is it safe? well yeah, probably, but I still don't want to do it.
December 3, 2014 6:46 AM   Subscribe

My son (age 20) has one impacted and one soon-to-be-impacted bottom wisdom tooth so they need to come out. His top wisdom teeth have come in fine. Dentist recommends pulling all four. Why can't he keep his top teeth?
posted by headnsouth to Health & Fitness (39 answers total) 1 user marked this as a favorite
Even if they're fine now, they might cause him problems later. It's just easier to take care of it all at once. I had problems with just one of mine and ignored the dentist's recommendation to pull all four. Less than a year later I was in there again because of a problem with another one. That time I let him get rid of all of them.
posted by something something at 6:50 AM on December 3, 2014 [9 favorites]

My understanding is that wisdom teeth can cause issues later on. They are difficult to brush and floss - being so far back in the mouth, and can therefore need further treatment later on. They're not needed for eating, especially if there are no teeth below them. Plus if you do have issues with them later on, you don't want to go through getting wisdom teeth pulled again. (Because if you do have an issue with a wisdom tooth they'd like recommend extractions versus treatment of the tooth) In addition, if they are fully in they should hopefully be relatively simple extractions so you might as well get the pain over with all at once.

On preview: I had the same questions as my lower wisdom teeth weren't in and weren't causing problems. I had them pulled following my dentist's advice (I was concerned about the extra cost.) I can now attest that I doubt I would have been in any less discomfort getting 2 pulled versus 4.
posted by Crystalinne at 6:52 AM on December 3, 2014

Being impacted is not the only reason to pull wisdom teeth. Here are more reasons.
posted by Bentobox Humperdinck at 6:52 AM on December 3, 2014

Wisdom teeth can cause all sorts of mouth issues later down the line. A few people are lucky and have theirs come in perfectly straight and have large enough jaws to accommodate them without any other crowding. Most of us are not that lucky, and like something something said, it's just so much easier to have one mouth surgery than to have multiple mouth surgeries.
posted by phunniemee at 6:53 AM on December 3, 2014

Nthing the "they'll probably cause problems later". A college friend said that her wisdom teeth all grew in just fine, and she opted to leave them alone even though her dentist said they should be extracted - and then when they all got really bad cavities a year later, her dentist said "that's why I wanted to extract them." So she ended up losing them all anyway.
posted by EmpressCallipygos at 6:54 AM on December 3, 2014

I also opted to have just two of my wisdom teeth removed as a teenager. Several years later, as an adult, I ended up needing each of the others removed (separately). So that took three trips to the oral surgeon instead of just one. I don't really regret my choice, but it might have saved some time and money to do them all at once.
posted by mbrubeck at 7:00 AM on December 3, 2014

I had one wisdom tooth pulled when I was in my thirties. I'm now in my mid-fifties and the other three are just fine.
posted by ThatCanadianGirl at 7:04 AM on December 3, 2014 [5 favorites]

I have all four of mine, at age 66. But Bentobox Humperdinck's link would seem to suggest prophylactic extraction (for "Peace of Mind") even if they are all fine. I'm now wondering whether my recent flurry of cavities (in other teeth; the wisdoms have never needed a filling is to be blamed on them being "a breeding ground for oral infection and inflammation." I'll floss them a little more, but I'm going to leave them there. (Some arguments against preventive extraction.)
posted by beagle at 7:13 AM on December 3, 2014

To PubMed! It looks like the Journal of Oral and Maxillofacial Surgery had a supplement on this topic in 2012.

How often do asymptomatic, disease-free third molars need to be removed?
According to the Current Care Guideline, preventive removals at a young age are justified for 3 groups of teeth in the mandible: partially impacted teeth in the horizontal position, partially erupted teeth in the vertical position, and incomplete roots growing close to the mandibular canal. In conclusion, one fourth of retained and disease-free M3s need to be removed preventively at a young age, whereas the rest should be treated according to signs and symptoms.
What are the local and systemic implications of third molar retention?
Patients deciding to retain M3s should consider the potential long-term effects on their periodontal status and the potential for the retained M3s to serve as a chronic source of inflammation that stresses their systemic health.
Is there pathology associated with asymptomatic third molars?
The data suggest that the absence of symptoms associated with retained M3s does not equal the absence of disease or pathology. The clinical implications of these findings suggest that patients who elect to retain their M3s should have regular periodic clinical and radiographic examinations to detect disease before it becomes symptomatic.
What are the risks of operative intervention?
Quality-of-life studies have indicated that around 10% of patients undergoing M3 removal may have a complication. However, most complications are mild and self-limited and undergo complete resolution. Most patients are back at work or school after 2 to 3 days, and long-term complications are rare. Clinicians advocating M3 removal should review in detail the risks of operative intervention in conjunction with the benefits of removal and should be prepared to prevent, anticipate, and manage these complications.
What is the effect of timing of removal on the incidence and severity of complications?
Studies indicate that as one becomes older, third molars (M3s) become more difficult to remove, may take longer to remove, and may result in an increased risk for complications associated with removal. The age of 25 years appears in many studies to be a critical time after which complications increase more rapidly. Conversely, there are no studies indicating a decrease in complications with increasing age. It also appears that recovery from complications is more prolonged and is less predictable and less complete with increasing age. As such, many clinicians recommend removal of M3s in patients as young adults. Advocates of M3 retention need to review carefully with their patients the risks of delaying M3 removal with the same degree of emphasis as the risks associated with operative treatment.
posted by zamboni at 7:13 AM on December 3, 2014 [7 favorites]

