Hi t4e,
You ask a common question but it requires a complex response.
You would think that if an unerupted wisdom tooth is not causing any problems then why subject a person to what seems to be needless surgery. Here's the answer and the reasoning behind the answer.
First, humans used to have 4th molars. Over time our jaws got smaller and not only did we no longer need these teeth, we also lost the room for them on the smaller remaining jaw. Well, most of us no longer get 4th molars. We still however, get 3rd molars... Wisdom Teeth. Our jaws are STILL getting smaller... especially people with a European lineage... so we simply no longer have the room for these teeth to make it all the way into the mouth. Additionally, wisdom teeth, are frequently malformed or out of position.
The net result is that IN PEOPLE WHO DON'T HAVE THE ROOM or PEOPLE WHO HAVE WISDOM TEETH OUT OF POSITION are at a high risk of serious problems associated with these teeth. These problems include serious infections and damage to the teeth that are already in the mouth when the wisdom teeth bump into their roots, gum problems and bite problems.
Wisdom teeth are most easily extracted when they are still forming. So, wisdom tooth extraction recommendations occur somewhere in the middle teenage years—when the roots are about 2/3's formed.
Extraction of wisdom teeth... especially lower wisdom teeth can be problematic. They frequently are forming near the main nerve that supplies the feeling to the lower teeth, LIP and CHIN. Trauma to this nerve can result in a condition called paresthesia... numbness, possibly permanent of the lip and chin. Before the root tips are completely formed, there is a soft "pad" of tissue at the root end of the tooth. This serves to cushion the forces applied to the tooth during extraction when the root is near the nerve. Upper wisdom teeth may be in or near the maxillary sinuses.
Partially formed wisdom teeth also are less likely to have hooked roots... the hooks haven't formed yet.
Waiting to see if an impacted (under skin and/or bone) wisdom tooth will cause future problems means that should an extraction finally be necessary as an adult, then we are more likely to have to deal with paresthesias or difficult teeth to extract. The bone in adults is harder than in younger people. This can make an already difficult extraction even harder. Adults are far more likely to experience loss of feeling following lower wisdom tooth extractions. In some cases, when wisdom teeth are already next to the nerve, the dentist may recommend NOT to extract UNLESS problems start to occur. Then conditions like repeated or serious infections take precedence over being cautious about paresthesia.
I don't know actual statistics but my experience is that at some point, most impacted or malpositioned wisdom teeth go on to need extraction anyway because of the problems they cause.
If you haven't experienced the pain associated with an infection around an impacted wisdom tooth, you cannot begin to understand how awful it is.
So rather than wait for these problems as an adult, dentists recommend extraction when it is obvious that the wisdom teeth will come completely into the mouth. This can be predicted with great certainty.
Finally, unerupted teeth, not just wisdom teeth have a chance for dentigerous cyst formation. While not common, when it occurs, it can destroy a lot of bone and the removal of the tooth and cyst is also more destructive. Unerupted wisdom teeth also are associated with a locally invasive tumor...ameloblastoma. If you think a cyst is destructive, you ain't seen nothin' yet!
Knowing what I know, it is my opinion that it is better to get the wisdom teeth out before they become a problem... even if it means surgery before problems have occurred. This is an opinion shared by most dentists.
PLEASE UNDERSTAND THAT WISDOM TOOTH EXTRACTION RECOMMENDATIONS ARE NOT FOR TEETH THAT HAVE ROOM OR ARE EXPECTED TO SUCCESSFULLY ERUPT INTO THE MOUTH.
Finally, the patient or the patient's parents have the final say before surgery. The dentist cannot make you undergo surgery but he can certainly recommend a course of treatment that is in the best health interests of the patient.
I hope this helps.
Regards,
Laurence Stein, DDS
