Do wisdom teeth really need to come out, or is my dentist trying to hustle me?

November 4, 2008 7:51 PM

Do wisdom teeth really need to come out, or is my dentist trying to hustle me? My question, dear MeFites, is... do you really need to have your wisdom teeth taken out if they're not causing you any pain?

My question, dear MeFites, is... do you really need to have your wisdom teeth taken out if they're not causing you any pain? I mean mankind has lived with these things in their head for thousands of years before modern dentistry and health funds made it "compulsory" to have them removed haven't we?

I have always had good strong straight teeth. The last time I saw a dentist was when I was 12 years old for a general checkup. I am now 30, I've never seen a dentist since as I've never had any trouble with my teeth, but I thought it was about time for a general checkup (I was not in any pain btw).

The dentist today took some xrays and did an examination and told me I need to have all 4 wisdom teeth out asap due to cavities and then probably a filling or root canal on one of my back molars. I won't bore you with the details but I really got the "used car salesman" vibe - scare tactics, time pressure tactics, etc.

Now my stance on wisdom teeth has always been that I wouldn't have them out - while the expense doesn't really bother me I'm not interested in the pain or the risk involved in being anesthetised.

My question then is - do my wisdom teeth really need to be removed if they're not causing me any pain, provided I learn to clean them better and just get the cavities filled??

Has anyone been in my situation and ignored the dentist with dire consequences??

I'd be very grateful for any advice you can give me and my "teef" :) Thank you :)!

posted by katala to health & fitness (52 comments total)

If you doubt the dentist's diagnosis, which seems to be that the wisdom teeth roots are rotting, then how about getting the xrays looked at by a second dentist?

Fwiw I had my wisdom teeth out because they were giving me problems. I was about 25 iirc, and the toothaches were getting progressively worse.

My wife ignored a dentist for some years and ended up having root canals worked on. Not fun.
posted by anadem at 7:59 PM on November 4, 2008

Well first of all, of course you should be a second and possible third opinion. Secondly, also anecdotally, I'm 25 and have regular dental check-ups and no one has ever said anything about me needing my wisdom teeth taken out. So that's one data point.
posted by puke & cry at 8:01 PM on November 4, 2008

I had mine taken out late for the same reason. Doc told me they were the reason I was getting so many cavities, because I couldn't get way back there to brush well enough. It was, though, right after I switched dentists. So maybe I just got the same pitch...
posted by pilibeen at 8:01 PM on November 4, 2008

My wisdom teeth grew in fine (asides from teething and nomming advil liquid gels when they started inching their way up through the gum). No extraction was required. I'm 22, slight crowding on the bottom.
posted by Phalene at 8:02 PM on November 4, 2008

Well one reason we've done so well with wisdom teeth throughout history is that absent modern dental care, by the time they normally come in, i.e. in one's teens or twenties, most people have lost a few teeth, leaving sufficient room for those to come on.

Wisdom teeth are actually a problem for a lot of people. Whether or not they're causing you pain right now doesn't actually tell you anything important, as cavities in those teeth can lead to serious infections. Once the cavities have worn through the enamel, the bacteria that normally live in your mouth can get into the insides of your teeth and cause serious problems. We're talking tissue death and major infections.

If you want a second opinion, by all means, get one. If you don't like the dentist you went to, by all means, go to another one. But do get this looked into, because the fact that your dentist may be trying to hustle you doesn't necessarily mean that he isn't right.
posted by valkyryn at 8:03 PM on November 4, 2008

The dentist today took some xrays and did an examination and told me I need to have all 4 wisdom teeth out asap due to cavities and then probably a filling or root canal on one of my back molars. I won't bore you with the details but I really got the "used car salesman" vibe - scare tactics, time pressure tactics, etc.

Whoa whoa--cavities are serious business and can lead to all sorts of problems, from bad breath to infections to blood clots. You've been seriously remiss in taking care of your teeth (the fact that you don't have pain doesn't mean that your oral health isn't otherwise bad--the needed root canal is an indication of this) and this can definitely impact your health generally. Sure, you can get a second opinion, but chances are you'll hear more of the same.

