Maybe I wanted to keep my wisdom (tooth).
June 20, 2012 6:21 PM   Subscribe

Why not let my dental nature take its course, regarding my wisdom tooth extraction?

I went to the dentist for a toothache - my right lower third molar/wisdom tooth was partially erupting. My dentist decided to make an appointment to take out both my lower wisdom teeth (even though the left was doing fine, well, by me anyway).

She also asked me to book an appointment to get a full crown for my right lower second molar - which is already mostly cavity.

So I'm thinking that, in nature if my second molar became that bad I would eventually lose it at that point, probably (or die from infection, whatevs) and this would allow enough room for my wisdom tooth to come in.

So I'm wondering if there's a reason why my dentist wouldn't do this. *Are* there dentists out there that will do this? Say, "your wisdom tooth is on a good trajectory, but your mouth is crowded - let's take out one of your older and more damaged teeth"? Is it a matter of dentists not wanting to worry *if* the wisdom tooth comes in properly (and now having a patient missing a second molar and having to have the wisdom tooth out anyway)?

Not being a gross anatomy person, I'm asking out of pure curiosity, not trying to find a problem with my doctor or anything - I assume what she did is completely common.
posted by Lt. Bunny Wigglesworth to Health & Fitness (15 answers total)
I'm no dentist, and I am totally speculating. If your third molar is coming in at an angle instead of straight up-and-down, even with the second molar out of the way, it might erupt at an angle, so that the biting/grinding surface of the tooth doesn't actually do its job.

The Wikipedia article says there's some controversy around whether to remove asymptomatic wisdom teeth prophylactically. But that's not quite the same thing.
posted by gingerest at 6:45 PM on June 20, 2012

Hey! They're MY teeth!

I used to have problems with wisdom tooth crowding. They'd pop up, then disappear, then pop up etc etc. Then I had a broken molar removed (also lower right - it had been broken for years, but started hurting), et voila: no more wisdom teeth problems.

This was not sanctioned by any dentist... it just sort of happened.

This is not dental advice, just a description of my teeth.
posted by pompomtom at 6:48 PM on June 20, 2012 [2 favorites]

Because the roots of the already-descended wisdom teeth can be positioned so they interfere with and cause infections in your salivary glands? That's what happened to me and I ended up getting all four out in my mid-thirties.
posted by BlahLaLa at 7:04 PM on June 20, 2012

(Clarification - I totally understand why a wisdom tooth would be removed if it were obviously a problem - distal impactions, mesial impactions, bony impactions, etc. or causing infections. my question is about wisdom teeth that seem fine, but are impacted primarily due to crowding. Sorry if there was confusion!)
posted by Lt. Bunny Wigglesworth at 7:16 PM on June 20, 2012

The roots may continue to grow for some time. If that happens, they may hook around such that it's very difficult to just 'pull' them out. The then have to be broken up and picked out.

Also, they can hook around a nerve, causing impingement that way, or serious nerve damage at delayed removal.

Finally, any surgery is generally easier to recover from when you are younger. If wisdom tooth removal happens later, it often requires more missed time from work, and general agony.
posted by bilabial at 7:25 PM on June 20, 2012

You could totally get a second opinion. I just got my top two wisdom teeth taken out, and the oral surgeon my dentist sent me to looked at my x-rays, poked around a bit, and then very clearly laid out all the options (ranging from none to all four teeth removed) and his recommendations.

One of the factors is definitely bite surface - also, I dunno if it would be problematic to have a gap in your teeth (rather than just having no teeth after a certain point) in terms of trying to chew back there. But this is definitely a question you should be able to ask your dentist and/or oral surgeon and get a clear answer with the risks laid out for you.
posted by restless_nomad at 7:33 PM on June 20, 2012

(Not to thread-sit - I'm not asking for personal consideration - the teeth are gone and the crown has been fitted. This is purely a "has any dentist considered this?" not a "how can I get around a wisdom tooth extraction?" question)
posted by Lt. Bunny Wigglesworth at 7:44 PM on June 20, 2012

One thing to consider: when a tooth is missing, the opposing tooth is going to push food against your gum when chewing, which can cause lots of pain and trauma. In addition, a missing tooth causes the remaining teeth to bear more pressure, which in turn can weaken them, causing further problems down the road.

