How should I decide whether to have my wisdom teeth removed or not?
April 12, 2013 4:32 AM   Subscribe

My dentist says they should come out because they will eventually rot and worse, allow decay on my second molars. My surgeon says that while there is decay on one of the wisdom teeth, there is actually a tendency for older people to get fewer cavities. I am having trouble processing this and other information. How do I decide? What other data and information should I collect?

I am a few days away from turning 40 years old. I have all four of my wisdom teeth. They are not impacted and are generally causing no problems, except for perhaps crowding my teeth. (I will discuss that further below.)

My dentist has been suggesting that I have my wisdom teeth removed for the past few years. There are some cavities on one of them. She theorizes that they are difficult to keep as clean as my other teeth, and that flossing between them and the second molars is difficult, which will cause decay on the second molars. She suggested that recovering from wisdom teeth removal at 40 would be easier than recovering at 50 or 60.

Regarding crowding... I had braces as a teenager. Over the past 15 years, my teeth have slowly crowded in the front. IMHO, they are not unattractive now, but I look at my 67 year-old father's lower front teeth and how they have crowded, and I know that I'd be unhappy with that level of crowding. So, I intend to get Invisalign braces to straighten them (and keep them straight). My dentist argues that removing the wisdom teeth will make that process much easier.

I went an oral surgeon. He thinks the surgery would be an easier one. However, he ultimately deemed the surgery an elective one. He agreed that anyone performing orthodontic work would want them removed, and he noted that there is decay on one of the teeth. He didn't really try to dissuade me from surgery; after calling it elective surgery, he proceeded right into scheduling the surgery, writing prescriptions, and giving me instructions.

I am wondering if I should make a run at keeping the teeth in my head until I am dead and cremated. What other information should I seek to help me make this decision? Do any of you have anecdotal experience with keeping wisdom teeth into middle age and beyond? When answering, ignore the expense of surgery or the expense of future dental work. That information is irrelevant to my decision.
posted by starkraven to Health & Fitness (26 answers total) 1 user marked this as a favorite
I can't comment directly, but I had a similar scenario to you, only I think slightly more severe (the wisdom teeth much closer to causing problems).

My dentist said I should have one out, as it was going to be a problem. I said no, thinking he was in it for the money.

I was back a few years later in pain and had to have it out.
posted by curious_yellow at 4:38 AM on April 12, 2013

Recovering at 60 from having my wisdom teeth pulled was not difficult at all.
posted by Obscure Reference at 4:48 AM on April 12, 2013

Your wisdom teeth are causing crowding to the degree that you are about to invest in cosmetic braces to correct it. Were I you I would remove the wisdom teeth to protect your orthodontia investment. There is no real benefit to keeping them.
posted by DarlingBri at 5:17 AM on April 12, 2013 [6 favorites]

I would not go through the pain and expense of braces without removing the wisdom teeth.
posted by myselfasme at 5:29 AM on April 12, 2013 [4 favorites]

If your wisdom teeth aren't impacted, you don't need general anesthesia to have them out. I had mine pulled with novicaine and I went to work that same night. It took about 15 minutes total. I got a Valium for the exctraction and frankly, it was no big deal.

I'm not sure why you're resistant to having your wisdom teeth extracted. You've had two dental professionals tell you that it would be a good idea. And you can see with your own eyes that it's causing an issue with tooth movement.
posted by Ruthless Bunny at 5:32 AM on April 12, 2013

Getting my non impacted wisdom teeth out was no big deal (one had such a cavity that it broke. Ew. Wanted to burn my mouth with fire). A good dentist can take them out. I had novacaine (and Valium. Because I was nervous). Went to work the next day. An I'm a baby about pain.
posted by atomicstone at 6:01 AM on April 12, 2013

They're not kidding about wisdom teeth messing up your second molars. I had no insurance for years, and with 4 impacted (and 2 sideways!) wisdom teeth, I let it go. I flossed as best I could, water picked, mouthwash - the whole bit. The issue happened beneath the gum line. I had to have my second molars removed at the same time as my wisdom teeth as they weren't worth salvaging. Go, get it done. The recovery isn't that bad - a few days of not wanting food and changing gauze.
posted by skittlekicks at 6:02 AM on April 12, 2013

It is an elective surgery because it is not an emergency surgery. Elective =\= foolish or pointless. Your reasons for not wanting crowded teeth are cosmetic, the surgery is elective, so what? A lot of dental stuff is cosmetic, but having a nice looking smile has value, and if you want it you should do it.
posted by treehorn+bunny at 6:02 AM on April 12, 2013

A good friend had his wisdom teeth taken out in his late 30s. His doctor said, look, maybe they'll be fine, but maybe they'll get impacted while you're traveling out of the country and it'll ruin your trip. I'd just do it now.
posted by kat518 at 6:06 AM on April 12, 2013

Best answer: Used to work at an oral surgeon's office.