Now my stance on wisdom teeth has always been that I wouldn't have them out - while the expense doesn't really bother me I'm not interested in the pain or the risk involved in being anesthetised.

I think it's generally a bad idea to make medical decisions like this before you know an expert's opinion on whatever procedure your talking about, as it pertains to your medical history specifically. You may not need to be knocked out, especially if your teeth aren't impacted.
posted by PhoBWanKenobi at 8:19 PM on November 4, 2008 [2 favorites has favorites]

your

I meant you're. Duh. :)
posted by PhoBWanKenobi at 8:26 PM on November 4, 2008

I was told as a teenager that I would not need to have my wisdom teeth out, so when at 21 I was told I should get them out, I was skeptical. I got a second opinion that agreed, and still ignored it for two years, until I started getting infections in the gum around the wisdom teeth that lasted for days and hurt like a mofo. They're not impacted, but slight remnants of gum over the teeth make it impossible for me to clean them properly and lead to a buildup of bacteria that I can't prevent. I'm now getting mine out in December.

I mean mankind has lived with these things in their head for thousands of years before modern dentistry and health funds made it "compulsory" to have them removed possible to live longer than 30.
posted by jacalata at 8:35 PM on November 4, 2008 [3 favorites has favorites]

Get a second opinion.

One of my wisdom teeth erupted correctly, the other three are all at a right angle(ish). In two cases, the second molar was removed, so that the wisdom tooth could erupt in its place. This seems to have worked well. In the remaining case, it's somewhat dormant and the dentist is very much "wait and see."

When it comes to dentistry, there are nearly always other options. Unless there's infection, a good chance of infection, or structural damage being caused by poorly aligned wisdom teeth then, from what I've read over the years, there's no reason to just have them out without reason.
posted by wackybrit at 8:36 PM on November 4, 2008

Put aside your pride in your earlier decision, based only on a layman's guesses, and get a second, professional opinion.

You are risking your health.
posted by IAmBroom at 8:42 PM on November 4, 2008 [4 favorites has favorites]

Get a second opinion, but if both dentists agree that you have cavities and should have the teeth out, do it. Most people have a hard time getting to their back molars and/or wisdom teeth to brush and floss properly.

Also, the absence of pain is no indication that there's not a problem. My first root canal was due to a tooth that had actually cracked in half--but it didn't hurt at all. That crown still bothers me a lot, because there's almost nothing left of the original tooth. I wish I'd taken care of it earlier, but it didn't hurt so I thought it was no big deal.

I got all four wisdom teeth out in my early twenties because if they came in it would mess up all the work my three years of braces had provided. That was a good enough reason for me to take them out.

Gum and tooth problems are linked to heart disease. You should be visiting a dentist at least once a year for a cleaning and checkup for that reason alone.
posted by purplecurlygirl at 8:57 PM on November 4, 2008

"... the risk involved in being anesthetized."

I had mine out with only Novocaine (back in the dark ages that were the 70s). They don't necessarily put you under or even use nitrous oxide.
posted by Carbolic at 9:10 PM on November 4, 2008

A second opinion couldn't hurt, especially for anything that has the potential to be a massive fuckup/pain in the ass.

FTR, my wisdom teeth came in fine, all straight and normal. My jaws have been fucked ever since I was wee, but my dentist said that we should take them out *before* they start to cause problems. I wound up getting some sort of weird abcess thingy (I'm not sure if that's the correct term, but it was this weird pocket of doom on my gum right at the bottom left tooth) and got them all yanked at the same time since it was easier to do that than just treat the pocket problem (which would them come back later).
posted by sperose at 9:10 PM on November 4, 2008

I have all five of my wisdom teeth.

Every time I see a new dentist, they want to take the wisdom teeth out "at least that little fifth one over up there". I continue to say no. Why mess with a healthy tooth?