If you don't trust your dentist, find one you do trust and follow their advice. You likely won't regret it years later.

(Voice of experience; I'm in the middle of extensive corrective dental work due to letting my dental nature take its course in earlier years.)
posted by The Deej at 7:44 PM on June 20, 2012

Just saw your last comment. You won't regret your choice.
posted by The Deej at 7:45 PM on June 20, 2012

Perhaps because of the remaining gap? If your wisdom teeth were coming in right under your second molars that would be one thing, but even though my bottom teeth were crowded and have shifted a bit now that my wisdom teeth are out, they haven't shifted enough to fill up an entire tooth-sized gap or even half of one, so the wisdom teeth would be isolated.

My understanding that teeth standing alone without the support of a row are more vulnerable to being knocked about, loosening roots, etc. Not a dentist or dental expert, though.
posted by clerestory at 11:32 PM on June 20, 2012

The other reason why having a gap in your teeth is a problem is because when you chew that sends force back down into your jaw. Bones build strength in response to force so this helps keep the jaw strong. Removing a tooth removes this signal and the bone can atrophy, thus making the teeth on either side less stable etc. As an aside, that force into the jaw is also linked to satiety signalling, your body knows you're eating by a number of ways and responds accordingly and this is one of them (it's kind of cool).

Of course lots of people have had random teeth pulled in the middle without it being a huge deal and this used to be more common before things like implants and stuff. But modern dental practise tries to avoid pulling teeth in the middle of the row for no reason and prefers to crown them where possible (so to restore the chewing surface). Whereas yanking wisdom teeth still seems to be pretty accepted since they're on the end and so often turn bad (they're really hard to clean if nothing else), although I agree that it can be a bit overdone.

In your case if you'd had the molar removed then later needed the wisdom tooth removed - which is still fairly likely - then you'd be losing quite a lot of chewing area at the end there and the resulting jaw atrophy could be quite significant. As is it, I lost jaw bone mass due to an infection in my wisdom teeth despite that they looked and felt fine. That infection is somewhat common and jaw loss a normal side effect (the inflammation eats away at the jaw basically), add in an already weakened jaw area and I can imagine it being a problem.

So your dentist was probably weighing up likely effects based on the biology and the common problems they see and trying to make the best decision for your long term jaw and tooth health. Since it's a prediction it might not turn out that way of course, but I can see the reasoning.
posted by shelleycat at 12:20 AM on June 21, 2012 [1 favorite]

You can speculate all you want, but asking your dentist about this might be the best way to understand your option.
posted by Ruthless Bunny at 6:52 AM on June 21, 2012

When I had my wisdom teeth extracted the dentist advised having them all removed because due to their location they are difficult to properly brush and floss, which results in major cavities, root canals, and other problems. That's one dentist's opinion, but it sounds plausible.
posted by kaybdc at 7:17 AM on June 21, 2012

Once you are past your teens, your wisdom tooth is unlikely to erupt completely into your bite without orthodontic help. Also, a partially erupted 3rd molar may be in an unfavorable position w/r/t restoring the decayed 2nd molar, so that's another factor in the consideration of extraction.
There are certainly situations where the circumstance you describe is considered, i.e. removing the decayed 2nd molar and positioning the 3rd in its place, but it's not the first choice, especially if the prognosis for the 2nd molar is reasonably good.
I, personally, vocalize these options when diagnosing and treatment planning, some of my colleagues do not. YMMV.
posted by OHenryPacey at 9:40 AM on June 21, 2012

I had a back molar pulled, and my wisdom tooth on that side came in and filled the gap. It is in almost exactly the same place that the old molar was, and seems to function in the same way. No dentist has ever mentioned removing that wisdom tooth, even though I had my top two removed last year. The corresponding wisdom tooth on the other side is not even close to erupting.

This happened when I was in my early twenties though, so I guess that may make a difference. This all was without the care or intervention of a dentist, since at the time I was broke and had sporadic insurance coverage (hence the tooth pulling, instead of more heroic measures.)
posted by Arethusa at 7:01 PM on June 21, 2012

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