Motivation: I dislike going to the dentist. I do not mind the whining drill, but after finishing poking through my teeth, every dentist tells me to take out all my wisdom teeth. And, I have resisted for more than a decade. In few other fields of medicine are prophylactic painful procedures so prevalent for a less than life-threatening outcome - a cavity in a wisdom tooth. To further solidify my argument for my next visit, I wondered about the data backing this recommendation.
As way of background on dentistry, current American guidelines recommend extracting wisdom teeth that fail to erupt completely ("impacted wisdom teeth" in dentistry parlance) preferably during adolescence. Since no randomized trials exist in adults, reviewed below is a paper which examines the strength of existing evidence.
Paper: Shallu, B. and Rajesh, S. "Is it Wisdom to Remove a Wisdom Tooth? - Extraction versus nonextraction Management of Impacted Tooth" Ind. J. of Den. Sci. (2010); 2: 4-6
Results:
Incidence of Pathology in Wisdom Teeth: When followed for four years, about 10% of non-erupted wisdom teeth result in adults develop surrounding gingival inflammation or pericoronitis. There is low incidence (less than 1%) of root resorption in surrounding molar teeth as a result of non-erupted wisdom teeth. Incidence of inflammation spreading from wisdom teeth to surrounding teeth (ie. causing dental caries) is estimated at 1 to 4.5%.
Early Removal of Wisdom Teeth vs. Later Removal: In post-intervention series, persons aged 35 to 83 years of age were less likely to experience dry socket, secondary infection, and parasthesias compared to those aged 12-24. The highest risk of complications occurred in people aged 25 to 34 years.
Erupting Wisdom Teeth Causing Crowding of Anterior Teeth: Primarily theoretical prediction without substantial longitudinal clinical data. (From a Cochrane review), a single trial comparing outcomes at 5 years did not find substantial differences between tooth extraction and observation.
Discussion: I think that I will take the one out of ten chance that keeping wisdom teeth may result in pathology in the next four years. There are no data to support benefits of early asymptomatic extraction. In fact, in England, the governmental health organization, NICE, recommended against prophylactic removal of asymptomatic wisdom teeth. A similar Cochrane review on this topic also found insufficient evidence. I was personally surprised at the lack of data given the estimated mutli-billion dollar industry among oral surgeons dedicated to wisdom tooth removal. I think that like other similar problems in medicine such as with gallstones, preventive intervention may not be justified on a population basis.
As way of background on dentistry, current American guidelines recommend extracting wisdom teeth that fail to erupt completely ("impacted wisdom teeth" in dentistry parlance) preferably during adolescence. Since no randomized trials exist in adults, reviewed below is a paper which examines the strength of existing evidence.
Paper: Shallu, B. and Rajesh, S. "Is it Wisdom to Remove a Wisdom Tooth? - Extraction versus nonextraction Management of Impacted Tooth" Ind. J. of Den. Sci. (2010); 2: 4-6
Results:
Incidence of Pathology in Wisdom Teeth: When followed for four years, about 10% of non-erupted wisdom teeth result in adults develop surrounding gingival inflammation or pericoronitis. There is low incidence (less than 1%) of root resorption in surrounding molar teeth as a result of non-erupted wisdom teeth. Incidence of inflammation spreading from wisdom teeth to surrounding teeth (ie. causing dental caries) is estimated at 1 to 4.5%.
Early Removal of Wisdom Teeth vs. Later Removal: In post-intervention series, persons aged 35 to 83 years of age were less likely to experience dry socket, secondary infection, and parasthesias compared to those aged 12-24. The highest risk of complications occurred in people aged 25 to 34 years.
Erupting Wisdom Teeth Causing Crowding of Anterior Teeth: Primarily theoretical prediction without substantial longitudinal clinical data. (From a Cochrane review), a single trial comparing outcomes at 5 years did not find substantial differences between tooth extraction and observation.
Discussion: I think that I will take the one out of ten chance that keeping wisdom teeth may result in pathology in the next four years. There are no data to support benefits of early asymptomatic extraction. In fact, in England, the governmental health organization, NICE, recommended against prophylactic removal of asymptomatic wisdom teeth. A similar Cochrane review on this topic also found insufficient evidence. I was personally surprised at the lack of data given the estimated mutli-billion dollar industry among oral surgeons dedicated to wisdom tooth removal. I think that like other similar problems in medicine such as with gallstones, preventive intervention may not be justified on a population basis.
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