I'm mumble-mumble years old, have all my 33 teeth and I feel fine, thank you for asking.
posted by seawallrunner at 9:18 PM on November 4, 2008

I'll second the "get a second opinion" answers. I can't speak to your individual situation, but I'll tell you anecdotally that I'm 40 years old and I've never had a tooth extracted. I have a mouth overly full of crooked teeth, but I'm lucky in that I don't get cavities.
posted by amyms at 9:20 PM on November 4, 2008

The Wikipedia article on wisdom teeth cites two studies that showed there are no benefits to removing wisdom that aren't giving you problem.
posted by driveler at 9:26 PM on November 4, 2008

Get a second opinion - I've found dentist opinions will vary considerably.

That said - if there is some reason the wisdoms are harder to clean, you need to consider that some day you might end up in excruciating pain and not have a dentist handy. Wisdom tooth extraction is pretty straightforward and easy.

Get the nitrous if you can.
posted by TravellingDen at 9:27 PM on November 4, 2008

all 4 wisdom teeth out asap due to cavities

Cavities, as in "you have cavities right now, after not seeing a dentist for 18 years"? Yeah, that'll be some work.
I had to get a back molar (wisdom tooth? not sure) drilled out and root canal-ed ASAP because I hadn't been in for 2 or 3 years. The whole "time pressure tactics" thing may be rather suspect when dealing with used vehicles, but time is very much of the essence when dealing with your health, dental or otherwise.
posted by niles at 9:34 PM on November 4, 2008

If you got a weird vibe you should definitely ask another dentist.

I had one impacted wisdom tooth which had to come out. The dentist told me unequivocally that I should get them all out because they're hard to clean, etc etc. So I did, and never felt like it was used-car pitch or whatever.
posted by O9scar at 9:49 PM on November 4, 2008

As a kid, lots of cavities, no talk of braces or molars out. Then as a young adult, a new dentist said my molars would have to come out. When I asked if it was because of [uninformed guess as to what the reason might be that I've since forgotten], he said no, for another reason, but didn't tell me what the reason was. Since then (and it's been well over a decade) no dentist has ever brought them up again.

So it's possible you don't need them done, but if my story above ended in "and my next dentist mentioned it, too, and gave me the same reason" then I'd be pushing you to do it, so go get that second opinion.
posted by davejay at 9:58 PM on November 4, 2008

"mankind has lived with these things in their head for thousands of years before modern dentistry"

Yes, because the typical adult would have lost several teeth through adulthood, freeing up room in the jaw. Paradoxically, it is modern dentistry saving all your teeth that makes your wisdom teeth a problem.
posted by i_am_joe's_spleen at 10:27 PM on November 4, 2008

How were you referred to this dentist? This dentist could be a high pressure sales guy. Or he could be a good dentist who worried about the conditions in your mouth after 2 decades without dental care. Get a second opinion.

Now my stance on wisdom teeth has always been that I wouldn't have them out
If that's your stance, then it really doesn't matter if he's a competent dentist. A second opinion is a waste of time, if you've already decided.
posted by 26.2 at 10:46 PM on November 4, 2008

I'm with seawallrunner. I have five wisdom teeth and every dentist I've seen since I was a kid has told me that they had to come out. But they don't bother me, my bottom teeth are reasonably straight, and I hope that since I'm over 40 they have stopped growing and won't become a problem.
posted by bink at 10:52 PM on November 4, 2008

Every dentist I have ever seen has told me I need to get mine taken out, but they don't bother me so I never did. My teeth are a very tiny bit crowded, I guess, but they are straight.

When they were breaking through the gums that was annoying and hurt and I thought, "Well I guess it's time to go get them removed" but it went away before I could make an appointment with a dentist.

I have never had a single cavity or any other problem.
posted by bradbane at 11:53 PM on November 4, 2008

I had one wisdom tooth start to develop and was told I would have to have it out before I turned 25. Well, I am 33 and still waiting for it to appear. Other than that, I had no wisdom teeth at all. Suck on that, meatbags!

