According to the American Association of Oral and Maxillofacial Surgeons, approximately 50 million Americans will need to have their wisdom teeth removed before age 25. Often time patients are not even aware of the troubled nature of their wisdom teeth. Virginia Denicola, 57, of Philadelphia almost lost her life from complications of a wisdom tooth. Although she had regular checks up with her general dentist, a very large cyst was forming around her impacted tooth (hidden tooth inside the jaw) without her noticing anything.
One day her face started to swell up and in a matter of a few days, the swelling was so extensive that she could hardly breathe. She was rushed to a local Philadelphia hospital and immediately admitted to the intensive care unit. After thorough studies, CT scans and x-rays of her face surgeons found a wisdom tooth pushed all the way back in her jaw, almost near her ears. A very large cyst had formed around the impacted tooth that gradually grew to destroy more than half of her jaw.
In a 20-year study out of 856 patients with broken jaws, 65% fractured their lower jaw in the area of their un-erupted wisdom teeth. Over 40% of adult patients that never had their wisdom teeth removed as a teen developed infection, decay, or gum disease by age 45 and had to get rid of their wisdom teeth. They were also more prone to bite their cheeks more often than individual who had their wisdom teeth taken out. It is estimated that about 25% of adults over age 40 will develop problems with impacted wisdom teeth requiring extraction and that the risk of surgical complications in these patients increases by about 30 percent from what it is in adolescents.
"That doesn't mean we have to pull everyone's wisdom teeth," according to Dr. Mansoor Madani, director of Pennsylvania Institute of Oral Surgery in Bala Cynwyd, PA. In fact, oral and maxillofacial surgeons are now being taught to avoid removing functioning and erupting wisdom teeth that are not causing any problems. "People should be aware that your wisdom teeth don't necessarily have to bother you before you consider having them removed; they could be quietly eating up your jaw bone or shifting your other teeth," adds Dr. Madani, who is also Associate Professor of Oral and Maxillofacial Surgery at Temple University in Philadelphia and operated on Virginia.
Virginia underwent a major reconstructive procedure. More than half of her jaw was removed and a titanium jaw was made for her to replace the missing jaw. Bone was also grafted from her hipbone and grafted to the site. Later on, the prosthetic jaw was removed and part of her jaw grew back. "I am thankful for being alive now, this would not have happened if I had my wisdom teeth checked and removed when I was a teenager," says Virginia.
American Association of Oral And Maxillofacial Surgeons recommends evaluation of wisdom teeth by age 25. "Our hope is to make people aware that wisdom teeth have the potential for causing trouble, however, not all need to be removed. The risks and benefits of removing teeth for each patient must be assessed carefully by your dentist," says Dr. Madani. For more information, visit www.paoralsurgery.com.
Controversies About Wisdom Teeth
Forty years ago, the controversy was whether or not to remove everyone's tonsils, now it is about wisdom teeth. More than 1 million wisdom teeth are extracted each year in the United States -- even if they don't cause any problems. Oral surgeons perform 90% of these procedures. Keeping one's wisdom teeth has risks, including cyst formation (a sac filled with infected fluid around the crown of the tooth like a water balloon), gum irritation and infection in most cases with pain and swelling. They can certainly damage the other teeth adjacent to them. On the other hand, taking out the wisdom teeth may also cause some unwanted side effects such as infection, bleeding and even in rare cases nerve damage. There are multi-center studies, sponsored by The American Association of Oral and Maxillofacial Surgeons, to come up with new strategies and recommendations as to who is the best candidate to have their wisdom teeth removed. What makes that such a hard case is that oral surgeons don't have predicting factors that let them know who's going to be at high risk of developing problems with wisdom teeth and who's not.
Third molar problems are probably an evolutionary leftover from prehistoric humans, who had larger jaws and didn't have to worry about impacted teeth. Today, many people's jaws are too small to comfortably accommodate a third set of molars. The result is that a developing wisdom tooth's path is often blocked by bone, gum or another tooth -- in which case the tooth is considered to be impacted. Some teeth are fully impacted, failing to break through the jawbone at all, while others are partially impacted, with part of the tooth poking out through the gums. Sometimes an impacted tooth lies in the jaw at an angle instead of sitting straight up. A wisdom tooth coming in at an angle can generate enough pressure to erode the bone that supports and protects the back of the adjacent second molar.
