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Could Wisdom Teeth Become Things of the Past?

Monday, February 3, 2014 - 3:18pm

Child holding mouth open with one finger to reveal bloody space where tooth used to be.

 

Just before my daughter turned 5, she had dental work done with local anesthesia to fill troublesome cavities. The trauma from the experience alone was enough to make her dislike going to the dentist even for routine cleanings and checkups.

However, many years down the road, that experience might lend her an even greater benefit than we ever could have imagined.

Research has shown young children injected with shots of anesthetic for dental work sometimes never grew lower wisdom teeth later, suggesting these shots might make it possible to deliberately stop wisdom teeth from growing.

This initial study published in the April 2013 issue of The Journal of the American Dental Association looked at dental records from 220 children treated between ages 2 and 6. The researchers acknowledge more work is needed on a larger study group of children to confirm their findings.

However, the study raises an interesting question: Could a “vaccine” or a medical procedure to prevent wisdom teeth from growing become a routine practice one day, essentially dissolving the troublesome teeth for good?

Wisdom teeth 101
Wisdom teeth are permanent teeth that form at the back of the mouth and typically break through the gum at about age 18. They are the third set of molar teeth to erupt, says Kamal Busaidy, BDS, FDSRCS, an associate professor in the Department of Oral and Maxillofacial Surgery at The University of Texas Health Science Center at Houston (UTHealth) School of Dentistry.

We typically have four wisdom teeth — two on the top and two on the bottom. While our other permanent teeth begin to form shortly before or at birth, wisdom teeth are a little different.

“While the cells that are necessary to form wisdom teeth are all present in the jaws at birth, they do not start the process of forming the wisdom teeth until about the age of 7,” Busaidy says. “They usually can be seen on X-ray by the age of 12, but they are not fully formed until about age 18.”

Wisdom teeth serve a purpose for biting and chewing, just like permanent teeth. However, since the majority of wisdom teeth do not erupt properly into the mouth, they usually do not serve this function efficiently, Busaidy says.

Wisdom teeth may have evolved in our ancestors to replace teeth that would become worn out with chewing an abrasive diet, Busaidy says. “Modern diets are not as abrasive and the jaws of modern man are smaller than our ancestors, leaving less space for wisdom teeth,” he adds.

Crowded mouth
“Two's company, but three's a crowd” could sum up the problem with third molars. When it comes time for wisdom teeth to break through the gums, there often isn't enough room for them to fit properly or even comfortably in the back of the mouth.

“In addition, they commonly erupt either into the tooth in front or backward toward the back of the jaw,” Busaidy says, adding this is known as impaction.

Impacted wisdom teeth can lead to other problems, including pain and discomfort, gum disease, tooth decay and even infection, all of which would necessitate their removal, he says.

“On rare occasions, if a wisdom tooth becomes impacted or stuck in the jaw bone, it can cause the development of a cyst or other troublesome condition that may threaten the integrity of the jaw itself,” he notes.

The prevailing opinion of oral health experts, Busaidy says, is that wisdom teeth should be removed if they are actively causing pain, inflammation or infection.

“In addition, when wisdom teeth are impacted, they are usually removed to prevent gum or periodontal disease developing in the adjacent teeth,” he says. “It’s possible for wisdom teeth to alter the alignment of teeth straightened by orthodontics, so orthodontists commonly request teenagers to have their wisdom teeth removed at the conclusion of orthodontic therapy.”

It's likely that many of us had our wisdom teeth removed as teenagers or young adults in our 20s, before symptoms flared up. That's because many dentists see that as the optimal time to have the surgery rather than waiting until you're older.

“When the roots of a wisdom tooth are fully developed, it can make removal of the tooth more difficult than would be the case when the roots are only partially formed,” Busaidy says. “In addition, when the roots are fully formed, they are closer to the inferior alveolar nerve. This nerve in the jaw bone is responsible for sensation in the lip, chin and lower teeth. While the overall incidence of damage to this nerve from wisdom tooth surgery is typically less than 1 percent, it is lower in younger adults undergoing the procedure compared to older adults.”

A dental debate

For years, wisdom teeth removal has been a fairly common practice as many dental experts advise taking them out before they cause problems. But now some dentists don’t recommend it because of the risks involved with anesthesia and surgery and the cost of the procedure.

Oral health experts and surgeons are divided on whether it’s OK to keep wisdom teeth that aren't causing problems as long as they are closely monitored by the patient and dentist.

“Some in the dental community believe wisdom teeth should be left in place,” Busaidy says. “They argue that the risks posed by wisdom teeth do not warrant their removal and that the health care costs associated with the surgery do not benefit the patient or community.

“Those who advocate removal of wisdom teeth argue that the risks are minimal when the surgery is performed by a board-certified oral and maxillofacial surgeon,” he adds. “They believe that the cost of infection, gum disease and decay from retaining wisdom teeth far outweigh the financial costs to the patient or community.”

In some cases, wisdom teeth can be left in place with minimal long-term risk to the patient, he notes, while others should be removed to prevent or eliminate disease. The only way to know for sure is to evaluate each case individually.

“A board-certified oral and maxillofacial surgeon is best placed to provide an opinion on any individual case and can perform the surgery with minimal risk to the patient,” he adds.

Nevertheless, Busaidy believes wisdom teeth should be done away with.

“Personally, I do not minimize the risks posed by retaining wisdom teeth,” he explains. “I have treated too many patients with severe neck infections related to decayed or impacted wisdom teeth necessitating emergency surgery in the hospital. Since pain is not always an early sign, many of these patients do not realize how bad things are until their disease has progressed to a late stage.”

More studies needed
If researchers do find a way to keep wisdom teeth from growing, it might end the debate about keeping or extracting them.

The researchers think two things may account for the missing lower wisdom teeth in the children studied: the anesthetic solution or trauma from the needle hitting the wisdom tooth bud.

Nonetheless, more studies are needed to confirm the researchers' theories and figure out the benefits of preserving wisdom teeth, Busaidy says.

Busaidy cites one possible such benefit to retaining our wisdom teeth.

“If it is necessary to remove a molar tooth due to decay in adolescent years, we can sometimes use the wisdom tooth to replace it by encouraging it to drift forward into the space created by the loss of the molar tooth further forward,” he says.

As for whether or not my daughter, now 7, will have wisdom teeth, only time will tell.

HealthLEADER is an online wellness magazine produced by The University of Texas Health Science Center at Houston (UTHealth).