Anyway, wisdom teeth are pretty susceptible to decay. The enamel is often inferior compared to the other teeth. They are also more likely to develop roots that interfere with your sinuses. But, really, there is no reason to have them out if they aren't causing you problems. I think the question is, does he think they should come out because they are rotting apart or because they are wisdom teeth. I would see another dentist and specifically say you would like to treat them like any other tooth in your mouth.
posted by Foam Pants at 12:25 AM on November 5, 2008

Over lunch the other day with several friends (ages 30something to late 50s), we realized that everyone at the table had declined to have wisdom teeth removed. None regret the decision, though all had some degree of crowding in the front. The extent to which it was noticeable happened (coincidentally? I have no idea...) to correlate with age. The oldest has one tooth that literally got shoved in front of and above all the others. Snaggletoothed.

None of us have pain back there, but do have problems keeping those suckers clean. For my part, the jaw bones block the toothbrush from getting back in there far enough. Oh, and the gums were hurting constantly for at least a year or so while they were erupting. During the first 10 years or so, I also was bedeviled by those gum flaps slooooowly receding from the bottom two, because they trapped a lot of gunk underneath. Sometimes a drugstore dental pick was the only thing that could pull stuff out of there. Periodically it'd go beyond a hygiene issue; one popcorn kernel or shard of nut under there and owwwwwww. Shove some broken glass under your fingernails to approximate that delightful sensation.

For what it's worth, when mine first came in the regular dentist and Mister Second Opinion Dentist both insisted that all 4 had to come out immediately. I opted to wait. And wait some more. In the decades since, 3 other dentists have said (with bored voice), "Nah, they're fine. Someone told you these need to come out??" (eye roll).

Our conversation didn't turn to cavities, so can't help you there.

It's your body. If you're okay with risks that could range from temporary nuisance to possible heart damage, then ignore your dentist. Otherwise find someone you trust, explain your priorities, and ask for a rundown of options to address those concerns. Maybe they can offer a way to mitigate some of the more serious risks without resorting to the pain and anesthesia of extraction. *shrug*
posted by nakedcodemonkey at 1:27 AM on November 5, 2008

all 4 wisdom teeth out asap due to cavities

Because you currently have cavities or because you might get cavities?

If your wisdom teeth are healthy, don't get them removed. Your dentist is trying to get you to have unnecessary surgery because it financially benefits him.
posted by missmagenta at 2:02 AM on November 5, 2008

Had a wisdom tooth out this week in the chair, it took all of 15 minutes and very little pain. I've only got the top ones and while they hadn't been causing me problems, the fact that they were growing unopposed meant a raised last tooth that pushed all the crap into the gap between.

I think it's worth getting a second opinion. Perhaps top ones are very different to the lower ones, but I was shocked at how quick the procedure was. I'm in AU on bog standard private health insurance and it cost me $40 fwiw.
posted by Mil at 3:51 AM on November 5, 2008

Keep your teeth and up your hygiene game so you never falter in the face of quacks who want to cut you up for no good reason.
posted by ewkpates at 4:26 AM on November 5, 2008

Wisdom teeth out? Probably not (if they are healthy). Last winter a friend was having her daughter get her wisdom teeth removed...the dentist suggested it. At the same time, a friend who is an orthodontist was visiting, and said that if the teeth were healthy he would NOT have them out.

He went on to say that in dental school, it is the dental surgeons who teach the material on wisdom teeth (removal). He said that dental surgeons make lots of money on these unnecessary removals. Conflict of interest...

Flash back to the 1970's. I had a wisdom tooth (I still have all 4) that the dentist said needed to come out because it was biting the gum. The dentist pulled, and prodded and poked, but the tooth refused to budge.

He took an x-ray, and there was the beautiful tooth giving the dentist the finger ("you're not going to get me out"). The dentist gave up and just cut away some of the gum flap. (I had learned an even easier remedy years earlier...gargle with hydrogen peroxide to cut down the gum infection caused by the wisdom tooth bites. Being lazy doesn't pay.)

A few years ago our dentist said that our sons' wisdom teeth had to come out. We did not do it, and the boys are fine. I would have gotten second opinions from every dentist, perhaps even sending the boys' x-rays to our orthodontist friend.