It's most likely a matter of prophylactic concerns and convenience/comfort - better to get them all out in one surgery than have to possibly come back for a second. This can also be seen in other procedures like when the need to remove either the adenoids or the tonsils can lead to the removal of both.

I'm 39 and my wisdom teeth have never erupted or given me any trouble. I've sent hem on x-rays and a few are in there sideways. Every dentist has said to leave them in there, but if there was ever a problem, they would all come out.
posted by Tanizaki at 7:17 AM on December 3, 2014

I had all four of mine done at once a decade ago, and asked my dentist the same question. His response was that any teeth left would almost certainly cause me trouble later on, and for that reason it was better to minimize the risk of general anesthesia and the cost by only doing a single session of surgery.
posted by ryanshepard at 7:22 AM on December 3, 2014 [1 favorite]

This isn't worth much, but having mine out unexpectedly cured me of frequent and severe migraines for about a decade. The migraines did return eventually, but they're more sporadic and far easier to endure. I think it's appropriate to play the odds based on the research rather than a random internet anecdote, but anecdotally I'm in the good-riddance-to-wisdom-teeth camp.
posted by Monsieur Caution at 7:29 AM on December 3, 2014 [1 favorite]

Another anecdatapoint here - I had two removed (one seriously impacted, one on the verge) a few years ago, around age 40, and 6 (or so) years later the other two are still fine. It was the oral surgeon who did the extraction who was pushing for me to get them all out, my actual regular dentist was fine with a "wait and see" approach (although it should be noted that I get regular check-ups twice a year, so my dentist is probably pretty confident that he'll be able to catch future problems before they get serious.)
posted by soundguy99 at 7:31 AM on December 3, 2014

Many great reasons listed above.

My main reason? Because who wants to go through that twice.

I had all of mine pulled just with Novocaine. I didn't go under. I had no problems at all, and went to work that same night. Most people aren't me though, and it's pretty miserable for most folks.

Also, they may not be impacted now, and they're much easier to pull and it's a lot less painful than if they do get impacted later.
posted by Ruthless Bunny at 7:33 AM on December 3, 2014

My dad had them out all one at a time, as they became problematic, over the course of 15 years or so, with each extraction increasingly difficult and painful, which made my father difficult and painful for the rest of us to deal with while he recovered, and by the fourth extraction my mom threatened to divorce him if he had any wisdom teeth left when he came home from the surgery.

As you may imagine, my siblings and I all had ours out in one fell swoop.

So, you know, slightly increased risk of divorce due to delaying extraction. ;)
posted by Eyebrows McGee at 7:40 AM on December 3, 2014 [3 favorites]

Dentist's opinions about this vary. I ignored the same advice and kept my upper wisdom teeth, and another dentist later congratulated me. Both upper wisdom teeth still largely fine, thirty years later. Ymmv.
posted by Namlit at 7:45 AM on December 3, 2014 [1 favorite]

My bottom two were impacted and my top two were fine. Five years ago I had the bottom ones out and the oral surgeon suggested leaving the top two alone. I've been perfectly fine since and I appreciate the fact that I only had to deal with two gaping holes in my gums. From what I hear, the surgery for upper wisdom teeth removal is much easier than the lower ones, so I'm fine taking my chances if down the line they need to come out too.

My husband who has terrible anxiety surrounding the dentist had all of his out at once because he wanted to be sure he'd only have the surgery once. He's also been perfectly fine since.
posted by lydhre at 7:48 AM on December 3, 2014

Is a second opinion an option? Asking because I had a dentist in a town I lived in for four years insist I needed all four out or there was gonna be big trouble in the near future. Due to a difficult procedure they only ended up taking the top two. Dentist's office called me on a regular basis for about a year after trying to get me to come in and let them take the other two but I ignored them.

