For four less choppers.

September 27, 2005 10:16 AM

Should I have my wisdom teeth removed?

I'm a 30-year-old male. My wisdom teeth erupted in my early 20s and have grown in fine ... they are straight and there's enough room in my mouth for them.

I didn't go to the dentist much the first half of my 20s, but have been a good dental patient the last 4 or 5 years. I brush often and floss occaisionally and can't recall the last time I got a cavity.

My current dentist (been with him about 2 years) has been suggesting since my first day with him that I have my wisdom teeth removed. His reasoning is that they are hard to keep clean and un-needed. The hygenist certainly removes a lot of plaque from them when doing a cleaning.

To me, having them removed sounds like "voluntary surgery" which is something I'd like to avoid.

I live in the US and have good dental insurance. It wouldn't be free but the cost isn't a hardship.

Has anyone had them removed in a similar situation? Any other advice?

posted by sohcahtoa to health & fitness (36 comments total)

I think as long as they give you no problems, and are kept pretty clean you should leave them. ANY surgery is major surgery, especially with anesthesia.

Don't do it unless you have a need to do so.
posted by edgeways at 10:22 AM on September 27, 2005

Lucky you, if your wisdom teeth have grown in straight and haven't crowded out your other teeth. Mine came in sideways, and ruined all that expensive orthodontistry work! Eventually, I had both the top and bottom wisdom teeth removed. It wasn't much fun.

Get a waterpik to help keep 'em free of food gunk, and don't have them removed. Make yourself a promise that twice yearly dental visits are the minimum.
posted by Corky at 10:28 AM on September 27, 2005

I agree with edgeways.

I have all of my wisdom teeth and they are not giving me any trouble at all.

Simply get them cleaned at your dentist every six months or every year (as your plan allows) and leave them in.
posted by seawallrunner at 10:28 AM on September 27, 2005

Removing wisdom teeth that are giving you no problems sounds nuts to me (as well as suspiciously like your dentist padding his billable work.)

I've had my wisdom teeth for a couple of decades. I've probably seen a dozen different dentists in that time, and none of them have ever suggested having 'em out for the heck of it.
posted by Zed_Lopez at 10:28 AM on September 27, 2005

mine "floated," up and down, pushing through my gums a few times a year all during my 20s. that pain, plus the cleaning issues, pushed me toward extraction. my teeth were not impacted but I still went under general anesthetic for removal. the procedure and recovery were relatively painless.

in your case, they're causing a dental hygenist an extra 20 mintues of work twice a year. probably not worth it to have them removed.
posted by killy willy at 10:31 AM on September 27, 2005

My dentist has been suggesting the same thing, but once I got a Sonicare and my gum pockets decreased by 2/3 (I've never had a cavity as of 35 years now but my gums weren't so healthy) they stopped suggesting it.
posted by luriete at 10:31 AM on September 27, 2005

There was a study on wisdom teeth released in the Journal of the American Dental Association earlier this spring. This press release summarizes the findings. The conventional wisdom seems to be that wisdom teeth (aka third molars) usually cause problems for people, either by staying impacted under the gums or erupting at weird angles, which puts pressure on adjacent teeth and may complicate brushing.

If your wisdom teeth truly are misaligned and thus difficult to keep clean, you may develop gum disease or infections over time, which of course could affect the rest of your teeth. I am guessing your dentist figures it's better to take them out now rather than risk future infections and illness.

You could take a wait-and-see approach to this. It would probably be helfpul to know whether you do need surgery or--since the teeth have broken through--this could be performed through an extraction. This brief health sheet from the ADA has some additional information you may find useful.
posted by Sully6 at 10:32 AM on September 27, 2005

If they're in, straight, and aren't causing any other problems, leave them alone.

Mine were fully impacted and had to come out. And my daughter (17) just had hers out this past Friday. She's swollen and miserable, but it was necessary for her.

Get better and brushing and flossing and skip the surgery.
posted by cptnrandy at 10:32 AM on September 27, 2005

"Any other advice?"

Get your second opinion from another dentist.
posted by mischief at 10:34 AM on September 27, 2005

Incidentally, the dentist wouldn't do the extraction, but he's provided me with a referral. I don't know if there's a kickback.
posted by sohcahtoa at 10:35 AM on September 27, 2005

as well as suspiciously like your dentist padding his billable work.