In short, if the teeth are not causing problems (that good hygiene will cure), leave them in. (My belief is that tooth-pulling is such a violent act).
posted by mbarryf at 5:08 AM on November 5, 2008

If you do decide to get the teeth taken out, don't let a dentist do it. Go to an oral surgeon. That's what they do -- oral surgery. That's why they call them oral surgeons. See the logic there?

Wisdom teeth are not in the ideal location for removal by someone who doesn't know what they're doing and they often grow in at any or all different angles. I had a dentist hacking and sawing away at me -- literally for hours -- and he still didn't get the whole thing, there was a piece of the root left. Which I had to get removed by (drum roll) an oral surgeon. The whole thing was a nightmare.

No need to let some mope who you don't trust anyway into your mouth with knives and drills; go to someone who will knock your ass out and hack those beauties out of your head while you're out of it.
posted by dancestoblue at 5:37 AM on November 5, 2008 [1 favorite has favorites]

If they're in straight, and you are cleaning them effectively, they won't cause a problem - like my wisdom teeth (all 4 still present and healthy).

If they come in crooked, or unnecessarily crowd your mouth, they need to come out - like my wife's wisdom teeth.

If they're in straight but are rotting, pull the bastards. Odds are your dentist is opting for removal rather than drill and fill based on your previous history of wisdom tooth care. You have shown by the condition of your teeth that you are doing a poor job of keeping them clean. Filling won't fix your bad dental health habits.

It's easy to brush the ones in front. Wisdom teeth are more difficult. Some of us can get at them, some can't. You don't actually need them, but you do need to listen to medical professionals when you ask them for their opinions regarding your health. They are not salesmen. They have a legal obligation to protect your health, and not surprisingly they know more about this than you do - because that's what they spent years and years and years studying. Sure, get a second opinion if you wish, but don't ask them what they think and then refuse to listen to them when they give you an answer you don't like.
posted by caution live frogs at 6:10 AM on November 5, 2008

If you got a skeevy vibe, then by all means try another dentist. But I'd urge to find someone you are comfortable with and make them your regular dentist for periodic cleanings and checkups.

Part of the problem of not having a regular dentist is this scenario. You've got no long-term history or professional relationship with this guy (or anyone), so he's taking the most alarmist approach. Someone who had known all along that your wisdom teeth weren't bothering you would possibly be more inclined to a wait-and-see approach.
posted by desuetude at 6:14 AM on November 5, 2008

My dentist told me the story of an 90-or-so year old patient of his, who got infected lower wisdom teeth in her 90s and suffered excruciating pain. Problem: because her bones in general were so brittle, oral surgeons she was referred to wouldn't pull them, because they said they'd end up shattering her jaw in the attempt. Result: living out her final years with a constant, horrible toothache.

That's only one anecdote, although it is apparently first-person from a professional, who doesn't pull teeth himself (so probably doesn't have a direct financial interest in the procedure).
posted by gimonca at 6:33 AM on November 5, 2008

I think the answer to "do wisdom teeth really need to come out" is "sometimes yes, sometimes no." But I don't think you can become one of the people who get to keep theirs out of sheer will.

Basically, if your dentist is a creep, get a new dentist regardless. Try not to judge the new guy based only on whether he thinks they should come out.

I still haven't decided on mine, mainly because my dentist wavers between a non-urgent "I don't like the look of those, here's a card for an oral surgeon" and "those look like they're coming in OK, don't worry about it." If I'm honest with myself, the reason I don't want mine out is that I had a gap as a kid and I don't want it to come back.
posted by lampoil at 7:02 AM on November 5, 2008

My dentist (who I've been seeing for about 15 years) started telling me early on that I should consider getting my wisdom teeth out. He's not an oral surgeon, so unless he's getting kickbacks, he has no financial incentive. I asked him if it was an urgent problem. He explained "no, but they look like they could become a problem at some point, and it's just a lot easier on you to pull them when you're younger." In short, he said it was my call, but he also made it sound like it would be a problem at some point.