Eventually I moved back to my hometown. Hometown dentist (who had seen me before and after I moved) looked confused when I asked him if I needed to get the other two out. He said he saw no reason for that. In fact, he was surprised to see my top two had been extracted in the first place. And fifteen years later, they have still never caused me a moment's grief.

Yeah, I'd be getting another opinion for sure.
posted by futureisunwritten at 8:05 AM on December 3, 2014 [2 favorites]

Upper wisdom teeth are much easier to remove than lower, impacted wisdom teeth. I had my lower impacted teeth removed by an oral surgeon, but my uppers have been "watch and wait" for almost ten years now. If I do ever elect to remove them, it won't be a second "major dental surgery," it will be a straightforward extraction in my dentist's office. Thus far one of them has erupted without causing any pain or issues (aside from my incorrect belief that I had a small piece of sharp food stuck in the back of my mouth; surprise, it was a new tooth!).

That said, I have dental check ups every six months on the button and I'm willing to do x-rays often enough for the progress of the uppers to be monitored closely. If this is something that your son is unlikely to comply with for the next ~10+ years, yeah, you should probably just pull them now.
posted by telegraph at 8:08 AM on December 3, 2014

I have had one top and one bottom tooth removed on separate visits because I really needed to be able to recover as quickly as possible. I will probably have to have the other two out at some point, which my old dentist recommended, but I was very spoiled by having an excellent dental surgeon before moving and I want some time to find someone as great. One pragmatic issue is that the cost of my removals was not very high, given excellent dental insurance and health insurance willing to cover most of the cost of the anesthetics. If your son does not routinely see a dentist, will not routinely be seeing a dentist over the next ten years, or will at any point be unable to cover the cost of emergency wisdom tooth surgery without dental insurance, and is able to easily take the week off to recover now-- well, maybe it's something to think about.
posted by jetlagaddict at 8:19 AM on December 3, 2014

I had this happen to be recently, and had all 4 of mine pulled. When they're in his mouth, they're much harder to brush and keep his back teeth cleaned properly, and he is much more likely to develop cavities and issues with his back molars because of the wisdom teeth.

I have the dentist with a passion, so I had them removed to avoid any issues in the future. It's pretty standard.
posted by Sara_NOT_Sarah at 8:53 AM on December 3, 2014

Why would he want to? My dentist leaned on me for many years until I finally agreed to get my wisdoms pulled -- there are, as others have said, so many reasons to avoid buying trouble later by taking them out. But in addition, this is a significant operation, for which they knock you out and you have to take pain meds afterward. So why on earth would you have him do that TWICE?
posted by bearwife at 8:56 AM on December 3, 2014 [1 favorite]

Mr. Theraflu's remaining tooth grew into the space left by a removed wisdom tooth, became infected and had to be removed. At that point, the dentist removed the remaining three.
posted by theraflu at 8:59 AM on December 3, 2014

Yeah, I had mine out in 3 different sessions (spread over more than a decade), as they became necessary (didn't come in fully, causing recesses that were hard to clean, etc...). Should have done it in one.
posted by straw at 9:01 AM on December 3, 2014

My husband, in his mid-30s, didn't have his pulled earlier after getting a second opinion. He had no problems until this year when he knocked a chip off of one, and he had just that one pulled, with no problems. He didn't even bother to fill his painkiller prescription and stuck with Tylenol!

I'm with the people above recommending a second opinion, and considering family history with wisdom teeth before making the decision.
posted by telophase at 9:09 AM on December 3, 2014 [1 favorite]

I had a single impacted wisdom tooth removed (lower left jaw) and was told I needed to have the others - which all came in fine - removed as well, because the one above the hole (upper left) would "fall down" and the other two (upper and lower right). would then push my teeth out of alignment or something. I declined. That was 20-ish years ago. The upper right one has dropped a bit - my dentist can see it on x-rays, but it hasn't caused me any problems. My teeth haven't moved, either.

So, to answer your question: I think they recommend it as a common course of action, but unless there are specific reasons to have them out, he may be OK keeping them.