Unless his wisdom teeth can be removed through extraction, sohcahtoa would have to be referred to an oral surgeon, making it very unlikely that his dentist stands to benefit financially from advising this procedure.
posted by Sully6 at 10:37 AM on September 27, 2005

Mine were perfectly straight and my childhood dentist assured me I didn't need to have them removed. When I went to college, the dentist in my college town gave me the same story about how they were difficult to clean, cavities, etcetera, and said I needed to have them removed. He referred me to an oral surgeon and I had them removed.

My girlfriend later went to the same dentist and he tried to sell her on having her perfectly straight wisdom teeth removed, too. She didn't buy it and discovered the oral surgeon to whom the dentist had referred her--the same one who removed my wisdom teeth--was the brother-in-law of the dentist.

Fuck you and fuck you, Drs. whatever-your-names-were.
posted by fandango_matt at 10:46 AM on September 27, 2005

My dentist told me that I should have them removed (and if I did it would be in another state where he wouldn't be able to give me a referral) but if I wasn't going to, I could pick up some Gly-Oxide at the drugstore to keep them clean. In order to keep them from getting infected, I had the top two extracted so they wouldn't irritate the gum over the impacted bottom two - that was easy and worth doing.
posted by transona5 at 11:01 AM on September 27, 2005

fandango_matt, the fact that the oral surgeon was related to your dentist doesn't necessarily mean you were served poorly. It would have been most appropriate for the dentist to disclose that fact up front to you, certainly, but dentists and doctors refer patients all the time based on their personal relationships.

Removing wisdom teeth is the conventional, accepted wisdom because they do not serve a discernible purpose in our mouths anymore and many people who retain them do experience problems over the long haul. I don't think it's a dental conspiracy to generate revenue.

If you do decide to keep them, socahtoa, just make sure you keep up with your dental hygiene and check in with your dentist regularly. I do like the Sonicare, like luriete mentions, if you don't mind spending the cash.
posted by Sully6 at 11:03 AM on September 27, 2005

I understand and appreciate the fact doctors and dentists refer patients based on their personal relationships. I was served poorly because the dentist lied to me and was not acting in the best interest of his patient. My childhood dentist told me repeatedly I would probably not need to have my wisdom teeth extracted; the college dentist, upon hearing this, shook his head and said, "Oh no, no no. You should have those removed as quickly as possible--they're only causing problems." With this information, and thinking it better to act in order to avoid misery later, I decided to take his advice--which, as my girlfriend later discovered, was not entirely in my best interests.
posted by fandango_matt at 11:15 AM on September 27, 2005

I don't trust dentists about wisdom teeth. When I was getting my pre-college check-up, the dentist claimed my wisdom teeth were coming in crooked and they should be removed. Turns out all teeth are at that angle at that stage. I left 'em alone, they came in fine, and now my dentist (the best I've ever had) says there's no problem.

Since they're in and healthy now, I don't know why you'd go through surgery. If something goes wrong, then fix them. As for the plaque, do you use those little rubber gum picks that are often on the bottom of toothbrushes? (My dentist recommended them and my sore, terrible gums are in great shape.) I find sweeping that around the back and bottom of my wisdom teeth picks up loads of gunk and keeps them better. Likewise, if the gum behind gets inflamed and irritates itself on the tooth, sticking one underneath and giving a good clean clears it right up.

In summary: keep 'em in, keep 'em clean.
posted by dame at 11:23 AM on September 27, 2005

Unless his wisdom teeth can be removed through extraction, sohcahtoa would have to be referred to an oral surgeon, making it very unlikely that his dentist stands to benefit financially from advising this procedure.

Good point. I stand corrected. I should have said it sounds suspiciously like his dentist is getting kickbacks for referrals to an oral surgeon.
posted by Zed_Lopez at 11:46 AM on September 27, 2005

Removal of wisdom teeth is several days of pure misery, followed by a good long while of discomfort, plus a non-zero chance of death - as with all surgery.
posted by jellicle at 11:50 AM on September 27, 2005

Removal of wisdom teeth is several days of pure misery, followed by a good long while of discomfort, plus a non-zero chance of death - as with all surgery.

If you're under general anaesthesia, yeah. The chance of death is much, much less if you're not under general anaesthesia, and some people have wisdom teeth removed under local anaesthesia only (I did). Even then the chance of death is non-zero, but then, getting out of bed in the morning involves a non-zero chance of death.

Recovery varies widely from person to person as well--some people are bedridden and miserable for a week; some are up and around and just peachy the next day. (I was much closer to the latter than the former.)