I waited. About five years ago, one of them got infected. It was only slightly painful, and if I was really stubborn, I could have simply had that infection treated with antibiotics and deal with future infections the same way. I chose to get them pulled.

I got them pulled under a local anesthetic. It was, as promised, unpleasant and expensive but not painful per se. The process took about 10 minutes. I can imagine that if I had a problem with wisdom teeth at an old age, it would have been a much more unpleasant experience.
posted by adamrice at 7:03 AM on November 5, 2008

My lowers became impacted when I was about 18 and I had them out. That was a terrible experience, one I would not want to repeat even though I had had teeth out before. But there was no question that they had to come out.

The upper ones have never given me any trouble. I am now 58, and I have been told once or twice by dentists that I ought to have them out. But they don't bother me. Until or unless they do, they are staying right where they are and good luck to them. YMMV.
posted by Guy_Inamonkeysuit at 7:05 AM on November 5, 2008

I had plenty of room for all four of my wisdom teeth to come in, but my problem was I couldn't reach back there to properly care for them. I was getting cavity after cavity, even when using a fancy electric toothbrush and flossing (not only on the wisdom teeth, but on the molars next to them). So I had them yanked. No cavities ever since.
posted by FergieBelle at 7:10 AM on November 5, 2008

For what it's worth: Growing up my friend's Dad was a dentist. He claimed to put my friend through college on wisdom tooth extractions. His rationale was that while it was rarely ever REQUIRED, it was often a good idea nonetheless.

Me, I'm a scaredy cat and mine are coming in, so I'll hold off, thanks.
posted by GilloD at 7:24 AM on November 5, 2008

Get them out!
I actually wish my dentist had pushed me harder to get them out. My orthodontist, while checking out x-rays, mentioned that my wisdom teeth would probably have to come out. After the whole braces deal my dentist came to the same conclusion but I kept brushing them off.

Went to college and stopped seeing the dentist. During my second year I woke up in the middle of the night to one of the worst pains in my mouth ever. I downed pain killers and cried in pain, unable to sleep for 3 days and then the pain just disappeared.
It happened again 3 more times over the next 2 years and the pain lasted around 3-5 days but I never got it checked out.
One morning the pain came back, I suffered through it for 2 sleepless nights and on the 3rd night the lower right side of my face completely swelled up. I finally decided to get it checked.
It turned out to be a horrible infection. My wisdom teeth had all been on the move crushing my back molars in the process. I was immediately prescribed antibiotics to prevent the infection from spreading to my lungs (it had already moved down my throat and my neck had begun swelling).
Went for emergency surgery the next morning. All 4 wisdom teeth were removed as well as 2 molars that had been damaged beyond repair. The swelling was an abscess gone wild filled with puss that now had to be drained into my mouth for the next week through a tube inserted into my gums. Horrible. All of it. The pain, the infection, the healing process, all horrible.

Your experience might not be so bad... but, why risk it? Get them out.
posted by simplethings at 7:35 AM on November 5, 2008

When I was 18 my dentist recommended that I have mine removed because one was starting to poke through and my middle front teeth were starting to get pushed together. I hesitated for a year or two then had it (just one) removed in an emergency procedure when it got very painful and infected over a weekend.

What made it worse is that the roots weren't straight and pointed in opposite directions so it had to be broken and removed in pieces. While I awake - under just local anesthetic . It was incredibly painful and my entire face was bruised for weeks and twice I found small shards of broken tooth sticking out of my gums over a month afterwards that had been rejected by my body. Gross (but kind of cool).

On followup, dentist recommended have the remaining 3 removed to prevent the same thing from happening - and again, I hesitated.

Repeat same expensive emergency experience as before.

Again, on followup the dentist says to get the last ones removed and I agreed and everything went perfectly well and no pain after a day or two. I think the big difference is that with local anesthetic you fight and resist the pulling and cause more strain to your body.

