Foolish question about wisdom teeth from a mutant
January 7, 2019 2:20 PM   Subscribe

Dentists and other knowledgeable people: just how plausible is it that I failed to develop two second molars (upper left and right quadrant) but that two extraordinarily kind and thoughtful wisdom teeth stepped in to take over their position and role?

When I was 16, I probably* had 28 permanent teeth in my mouth and no sign of any wisdom teeth. At age 17, I had the first molar in my lower left quadrant extracted when it was too far gone for a filling, dropping my count to 27. As of Saturday, when I got a comprehensive dental exam (including a full set of x-rays, plus a panoramic view, plus perfect little photos taken of every tooth in my mouth), the count was 28 again, as one wisdom tooth was in the same lower left quadrant as my extracted permanent molar, but in the usual place at the back of my gum ridge, of course, not in the gap. X-rays proved that there are no other wisdom teeth lurking anywhere in my jaw.

*My dental care has been rather patchy throughout my life. I grew up in Montreal in the 60s with unfluoridated water and no regular dental visits, so when I developed bad cavities as a kid, that meant at least two baby molars extracted by Dr. H├ębert. I visited a Scarborough dentist at age 17 for the extraction of my permanent molar, but didn't start getting regular checkups, cleaning and my first fillings until I was 30, so I don't have lifelong dental records to check.

So on the face of it, I'm one of those somewhat rare people missing three wisdom teeth. However, my new dentist thinks that the final molars in my upper quadrants look more like wisdom teeth than second molars. She showed me the photos and I agreed that my "second molars" look more rounded than rectangular, and that the biting surface looks a little smoother and less complex.

While she's not convinced that I never developed second molars and that I eventually got wisdom teeth that grew in at just the right spots to pass as second molars for several decades, she's not ruling it out, either. But this stealth wisdom tooth theory doesn't seem very plausible to me:

1 - My upper molars aren't oddly spaced. Everything looks like a normal set of two molars in each quadrant instead of first molar, [gap], stealth wisdom tooth.
2 - From what I've Googled, anodontia (congenitally missing teeth) typically affects wisdom teeth, incisors and pre-molars. Missing first and second molars seems incredibly rare.

So have you seen or heard of any cases supporting my dentist's hypothesis, or should we just chalk up the slightly odd appearance of my second molars to good old human variability?
posted by maudlin to Health & Fitness (11 answers total) 1 user marked this as a favorite
Well, I'm the opposite end of wisdom tooth weird from you: I have one that's not only never likely to erupt, but so deep in my lower jaw that surgical extraction is contraindicated because it's sitting right on top of the nerve. So, wisdom teeth can be really, really weird.
posted by Making You Bored For Science at 2:52 PM on January 7, 2019 [2 favorites]

I had four of my upper & two lower adult front molar teeth removed when I was a kid as they started erupting in the roof of my mouth as apparently my jaw was super crowded with teeth or something I was pretty young when it happened so I'm not 100% sure which teeth or exactly why. When I got older three of my wisdom teeth finally came in & pretty much just act like molars to the extent I forget they're wisdom teeth, my forth one was a free spirit & decided to come out sideways & was removed. So as a non expert person I'd say it's possible.
posted by wwax at 3:14 PM on January 7, 2019 [3 favorites]

Nthing that it's possible for wisdom teeth to come in like normal teeth. A college friend had her wisdom teeth come in without incident. Although, after a couple years she had to get them out anyway, since her dentist told her that they're prone to cavities and she'd developed a couple really nasty ones.
posted by EmpressCallipygos at 3:33 PM on January 7, 2019

I am missing secondary molars on both bottom sides so... likely? my wisdom teeth came in sideways and had to be detonated though.
posted by evilmonk at 3:34 PM on January 7, 2019 [1 favorite]

I had four adult teeth (upper canines and lower equivalent) removed when I was a teen 'cos my choppers were crowded and bucked. All four of my wisdom teeth have come through as rear molars, neat with nary a wimper. For this I am grateful.
posted by Thella at 3:39 PM on January 7, 2019 [1 favorite]

Holy novacaine, wwax. I'm just now thinking that one or more of the "baby" molars I had pulled in Montreal might have been permanent molars. According to the Canadian Dental Association, permanent first molars come in around 6-7 years, and I'm pretty sure I was in elementary school when the extractions were done. (My dentist did say this weekend that it looked more likely that my first molars were missing instead of my second, but I shrugged that off as extra-improbable when I wrote this question.)

