Probably the most frequent question I get on WeChat is:
"Do I need to remove my wisdom teeth?"
This is usually coupled with the patient sending over a panoramic radiograph (otherwise known as an OPG or DPT). But is this enough to make a decision? Or do I need more information?...
Judging by how I just ended the sentence and the face I'm writing an article about it would lead you to suggest that the answer is no. So let's talk more about several factors we need to consider:
How does it look in the mouth?
So I know this may sound like a copout, But the dentist really needs to look in the mouth and assess a few things:
The position of the tooth
Is there a "pocket" between the wisdom tooth and the adjacent tooth
Is it trapping plaque?
How much of the tooth is showing? is it fully erupted or only a portion of the tooth is showing?
Are they impacted?
Related to the above, if they are impacted, are they actively causing an issue? if they are submerged in the bone then they are unlikely to be trapping any bacteria or plaque.
Are you getting orthodontic treatment where your teeth need to be distalised?
Not all kinds of orthodontic treatment require extraction of wisdom teeth, but it is however recommended as wisdom teeth can be troublesome and in the way when moving teeth. In short it does make orthodontic treatment significantly easier but it is not always considered a must depending on the orthodontic treatment plan.
Are you getting repeated infections?
If you follow the UK NICE guidelines, it is often quoted that you need 2 infections in a year before consideration of removal. I however think that 2 infections is rather frequent and would suggest that even 1 infection should warrant a check-up and discussion on removal.
Is there already active disease like decay or gum disease around the area?
If there is already decay in the wisdom tooth, then you should weigh up is it really worth doing a filling on the tooth? bearing in mind how difficult it is to keep clean. Sometimes it's quicker and easier to remove the tooth and you can keep the peace of mind the it won't cause issues later. If there is gum disease, I would highly recommend that the tooth is extracted as this will only worsen the gum disease.
Is it going to be a risky procedure? i.e. is it close to the nerve
The OPG X-Ray needs to be assessed for the proximity of the nerve from the roots of the wisdom teeth. If the teeth are close, another procedure called a Coronectomy may be indicated (Will discuss in a later article).
Contrary to belief, removing wisdom teeth does not alter the rate of movement of the other teeth. Previously there were misconceptions that wisdom teeth "push" your teeth forward, but it has been frequently found in studies that prior removal of wisdom teeth will not prevent movement or relapse of orthodontics.
So there you are, I hope this answers your questions, if you have more questions, I will answer them in the conversation we are already having, and anything unanswered I will edit and add to this article!
Dr. Oscar Sum is a dentist in Shanghai practicing in central Shanghai who performs Implant surgery, Orthodontics, and other advanced dental procedures. Please call scan the QR code to enquire about an appointment with Dr. Sum
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