Not a dentist, not your dentist, etc.
posted by okayokayigive at 9:13 AM on December 3, 2014

You're getting a lot of anecdotes but I'll just pile on: all four of mine came in just fine, but by the time I hit my early thirties I was having repeated infections in my salivary glands. A doc finally told me it was probably because of my wisdom teeth. Got all four pulled at once (no big deal) and haven't had a single infection in the 15+ years since.
posted by BlahLaLa at 9:41 AM on December 3, 2014

Another anecdatapoint: I have all my wisdoom teeth, I'm 46, never had a spot of trouble so far. No one ever said to me that it would be better to remove them preventively.
posted by Too-Ticky at 9:41 AM on December 3, 2014 [1 favorite]

If he's on your dental insurance now but won't be in a few years, that's a good reason to get them all pulled now. Otherwise if they cause him problems in a few years when he no longer has dental insurance he may end up suffering with them for a long time just to avoid the expense of having them out.
posted by Jacqueline at 9:44 AM on December 3, 2014 [1 favorite]

All four in by age 20, pulled at 45. Had no problems with the teeth, but flossing was a bear. Immediate increase in gum health, although dentist didn't feel my jaw was unduly crowded prior.

Thus I have provided the necessary anecdata to counteract the solid research provided above.

I still hate to floss, though.
posted by BlueHorse at 9:54 AM on December 3, 2014

Something to consider here is that if your son is on your insurance now (which I would assume given his age?), this is a good time to do it. I avoided some dental issues (not wisdom teeth, but a different big expense) as a teenager/college student because I really didn't want to deal with it at the time, and I really regret it now. It will overall be more expensive because my insurance is not as good as my parents' was, plus it's a lot harder/annoying to take time off of work as an adult as opposed to doing it in the summer/over Spring break or another break as a college student. Of course, if your son is not in college, is working and has his own insurance, etc. these aren't such big issues.
posted by rainbowbrite at 10:45 AM on December 3, 2014 [1 favorite]

Unopposed teeth can cause problems. Also before I did the uppers I tended to bite the inside of my cheek.
posted by Gungho at 11:11 AM on December 3, 2014

I had all mine out at once in my late teens, and I'm guessing perhaps it's the fact they usually cause trouble, and that they want to keep symmetry top and bottom for their bite to stay the same.
posted by nickggully at 11:18 AM on December 3, 2014

I had top unimpacted wisdom teeth and bottom impacted ones. I was told to get them all removed as an adolescent, but resisted.

As a 30+ year old adult, I got a cavity in one of the top ones and rather than fill the cavity and then see about oral surgery they sent me straight to the oral surgeon.

They told me that not only are the wisdom teeth hard to brush, witness cavity I got, they said that "unopposed" teeth--as my top wisdom teeth were, because the lower teeth hadn't erupted--are more likely to get cavities. And that problem would continue after the lower teeth were extracted.

Don't wait. They're harder to take out when you're older and besides that, I developed a large cyst around one partially erupted tooth (asymptomatic, but visible on xray) that had to also be removed when my lower teeth were removed.
posted by Jahaza at 11:33 AM on December 3, 2014

Consulted with a Facebook friend who's a dentist, and he says thus:
The clinical theory is that wisdom teeth should be removed, particularly if impacted in any way. Impacted teeth can become encysted which can displace and destroy other parts of the jaw. The teeth can also cause destruction of the twelve year molars. [non-impacted teeth] are hard to clean and get decayed very easy.
Thus the advice to take 'em all out.
posted by EmpressCallipygos at 12:06 PM on December 3, 2014

I'll chime in as another person who had my bottom two impacted wisdom teeth removed as a teenager (age 17) but left my top ones in, mostly because we didn't have dental insurance, it was a lot more expensive to do 4 rather than 2, and there was plenty of room in my jaw for the top 2 to erupt.

I ended up needing to get the top 2 pulled when I was 24 or 25, because I was having difficulty flossing and brushing them meticulously enough to prevent decay. I'm probably on the upper end of oral hygiene, plus I have the sort of genes that mean I've never had a cavity (knock wood) or other major dental problems, and I was really surprised that decay started happening so fast with the ones that were left in. I definitely take a low-intervention approach to most all medical and dental issues but in retrospect I wish I had gotten all four done at once. It was substantially more disruptive to my life to deal with it in my 20s than it was over spring break when I was a teenager.
posted by iminurmefi at 12:40 PM on December 3, 2014

Another anecdotal data point, I'm 53 years old and my wisdom teeth have never given me any trouble despite dire warnings from dentists for the last 30 years.
posted by Grumpy old geek at 1:52 PM on December 3, 2014

I had all 4 removed. I wouldn't do it all at once, though. I would do left side/ right side so you can chew food and sleep on one side.
posted by divina_y_humilde at 2:40 PM on December 3, 2014

Response by poster: Thanks everyone. I especially appreciate the responses that went beyond the vague "he may have problems later" that we got from the dentist. LOL @ dental insurance.
posted by headnsouth at 4:35 AM on December 4, 2014

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