I get the feeling that you're hesitant because the surgeons launched right into preparation after telling you that it wasn't critical that they come out. This is totally normal. It's so incredibly routine for them that he was probably on autopilot; we probably had two or three cases a day AT LEAST, and that was in a small town. Most of those cases are even less critical that yours; I bet a majority of their patients are under 25.

I would not wait to have them taken out. Any oral surgery, especially major extraction (say, 2+ teeth) on someone older than ~55 was considered higher-risk in this office. I'm sure most people go through it fine, but our surgeons would often recommend that older folks go to the hospital under full general anesthesia (anesthesiologist, intubation, the works) for their extractions. It sounds like there's really no reason not to do it now (unless you don't have dental insurance and would have to wait until they caused medical problems for health insurance to cover it; this is generally a bad situation).

For anesthesia, I would recommend the twilight (IV, usually Versed I think). Again, that was routine in our office; a NP handled it. They could do one or two extractions on nitrous and locals alone, but four is tougher. Not to get too gross, but even not being impacted, they are probably going to have to come out in pieces. I thought the twilight anesthesia was kind of fun, myself. I had a generally decent experience having my impacted teeth out at 18 as a preventative measure, all things considered.
posted by supercres at 6:29 AM on April 12, 2013 [3 favorites]

I was in roughly your same situation - non-impacted, no real problems with my wisdom teeth. But one of them started to get a cavity and there wasn't really anything I could do about it. It's a really tough area to keep maintained and the decay can spread pretty easily. Especially considering your interest in braces, I definitely think it's worth it for you to get these removed. Mine weren't impacted and it was an easy process. I would recommend going to a good oral surgeon if you can - I got there a little early and she was completely done before my actual appointment time! Very straightforward process.
posted by brilliantine at 6:30 AM on April 12, 2013

I think if you want to do orthodontia or Invisalign, you should consult an orthodontist before having the wisdom teeth out.

I'm somewhat in your boat (two wisdom teeth removed, and two remaining are non-impacted and perfectly fine). The orthodontist I consulted said that, if I wanted to do braces, he'd recommend taking out a pair of premolars to make room and moving the wisdom teeth forward as permanent teeth.
posted by Xany at 6:42 AM on April 12, 2013 [1 favorite]

Best answer: Think about it this way: the wisdom teeth are putting enough pressure on your other teeth to deform where they sit in the gym. For Invisalign to work, it will have to overcome that force just to start working. When Invisalign is done, the force will go right back to pushing your other teeth together. If you get them out, Invisalign will be faster and easier and your teeth will stay that way afterwards.
posted by DoubleLune at 6:43 AM on April 12, 2013

I was in the same situation with my upper wisdom teeth - non-impacted, not causing any serious problems, but in an awkward position that made brushing difficult and was starting to cause cavities. I didn't get them pulled until they started actually causing me pain, and I really wish I'd got it done sooner once I knew the decay was starting, because tooth pain is miserable.

The dentist yanked the first one in his surgery, with novocaine, in a procedure that took about 20 minutes. That was a relatively awkward tooth, and I did have some pain that night and the next day. I didn't have to stay home from work or anything, though, and the next tooth that got yanked a few months later was a quick, easy extraction with no pain afterwards. (I was 30.)

My dentist was willing to try to save the teeth if I wanted him to, but in his words - "you'd need them if this was five million years ago and you were gnawing gazelle bones on the savannah, but they're not any use to you now."
posted by Catseye at 6:47 AM on April 12, 2013

I see several reasons to get your wisdom teeth out - less cavities, less crowding, surgery now when you will recover faster vs. possible surgery later when you may recover more slowly.

I see no reason at all NOT to get them removed now (aside from expense, which you said to ignore). You don't need them, all they are going to do is create possible problems.

Get rid of them.
posted by insectosaurus at 6:50 AM on April 12, 2013 [2 favorites]

I had two wisdom teeth which were causing me no trouble, but my dentist recommended removal for similar reasons to yours (they would be almost impossible to keep clean, they would eventually cause crowding/discomfort). I, too, was skeptical. In the end, I had them both yanked in the chair and was back at work within the hour.

Have it done.
posted by Salamander at 7:06 AM on April 12, 2013

Best answer: I am 38 years old and I had my wisdom teeth removed about 15 months ago. My dentist said the same things to me that your dentist told you. I had cavities filled on one of my wisdom teeth about two years before and was facing having to do it again and again. They were also impacting the molars right in front of them. I had them taken out all at once, using twilight anesthetic.

It was anxiety causing for me as I dislike the dentist and generally don't have great teeth, but it ended up being mostly a non-event. The removal went smoothly and other than a reaction to the amoxicillan, it was fine. My teeth cleaning regime is much easier now.

