Monday, September 28, 2015

Teeth That Bother Me

Wisdom teeth. Third molars. The back teeth. Whatever your patients like to call them, they are the ones that I absolutely hate. Every time I see a new patient’s X-rays and I see these guys— whether they are impacted, partially impacted, or fully erupted—I always make the same suggestion: I recommend that you please schedule an appointment with our oral surgeon to have them removed or, at the very least, have a consultation to determine the risk factors.

Some of you may not agree with me. If the teeth are not bothering the patient, why have an unnecessary procedure? In my experience though, I find that, eight out of 10 times, these teeth are destined to be extracted. It could be when the patient is 25 years old, or 55. It could be when they schedule the procedure in advance and plan time to recover, or when the pain flares up right before they are scheduled to travel.

Let’s look at some of the pros and cons of keeping these teeth, which is a conversation that I frequently have with my patients.

Pros (of keeping them): 
1.      More surface area of teeth to chew with. Better digestion, maybe? Not sure if this has been studied or is clinically significant, but why not?
2.      Extra tooth to possibly replace missing second or first molar or serve as a bridge abutment. Except as a cantilever. Please don’t cantilever off a third molar.
3.      Less risk of nerve damage. This one is important.
4.      Potential for more dental work in the future. This is more for the dentist, I guess, than the patient. Who doesn’t love redoing fillings and filling cavities on wisdom teeth? I personally refuse to do so unless the patient is desperate, but I have seen some root canal treatments in third molars. That must have been one hardworking dentist!

Cons (of keeping them):
1.      Risk of infection and pain occurring when the patient has other plans, typically vacations, weddings, and holidays.
2.      Risk of bone loss around second molars. This happens frequently on the distal of those molars that we actually want to keep and compromises their longevity as well.
3.      Risk of decay on the distal of second molars. I have seen this happen, and I am even attaching a photo as evidence.

4.      More teeth to clean. This one isn’t that serious, but those hard-to-reach areas can become a big problem, leading to the issues mentioned above.
5.      Potential for more dental work. This can be a pro or a con, depending on what you are into.

So, who is with me in the quest to eradicate third molars? Except when they are close to the nerve, of course.

Have a great week!

Lilya Horowitz, DDS

1 comment:

Michael said...

As an oral surgeon I always recommend my patients to remove them. Sometimes they think I'm trying to give myself business but I'm a firm believer in extracting them every time. There are just too many complications that can arise by keeping them.


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