Having said all that, I'd still echo the "don't have them out if they're not causing you any problems" comments here.
posted by DevilsAdvocate at 12:34 PM on September 27, 2005

I'm with the leave them alone if they are straight and pain free crowd. What is the worst that could happen?: you get a cavity in a one of them and it needs to be extracted. Why not delay that pain (both in your mouth and in your pocket) as long as possible, it may never be required.
posted by Mitheral at 12:40 PM on September 27, 2005

as long as they've grown in straight, any future extractions shouldn't be any harder than having a regular molar pulled.

the only reason you'd want to have them out when they weren't causing problems is if they were impacted and might cause problems later when it would be harder to recover from the surgery.
posted by clarahamster at 12:47 PM on September 27, 2005

Mine are in, my mom's are in, my husband's are in. If you're going to keep them, get a good electrical toothbrush (our dentist sold us an Oral B something or other at an extremely cut-rate price and it's made all the difference in keeping the wisdom teeth clean.
posted by Medieval Maven at 1:09 PM on September 27, 2005

I've had a couple wisdom teeth extracted. One popped out, the other was minor surgery (and without a local!) The pain wasn't great and the recovery wasn't long.

I'm going to have the other two removed. I have really tired of having teething pains every six months to a year. And they are crowding my jaw and I can feel that my teeth are all jammed in crowded and shifting.
posted by five fresh fish at 1:30 PM on September 27, 2005

Keeping them clean can certainly be an issue - I have like 7 cavities between my 4 perfectly straight wisdom teeth. But of course they've been filled, which I imagine was somewhat simpler (I presume) than getting them pulled.
posted by advil at 1:57 PM on September 27, 2005

According to my dentist (whom I trust), if you have four normal wisdom teeth which are opposite each other, you will have less of an issue than if you have less than four (or if they are impacted). Teeth need to have an opposite number, if they don't, they often tend to move around, and this can fuck up your other teeth, which you need a heck of a lot more than wisdom teeth. They also don't tend to be as healthy as regular teeth, which coupled with their location (making for difficult brushing), often means you end up with cavities and gum issues you wouldn't have had otherwise.

I had mine pulled (under general anaesthetic) because one was impacted and I only had three anyway. I had pain for a day, that's it, and I had a sizeable bit of bone removed around the impacted one. My sister's experience was comparable (she went out to a movie the same night). I'd always recommend having a general, the horror stories all seem to come from people who had them removed under local. That said, if they're not bothering you, you have four, and they have come in normally, I'd hang onto them for now and just improve your oral hygiene as best you can. Especially if you see your dentist twice a year. That said, if you don't trust your dentist, get a different one for bog's sake!
posted by biscotti at 3:38 PM on September 27, 2005

If you have dental insurance and this will be cheap now, why not consider it preventative medicine?

You've got very little to lose, and a *LOT* to gain (no worries in the future about infections, also if you end up without dental insurance in the future, you won't need to find $2,000 to give a dentist to remove them should they become infected). You will not miss these teeth and they aren't ever going to do anything beneficial for you...

And this is coming from someone who puked blood after the operation and was bedridden and without solid food for 3 days. Not to mention the gauze and the medication it turns out I'm allergic to. BUT I SURVIVED AND YOU WILL TOO (NO MONEY BACK GUARANTEE, SORRY).
posted by shepd at 4:03 PM on September 27, 2005

I had mine out right before I went to college, and most of the pain subsided fairly soon (there was a little leftover pain a little bit longer in the place where my 5th tooth was- yes, I had 5 wisdom teeth). No problems.

But my mother had hers out in her early 40s, and ended up going through a bad infection. I hear the older you get, the harder it gets, so if you're gonna do it, do it now.
posted by ThePinkSuperhero at 6:46 PM on September 27, 2005 [1 favorite]

Do not get your wisdom teeth taken out if they are not causing you any problems. Do brush them well and get them cleaned. Be wary of your dentist when he says anything like: "This expensive and painful surgery isn't necessary, and you could live your whole life without getting it done, but I recommend it anyway."
posted by Hildago at 7:45 PM on September 27, 2005

I would also wait, but be informed that if for some reason they cause you problems later in life, you could be in extreme pain.

I know.
posted by justgary at 9:52 PM on September 27, 2005

Removing wisdom teeth is the conventional, accepted wisdom because they do not serve a discernible purpose in our mouths anymore and many people who retain them do experience problems over the long haul.