With regard to your surgeon's other comment about cavities. I have been lucky with cavities generally - I hadn't ever had one until I got two on my wisdom teeth, even though my tooth care regime has only really gotten acceptable in the last 5 years or so (mega good toohbrush, I floss regularly). I just (like, on Tuesday) had one of my other molars filled due to some pitting on the tops that would have turned into a cavity shortly. So, my experience has not been what your surgeon mentioned - I have been getting more cavities as I have been getting older, even though I take better care of my teeth now that I am a grown up.

FWIW, I also have crowding/shifting issues with my front teeth, bottom and to a lesser extent on the top and am a week away from seeing an orthodontist to get a consult on invisalign. I have been dealing with shifting teeth and toying with doing something about it for the last couple of years. I would have had the wisdom teeth out regardless as it was a cleaning issue rather than being directly related to crowding. I got the impression from my dentist that the shifting happening for me is happening for a variety of reasons, and not directly because of my wisdom teeth crowding.

Good luck with whatever you decide.
posted by Cyrie at 7:14 AM on April 12, 2013

If you do decide to have them out, I'd recommend against local anesthetic alone. I had three removed in my early twenties and the shots wore off twice during the removal of two teeth. Not fun at all, but I was poor at the time and had no coverage.
posted by bonehead at 7:51 AM on April 12, 2013

I had braces as a kid and before that I did have some kind of surgical procedure to remove a tooth or two, although the details have escaped me because it was back in the 1970's. My teeth are not crowded and there is room for my wisdom teeth.

Yes because you had other extractions. The OP clearly does have crowding because s/he now needs additional cosmetic orthodontic work to correct it.
posted by DarlingBri at 8:31 AM on April 12, 2013

i resisted having mine taken out until i was in my late 20s because they weren't causing me problems, but i finally did it because i was losing my health insurance and i wanted it to be done before i was uninsured. my theory was that i may never have problems but i might as well prevent their ever causing problems while it would be 80% paid for. but yours are causing problems already. i had one afternoon of feeling very lousy, because the pain meds were making me nauseous, after i switched to just advil it was fine. it was not a big deal and i think you should do it.
posted by katieanne at 8:33 AM on April 12, 2013

If you're in the US, and you do decide to get your wisdom teeth removed, you may need to get it pre-approved through your medical, and not dental insurance. I seem to recall that years ago, my wife thought that a tooth removal would be covered by dental insurance, but since it was a surgery, it wasn't. And since she hadn't gotten it pre-approved, they were delighted to be able to deny her coverage and it was paid out of pocket.
posted by see_change at 9:14 AM on April 12, 2013

I had two of mine out because one of them had a significant cavity that my dentist couldn't get to to fill, and she advised that if the cavity reached the root, it might mean a root canal. Getting them out (under twilight sedation) was no problem at all.

I kept the bottom two because they're healthy and there's room for them, and because my surgeon said it wouldn't be any harder to remove them later if they eventually become a problem, but I'm eight years younger than you. In your shoes, I'd just get them all pulled, especially if you have a crowding issue.
posted by restless_nomad at 9:40 AM on April 12, 2013

Best answer: In addition to the other good reasons to get your wisdom tooth, or teeth, out at this point, any time that you have active decay in a tooth in your mouth, it increases the risk for the rest of your teeth.
At the very least, have the decay addressed asap, either by virtue of the extraction, or a filling if you decide to keep the tooth.
posted by OHenryPacey at 9:42 AM on April 12, 2013

Response by poster: So much good information from you AskMeFites. Thank you. They're coming out.
posted by starkraven at 9:52 AM on April 12, 2013 [2 favorites]

I had my lower wisdom teeth out when I was 18 because they were impacted. I can say without hesitation that it was the most painful medical procedure I have ever had, and I am 63 now. My uppers are still in my head. They have caused me no trouble, and as far as I am concerned, they will stay there until or unless they do. Other dentists have told me I should have them out, but I just laugh. I have had 4 other teeth pulled (two before that experience,two after) and nothing hurt like those damn wisdom teeth. You mileage, of course, may vary.
posted by Guy_Inamonkeysuit at 12:08 PM on April 12, 2013

I had all my wisdom teeth out at age 38, after dentist after dentist told me I should for the previous 15 years. I really wished I followed their advice as I'm now in braces for the first time in my life at 40, but things are moving around nicely given the added room.

The thing that cinched it for me was that my second molars and gums were suffering because I couldn't keep my wisdom teeth clean. I haven't had a cavity in about 12 years, but I had deep ones in my wisdom teeth.

The procedure was easy (going fully under was like magic you snap your fingers and it is all over) and recovery was minimal. I was fine and eating normal food in a couple days, only sat around with ice and painkillers for about 24hrs. The best part is 6-12 months after it, my gums were doing much better all around and I can't wait to get my braces off in about a year and know that everything will be pretty stable and straight for the rest of my life.
posted by mathowie at 2:45 PM on April 12, 2013

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