All on wisdom teeth

1 -What are wisdom teeth?

Wisdom teeth are third molars starting coming around at 16-17. It may happen much later, or not at all. Wisdom teeth sometimes stay impacted all life long or do not exist. We often take them for second molars which come out at 12 and at times are blocked on their way by wisdom teeth.

2 -Is the number of wisdom teeth, when they erupt, a sign of entering into “age of wisdom”?

Of course some sort of wisdom was probably necessary to overcome the pain provoked by eruption or extraction of wisdom teeth a long time ago. Now using anesthesia and analgesics it is no longer the case.

3 -When do wisdom teeth grow?

They don’t grow at one time at a given age like most teeth, and over a short period time like few weeks. We observe most of the time eruptive periods which might be painful and even provoke fever like for babies’s first teeth. Their first eruption push may start at the earliest around 15-16 and they erupt most of the time from 20 or much later.

4 -What are wisdom teeth for?

The way we actually eat makes them useless. Having two molars (first and second coming out respectively at 6 and 12) is far enough to gring our food which is most of the time cooked, cut or reduced to soft consistency. As function creates organs, by not using them, wisdom teeth tend to disapear. They have the highest prevalence of missing teeth. One toth can be missing, sometimes 2 or 3, it depends. By not using or needing them gradually humankind delete it from its genetic program. So people who do not have wisdom teeth might consider themselves as “more evolved genetically”.

Another aspect of this evolutionary trend is the presence of evolved wisdom teeth on skulls dental arches found in Gauls cementaries. Gauls had a much harder fibrous diet, requiring an important jaw developpement and a bigger amount of molars.

5 -Are wisdom teeth responsible for all dental movements after a treatment?

Certainly not. Teeth movements generally occur during first months after orthodontic treatment because teeth move to functional position, which means teeth have been forced into a position that might not be best for functioning. Muscles recover their influence after treatment, which can create some dental relapse. Concerning dental crowding, wisdom teeth do play an important part. For many adults who never went through orthodontic treatment, lower incisor crowding is very common. You start noticing it from age 15 and it continues by steps mostly until age 20-22. Orthodontists call it “mesial drift”. It means that without any treatment, for lots of people there is a drift that pushes their back teeth to the front creating crowding mostly on lower incisors, but at times upper. So removing wisdom teeth will not guarantee 100% stability of front teeths alignment. Their eruptive force will simply increase this drifting force from back to front each time.  Wisdom teeth are aggravating factors but not main moving factors. Orthodontists have a close follow up on them. Great efforts were provided throughout treatment by the patient, and warranty for stability is highly expected!

6 -When does prognostic on wisdom teeth has to be made?

Dr Alexandrian recommends a prognostic from early months retention. Retainer systems, mainly archwires bonded on lingual side of lower and upper teeth, guarantee teeth alignment and protect them from eventual wisdom teeth eruption impact. However this is not enough on the long term, because even if front teeth stay aligned, wisdom teeth can, while trying to come out, create some crowding on posterior teeth or damage tooth roots next to them. That is why it is important, not to threaten overall nice result, to look into wisdom teeth future!

7 -How does orthodontist establishes his prognosis?

When giving his prognosis, orthodontist makes a decision balancing on one side predictable wisdom tooth eruption speed with possible amount and pace of growth during that period. These are 3 relatively random elements, but thanks to his clinical sense and having seen high number of cases, orthodontist’s prognosis is relatively reliable. The 2 elements that allow him to balance his decision are :

1- Panoramic X-ray which allows to see wisdom tooth size and orientation. If horizontal or next to closest tooth’s root, it will necessarily be removed since it might cause root resorption and significant movement. The stage in wisdom tooth edification will give an orientation (crown, half roots, fully edified) will also orientate his prognosis on how urgently wisdom tooth must be removed. Contrary to popular believe, it is in fact much easier to remove germs which are round than edified wisdom teeth with crooked roots, even though they are still under the gum. Already built and very twisted roots entail a more complicated operating procedure (tooth must be cut into pieces to be removed). Finally, wisdom teeth are often located near dental nerve, so the less they are thick, evolved and built up, the easier it is to keep distance from the nerve and avoid any operation linked problem. We therefore strongly advise to remove wisdom teeth before they erupt: one for operational ease, and two to avoid all other teeth to move.

2- Palpation in the mouth give a good evaluation of remaining space behind last molar. Depending on patient’s anatomy, predictable size on panoramic x-ray and patient’s age, a prognosis is established as well as a limit date to remove them. Having fixed bonded retainers,being there 24/7 makes intervention less urgent in front teeth movement risk. However it is our preference not to delay. In case wisdom teeth are horizontal, it might get complicated to remove them and especially if with significant size.

8 -Why are wisdom teeth removed so often ?

Orthodontists and patients prefer to avoid any possible risk. As soon as prognostic isn’t 100% sure on good teeth eruption, wisdom teeth are removed. Another reason for removing them is avoiding any inflammatory risk occurring anytime, eventually at the wrong moment, when not wanted, for exemple going for an examination or a competition. Quite frequently, out of tiredness, before sports or intellectual test, wisdom teeth provoke inflammation with fever and cheek swelling. Removing them in emergency is often much more complicated and unpleasant for the patient. Sailors who have to go on a journey around the world systematically get their wisdom teeth with appendicitis too before traveling because these are two problems which might happen any time.

9 -My orthodontist told me my wisdom teeth shouldn’t be extracted, What shall I do?

As long as Dr Alexandrian isn’t sure of favorable wisdom teeth eruption, she advises to check on panoramic X-ray once a year and follow up their eruption. Wisdom teeth may have enough space but round germ can rotate anytime and take new orientation which changes prognostic. As long as tooth isn’t fully engaged in its eruption path, supervision is required.

10 -My orthodontist advised me to remove my wisdom teeth. How to do so?

Depending on patients, 2 options are possible :

– For the braves: extraction under local anesthesia. Generally the specialist removes 2 teeth from same side up and down, then at second apointment 2 other ones. This makes operative procedure less invasive and patients can keep chewing on one side. Having only two wisdom teeth extracted at one time allows less swelling. Though patient has to come back for a second operation, witness consciously instrumental sounds and comments during intervention. Pain is fully removed by local anesthaesics.

– For the less brave : extraction under neurolepts (descendants of laughing gas) alllows to remove 4 wisdom teeth at once quite quickly by a specialist without feeling any pain and without being conscious of everything that is happening during the procedure. This type of technique was widely spread these last 10 years and is almost becoming the rule. It allows not to inject products as strong as needed for a general anesthesia and for the patient to live a perfectly comfortable operation. As soon as intervention is over, the patient wakes up and is able to go home immediately. There’s not a half-day supervision as with a general anesthesia, neither a need to come back for a checking apointment. In conclusion, removing wisdom teeth isn’t always pleasant though an ounce of prevention is worth a pound of cure. Removing them when there is no inflammation, at a choosen time, when staying home quietly is convenient if ever any swelling happens is much simpler to organise and less unpleasant than doing it in inflammatory conditions, with possible infection. If wisdom teeth aren’t removed as advised by the orthodontist, it is also possible to keep an X-ray supervision once a year and to push the deadline.

Good luck to all those who will enjoy summer to remove their wisdom teeth!

This website gives access to general information about orthodontic treatments. It is not meant to replace personal patient / practitioner relationship that you will get in our clinic.