Now with it all done (just wisdom removal no braces or sleep decices) my teeth have settled to where they should be and are all much more evenly spaced and straight. No pain from them being moved around and I'm happy to have them done - but honestly wish I'd just had them all out at once 10 years ago.
posted by jeffmik at 7:50 AM on November 5, 2008

I had a wisdom tooth out in hospital and as luck would have it the dentist had student with him. He said;

"Well, this one has a hole to the surface here, so that has to go. What about these others? This one's at right angles. What about that?"

"I think I'd take it out?"

"Would you? Why?"

"Well... It might fuse with this one."

"Oh, yes. True. That can happen. But I've been doing this for forty years and I've only seen it once. No, I'd leave it. He'd probably prefer to keep it. Or would you like another one out, Mr Phanx?"

"Argle agh Arg."

"There we are then."

Haven't had any further problems so far, and that was at least fifteen years ago.
posted by Phanx at 8:06 AM on November 5, 2008

Seems to me like this is a decision that should be made on an individual basis and upon the advice of a medical professional. My dentist wanted me to have mine taken out when I was 25 because I had one that was so decayed that she said I was in danger of an abscess. She thought that I might as well have the other three yanked at the same time. I am very cavity-prone, so I agreed. She, meanwhile, was a woman in her fifties and had one taken out on her lunch break one day before she worked on me.

There are hustler dentist's out there, so get a second opinion. But do drop the "I don't need to go to a dentist" attitude and see a dentist you trust at least once a year. Good dental care is one of the plusses of the modern age. Take full advantage of it and you'll be glad you did later in life.
posted by orange swan at 8:41 AM on November 5, 2008

My dad is a dentist, and I am still in possession at 42 of two of my wisdom teeth. His explanation to me has always been - you want to hang on to your wisdom teeth as long as you reasonably can, since having back teeth is the prerequisite for not having to have dentures later on (and dentures are awful).

The logic is that you would far prefer to have a crown/bridge combo in the future and you need some back teeth to hang them off of.

If you have no pain, and you can afford it, you can take a conservative approach of having the bad stuff filled or root canal-ed as necessary - but then you really need to do proper dental maintenance in the future.

One additional reason some dentists recommend removal of wisdom teeth - they are just plain hard to work on, seeing as how they are very far back in your mouth. Cavities on the back side of your wisdom teeth develop because you don't reach there with your toothbrush, and your dentist has trouble reaching there too. You can find a dentist who is willing to do that harder work. Ask around for someone who has previously mended rather than extracting a wisdom tooth for someone else.

Lastly, most dentists removing non-impacted wisdom teeth do not do all four at once. That leaves you no place to chew while recovering. Usually you do one side, top and bottom, and wait for that to heal up a bit. Since they are not impacted any oral surgeon should find them fairly easy to remove with just novacaine and nitrous. A few weeks later you do the other side. Anesthesia is a danger in and of itself, and really doesn't seem necessary if they are not digging these guys out of your jaw. The idea of a "used car salesman' dentist sounds awful.
posted by AuntLisa at 9:11 AM on November 5, 2008

Your teeth can shift as you get older and there is wear and tear on them. Even if you have room for wisdom teeth now, you may not as you get older, and you'll get scary uneven teeth. I would have them out now while you are young and healthy.
posted by jfwlucy at 9:16 AM on November 5, 2008

all four of my wisdom teeth came in impacted. i begged my dentist to just take all of them out already and be done with it, but he was both very old and very old school and said he didn't believe in taking out teeth unless he absolutely had to and anyway i'd had some teeth removed for my braces and so i had a lot of space for them to spread out.

fast forward ten years: they've crowded my teeth together, i've had to have cavities filled and super painful and expensive root canals done, and the two lower ones have been pulled out—i'll eventually have to get the upper ones pulled two because they're unopposed and will grow and push dirt into the gaps. i really wish he'd listened and just pulled them when i was younger and had asked him to as it would've saved me a LOT of pain and expense!
posted by lia at 10:04 AM on November 5, 2008

I'm 45 and all four of my wisdom teeth are sitting happily way up in my gums. They never came in, they never got impacted and since getting them out would be fairly major surgery (they're waaaay up there) I've always refused to even contemplate it. I change dentists a lot - when I was younger they kept telling me I had to get them out or I would be facing major problems but now they just say Huh, looks like they're going to stay where they are, whatever.
posted by mygothlaundry at 10:29 AM on November 5, 2008

The American Public Health Association recently "adopted a policy recommending that the removal of wisdom teeth only be done when there is evidence of infection, pain or other problems."