So if my first permanent molars were gone before my second permanent molars came in around the age of 12-13, I guess they could have shown up in the spaces left open by my missing first molars, then my wisdom teeth came in behind them in my late teens.
posted by maudlin at 3:40 PM on January 7, 2019 [2 favorites]

Like Thella, I had upper and lower fours removed as a teenager and retained my wisdom teeth as perfectly normal molars which arived with no more fuss than any other teeth. Said wisom teeth have been there now for about forty years and have given me no trouble to date (long may that continue to be the case).
posted by Quinbus Flestrin at 8:27 PM on January 7, 2019 [1 favorite]

My wisdom teeth came in just like regular molars, all nice and neat and normal. In hindsight, I'm pretty sure they arrived during a very painful few months during my 18th year. Lacking parents that prioritized dental care, I hadn't been to a dentist between ages 9 and 21. At age 22, my dentist removed all four of those molars, because there just plain wasn't room in my mouth for them and they were pushing all my other teeth. The migraines I'd suffered for ten years disappeared along with them.
posted by stormyteal at 12:03 AM on January 8, 2019

Yes. A few years ago my dentist informed me that one of my molars was in fact a wisdom tooth and he wanted to pull it. I vaguely recall the dentist of my youth (long since passed away) telling my mother that my wisdom teeth were "growing in sideways". Not being a particularly orthodontic-minded family, nothing was done about it at the time and I forgot about it. I wanted to keep it but he said it would cause issues and that the roots were fused. Pulling it did cause my teeth to shift; I wish I'd gotten a second opinion.
posted by TWinbrook8 at 3:29 AM on January 8, 2019

Thanks for all the responses. While I knew that wisdom teeth can be well-behaved citizens (as several of you have attested), I was really trying to make sense of my dentist's theory.

Theory Part 1: I never had any permanent first molars in my upper quadrants (a very rare version of anodontia).
Theory Part 2: I have upper wisdom teeth that showed up at the back of my gums with no gaps, crowding or weirdness. In each quadrant, the second molar is in the position where you'd expect to find the first molar, and the wisdom tooth is where you'd expect the second molar.

So the first part of the theory is almost certainly wrong, but that's my fault because I failed to tell this dentist about my childhood extractions. The second part is almost certainly true, as this paper's abstract suggests: kids with extracted first molars don't necessarily develop gaps when the second molar comes in. The last two responses in this forum thread agree.
Paul Geist: I have seen very good results after the extraction therapy, without any need for further treatment. It is astonishing, how "eagerly" the 2nd molar moves to the place of the 1st molar in such cases. The remaining teeth are healthy, without the substance loss and doubtful prognosis of a RCT/crown treated tooth. And the young children don't need to undergo long treatment.

Christopher Stephen Franco: Out of interest: if both parents of the child had impacted third molars, would this contribute to your decision making? Nevertheless, Cobourne & Harrison in 'National clinical guidelines for the extraction of first permanent molars in children', BDJ 217, 643 - 648 (2014). have some wonderful orthopantomagrams with before/afters of 2nd molars moving in the extracted first molar positions. But in any case like this, the medical and social history provide a strong starting point to choose the treatment that 'the patient will benefit the most from'. Cobourne & Harrison state, "As a general rule, if in doubt, get the patient out of pain, try and maintain the teeth and refer for a specialist orthodontic opinion."
posted by maudlin at 6:53 PM on January 8, 2019 [1 favorite]

Theory part 3: You never had wisdom teeth.

I was told at age 16 that I didn't have any wisdom teeth. I had been in braces for a while and had a fancy wrap around x-ray and it shows that there were no buds or anything in regards for my wisdom teeth to come out. I'm now 41 and have never had any wisdom teeth grow in or need to be removed. This certainly has a hereditary component, as this is somewhat common in my family. (Coincidentally I am of French Canadian heritage so while not Montreal if your family hails from Ste Alexis/ Ste Michel de Sens or the Gaspe we are probably somewhat related)
posted by koolkat at 1:46 AM on January 9, 2019

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