in a normal, upright position have minimal problems, and that the absence of symptoms from retained third molars indicates that the teeth are free from problems.
It was further noted by the investigators that recent studies have suggested that periodontal infections such as those observed in this study have a negative impact on general health, affecting the progression of cardiovascular disease, diabetes mellitus and pregnancy outcomes.
Patients with questions concerning wisdom teeth, even those without problems, are encouraged to:
* Talk to an oral and maxillofacial surgeon or their family dentist to determine whether it is advisable to remove the wisdom teeth before age 25.
* If it is decided to retain the wisdom teeth, consult with an oral and maxillofacial surgeon or your family dentist about special efforts that may be needed to prevent the development and progression of disease.
