The Wisdom on Wisdom Teeth

Surgeons favor pre-emptive action; others might wait and see.

X-ray with wisdom teeth highlighted in red
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"You know the old colloquialism, let sleeping dogs lie? Well these dogs are not sleeping," warns Richard Haug, executive associate dean at the University of Kentucky College of Dentistry. Ongoing study links even pain-free wisdom teeth to early gum disease that worsens over time, sometimes causing havoc far beyond the mouth. Indeed, pregnant women with gum disease around their wisdom teeth appear to be much more likely to give birth prematurely than unaffected pregnant women. The latest data suggest that as many as 80 percent of people will develop problems with their wisdom teeth.

But controversy lingers about when to take action. Most experts no longer believe that crowding is a concern, but the American Association of Oral and Maxillofacial Surgeons typically recommends pre-emptive pulling in young adulthood, before symptoms arise, when roots haven't yet fully formed and surgical risks are lowest. "If you have to have them out when you're 45, you will not enjoy that," promises Tony Pogrel, chair of the department of oral and maxillofacial surgery at the University of California-San Francisco.

Andrew Ziolkowski, 59, can attest to that. A dental checkup a couple of years ago revealed that cysts had formed around his impacted wisdom teeth and damaged his jawbone—a surprise to Ziolkowski, who hadn't experienced any pain. The necessary surgery required that his jaw be wired shut for weeks afterward and resulted in some nerve damage, a rare complication. "To this day I have no sensation in my lower lip and chin," says the architect from Germantown, Md.

Nonsurgeons are less gung-ho about preventive pulling. "If they're not causing pain or infection, and they're coming in straight, I usually take a wait-and-see approach," says Cynthia Sherwood, a general dentist and national spokesperson for the Academy of General Dentistry. Those who wait are advised to have their wisdom teeth checked yearly, since they are tough to keep clean and may get infected or shift position. "You're committed to that treatment plan until you die," says Thomas Dodson, associate professor of oral and maxillofacial surgery at Massachusetts General Hospital.

Because wisdom teeth don't form until around age 5, Anthony Silvestri, director of dental anatomy and occlusion at Tufts University's dental school, foresees a day when lasers will be used to prevent that from happening. He and colleagues have had success in animals. "It doesn't make sense," he says, "that everyone should be having surgery for a useless tooth."