Change dentists if you get a bad vibe. I did after I was given the hard sell on both wisdom teeth removal and braces, and now I totally trust that my new dentist will tell me if/when I actually need either of those things.
posted by limeswirltart at 1:03 PM on November 5, 2008

First: You would be surprised what you can have done without more than a mild local if you can convince the person doing it that you will sit still.

Yes, you should get a second opinion but there's no reason to think that you don't need dental care. I have this thing with people who say "no pain/problems" or "I never get sick." You aren't like this, I'm sure, but my darling friends tend to forget the time they would not STFU and made us drive 4 miles-an-hour from Oakland to LA because they had such an awful headache and then two days later went right back to crowing about how they "never get sick." That's all I'm saying. And even without that, it's routine maintenance. Go to the dentist. If you have a car, check the tire pressure. Clean the coils on your fridge. It's just what you should do.

If you are bound and determined not to have teeth pulled, let's hope you don't have hyperdontia - some people grow a few teeth here and there way past the cavity prone years.
posted by Lesser Shrew at 7:37 PM on November 5, 2008

Thank you all for taking the time to post, I really appreciate it :)!

You've convinced me that I need to take this dental work more seriously, so that I will do. I'm going to go get the x-ray prescribed, and then talk to the dentist about the options available.

While I do still think he was being alarmist and pushy, I can see now why he would do so - he's used to dealing with people who get their teeth checked regularly, and here's me who hasn't seen a dentist in 18 years, he was very likely trying to scare me into action for my own sake.

I do have cavities in at least 2 wisdom teeth so I'll have to see if I can have them filled and clean them better, or if they really need to come out. If they do I guess I'll just have to deal with it, better safe than sorry after reading some of your comments 0_0

I do tend to clean my teeth extremely well - twice a day with an electric toothbrush for at least 2 minutes - but obviously it's not cutting it for those back teeth.

Thank you again very much :)
posted by katala at 2:55 AM on November 6, 2008

Just FWIW, there is one downside to waiting until there's trouble to have your wisdom teeth removed.

Nerve damage.

As you age, the roots grow longer, and eventually can (and often do) grow so long that they're in the nerve in your lower jaw or reach all the way to the nasal cavity (which is good for an infection when they remove a tooth)

My SO had her wisdom teeth out at 26. One of the lower ones managed to bruise a nerve on the way out and it's never healed. If she touches her jaw in the right (wrong?) way, she still gets a pins and needles sensation. She describes it as rather unpleasant, but luckily not easily triggered accidentally.

Now, if they're already so long nerve damage a possibility, there's not really any reason to do it before you feel like it (or ever).

FWIW, I also had mine out late and had no problems at all, so it's not as if it will happen, but it's something to be aware of.
posted by wierdo at 11:20 PM on November 6, 2008

Just thought I'd post an update for anyone in future reading this post :)

I had my dental work done this week - on Monday I had the 3 cavities on the left filled, and on Tuesday 2 cavities and the wisdom tooth on the right removed.

It certainly wasn't pleasant, but it wasn't painful, and only took 1.5 hours per visit. The worst bit was the initial needle. The only pain I've had now it's over is a bad headache (probably a reaction to the local anesthetic) and a bit of an ache where my wisdom tooth was. I'm just taking panadol and nurofen as needed.

The cavities were quite severe, to the point where the dentist wasn't sure if some of the teeth would need to be pulled rather than filled until he'd seen the extent of the damage. Thankfully all but one could be filled.

So all up it was uncomfortable but not so much that it wasn't worth doing. I feel much better now knowing my teeth are healthy once again and I'll be seeing a dentist at least once a year from now on to nip any potential problems in the bud before they become big expensive problems ;)
posted by katala at 2:51 PM on November 12, 2008