How many people do you know who have had preemptive appendectomies?

For a more real example: the birthing hospitals around these parts opt to give their patients Caesareans >1/3 of the time (at $20K a pop).

Doctors and dentists are trained in a culture of intervention. It may not be a matter of padding their practice; perhaps it's a desire to feel useful. Feh. I'm keeping my two, skew, wisdom teeth until I see a real reason not to, and would definitely do so were I in your shoes.
posted by Aknaton at 9:53 PM on September 27, 2005

I just had one pulled. I'm 33, but the wisdom teeth came in when I was about 18. This particular tooth had gotten a cavity and eventually broke off, almost to the gumline. It was the bottom right wisdom tooth (blessedly, I have no upper wisdom teeth). It caused me no pain, but food kept getting stuck in it and I was afraid that I would get an infection. My dentist pulled it out within five minutes of the numbness taking effect (about 30 minutes for the whole procedure). It cost approximately $250, including an x-ray ($75). I took a vacation day from work, and two weeks later now, it's healed up. According to the dentist, my left lower wisdom tooth also needs to be removed, but it's not bothering me so I'm leaving it alone for now.

So, my advice is to leave them alone, unless problems develop. If problems do develop, go to a dentist who will pull them. Impacted wisdom teeth are a whole 'nother story, however, afaik.
posted by cass at 7:55 AM on September 28, 2005

(I also agree with the poster above who mentions dental insurance. I waited to get my tooth removed because I didn't have any dental insurance. I paid out-of-pocket. I imagine paying for surgical removal would be crazy expensive. A cousin-in-law of my husband's is going to be paying $900 for surgical removal of three wisdom teeth.)
posted by cass at 7:58 AM on September 28, 2005

The lack of immediate problems doesn't mean there's no chance of future problems. Your teeth are going to be in your mouth for as much of your remaining life as you can manage. If those teeth are pressing slightly in a way that will take a full 10-15 years to screw up your other teeth that's still a point at which you'll want those teeth for another few decades.

If you don't trust this dentist's judgement, go see another one. Tell them up front you're not inclined to do it and lacking a compelling reason you'd like to leave them alone. Maybe your current dentist just doesn't understand your preferences.

Maybe they can be left alone safely. But that's not something that "I don't have a problem" stories (possibly from people who might have a problem in the future) on AskMe can tell you.
posted by phearlez at 8:25 AM on September 28, 2005

How many people do you know who have had preemptive appendectomies?

I think that's a specious argument. Appendicitis--which necessitates an appendectomy--occurs in less than 8% of the population. In contrast, more than 60% of twenty-year-olds who retain their wisdom teeth have at least one tooth that is misaligned or impacted.

As for Caesareans, they account for more than 25% off all births nowadays, so your neighborhood hospital isn't far off the national average. There's an intense debate about this, but certainly some of the reason for the increase is (a) patient choice and (b) women giving birth at older ages and having complications.

Anyhow, not that this has a lick to do with socatoha's teeth. If you're not convinced by what your dentist has to say, I hope you'll get a second (and third if need be) opinion.
posted by Sully6 at 1:19 PM on September 28, 2005

I had one wisdom tooth pulled out when I was 18, but the other actually aligns with a tooth on top so I've tried to keep it in for a while. My dentist has always said it's needed to come out, and because of that, he hasn't bothered to treat any cavities in it. But I held onto it anyway...

Now, the tooth has started to hurt from decay. The dentist said "I told you so", and tells me that it really has to come out now because it can't be filled at this stage. But I don't know how much of it is because it's really a bad tooth, or just because he's neglected filling it for all these years. So did he see that the tooth would be ruined and would have to come out, or was this just a self-fulfilling prophecy? I guess I'll never know, but whatever the case, it certainly has to come out now...
posted by purple_frogs at 1:54 PM on September 28, 2005

I had mine out at 29. They were not causing me any problems, but were reasonably difficult to keep clean. I feel like my mouth is a LOT less crowded now, and since there are fewer teeth to floss, it feels like less of a chore and I do it more often. I don't particularly like brushing either, but I'm good about doing it often, and it, too, is noticeably less effort now.

The extraction and recovery were both pretty easy for me, and nothing a few days on Vicodin couldn't fix. Your mileage may vary, but my impression is that the process tends to be less painful if you get them out while there's nothing wrong with them.
posted by Caviar at 11:52 AM on September 29, 2005