If your wisdom teeth don't bother you, is it worth removing them?

international experience

In different countries, the answer to the question: “Do you always need to remove wisdom teeth?” different. In the USA, 8s are removed already in adolescence, before they lead to problems, that is, they act according to a preventive scenario. In the CIS countries, if teeth erupt correctly and do not cause problems, they are left behind. Apparently this is due to the characteristics of healthcare models.

At the same time, many scientific works on this problem among conscript soldiers in the Russian Federation attract attention, and it is no coincidence. It is at this moment that wisdom teeth begin to actively grow and reveal previously hidden problems. And treatment often requires surgery.

Where do the folds come from?

Oral and maxillofacial surgeons and orthodontists are well aware of how wrinkles are associated with missing teeth. For example:

“Eights” , also known as wisdom teeth, were considered unnecessary for many years. They were never treated and offered to be removed even if they did not hurt. It turned out - and dentists recognized this - that “eights” are useful from the point of view of preserving youth. If they have grown, they act as an internal frame for the cheeks, and the removal of these teeth promises early vertical wrinkles on the cheeks and sagging of the lower part of the cheeks, the so-called jowls.

Questions and answers Why do teeth fall out?

Molars are the main support for the cheeks from the inside. If they are missing, the cheeks become sunken, and asymmetrically sunken. And depressions quickly lead to the formation of deep vertical wrinkles and strengthening of nasolabial folds. Following the loss of chewing teeth, the corners of the eyes droop, “crow’s feet” appear, and they are complemented by the same jowls and marionette lines—multiple branching folds running down from the corners of the lips, because of which the lower jaw appears to be attached to a hinge.

The canines , both upper and lower, are responsible for the curve of the lower line of the oval of the face - approximately along the edges of the lower jaw. If they are missing, the oval of the face loses its clarity, folds and sagging like a double chin form. The corners of the mouth droop, which gives the face a tired expression, and after them the nasolabial folds become stronger. The same jowls and marionette wrinkles may appear.

The absence of one or more front teeth leads to the recession of the upper or lower lip, which then transforms into wrinkles. Later, wrinkles in the area of ​​the nasolabial triangle intensify, and sagging appears under the lower lip. The smile line goes down - now the corners of the mouth do not rise when smiling. Well, marionette wrinkles traditionally accompany the loss of a tooth, no matter where it is located.

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What is the diagnosis

Doctors often use 2 terms when describing problems with wisdom teeth.

Retention – when a tooth fails to erupt. It grew, but remained inside the jaw completely or partially. This can create a focus of inflammation, which either subsides or worsens again. But the most unpleasant consequence can be a cyst around the tooth if it has not erupted at all.

Dystopia is an abnormally positioned tooth, for example, horizontally. At first, such a tooth germ may not bother you at all. But when it starts to grow, it can lead to a lot of problems. You also need to remember that the tooth simultaneously grows in 2 directions towards the crown and towards the roots. If such a rudiment is tilted, then the tooth may appear from the side of the cheek or, conversely, grow inside the mouth and scratch the tongue.

One of the options for dystopia is a horizontal arrangement.

During the process of growth, a slightly inclined tooth in a narrow jaw can “catch” on the neighboring one, which will lead to an accident. The growing tooth will turn around and lie horizontally. Further, the growing tooth can gradually displace the remaining teeth and lead to crowding of the front teeth. This will create a new problem, not only an aesthetic one, but daily hygiene becomes more difficult and the risk of caries increases.

Often dystopia is combined with retention, which provides more reasons to remove problematic eights.

Features of wisdom teeth removal

Wisdom teeth, also known as third (outermost) molars or numbers of eight, are teeth that erupt later than others, and sometimes do not erupt at all. They do not participate in the chewing process and other functions of the oral cavity, and therefore are justifiably considered useless. But these teeth add troubles to a person’s life. Dental plaque accumulates on them and stone forms, creating favorable conditions for the development of caries, periodontal disease and other diseases. These teeth are difficult to clean with a regular toothbrush. In addition, during eruption they cause pain to their “owner”. This significant discomfort forces patients to turn to dentists with a request to remove unnecessary teeth that cause so much concern.

And, indeed, eights are the most problematic teeth. They are massive, often have the wrong direction of growth, and their roots lie at great depths in the bone tissue. All this complicates the extraction procedure. In such cases, complex removal is performed. The doctor's procedure is as follows:

• a deep incision is made in the gum;
• The tooth subject to extraction is separated from the soft tissue using a scalpel;
• make drilling of the interroot septum;
• forceps are fixed on the crown;
• The molar is rocked and removed from the socket;
• Sutures are placed on the gum tissue.

The operation takes place under anesthesia and is completely painless, but is considered quite traumatic. This implies the development of an inflammatory process, which, in the absence of timely treatment, can lead to serious consequences, causing sepsis and other pathologies. In addition, after the operation, the patient experiences swelling, pain, fever, pain when swallowing and other undesirable effects. Therefore, figure eights should be removed only if there are medical indications.

Risks

There are genetic features that do not change, but there are those that depend on various factors, including age.

Facial structure

One of the easiest ways to determine whether there is a greater or lesser risk of problems with wisdom teeth is through a mirror. Let's pay attention to the face. If it is elongated from bottom to top, has narrow cheekbones, and people say a small, neat face, then there may not be enough space for wisdom teeth. But the wider the cheekbones, the wider the “bone”, the more space there is for cutting figure eights.

Also, sufficient space in the jaw reduces their crowding and creates conditions for good hygiene. And this is the best prevention of caries, not only of the seemingly unnecessary tooth that we inherited from our ancestors, but also of all other teeth.

A consultation with an orthodontist and radiation diagnostics (X-ray/MRI) will help you understand the situation.

Age dependent

Problems that can arise with wisdom teeth at different ages can vary significantly2.

In youth, the main problem is inflammatory processes during the eruption of wisdom teeth. As well as the need to remove them for orthodontic treatment.

In adulthood, those who have retained their teeth begin to experience caries. The occurrence of pulpitis and cysts usually leads to a surgeon for removal.

In old age, the main problem is periodontal disease, which usually also leads to the removal of wisdom teeth. Or it becomes a preparation stage for prosthetics.

When to panic?

How long can you go without teeth before all these unpleasant consequences appear? Here you need to figure out what happens after tooth loss.

In the jaw bone there is a so-called tooth socket. If a tooth falls out, then the number of blood vessels in the area of ​​its former root decreases - they are no longer needed. Following this, the bone tissue around the hole begins to dissolve, and instead of the hole, a dent forms. Then the jaw drops and becomes thinner in this place.

In youth, elastic skin and rapid cell renewal allow you to live 3-5 years before tooth loss is reflected in the form of wrinkles. But after 40 years, such wrinkles appear within six months to a year after tooth loss! It is difficult to say which is more dangerous - after all, while youth allows a person to avoid prosthetics, the jawbone is destroyed. So, at any age, it is advisable to restore a lost tooth within 3 months. Otherwise, there is a risk of aging outwardly earlier than nature should!

Why is it so scary

Whether wisdom teeth need to be treated or removed immediately is not easy to decide. They are inconvenient to treat either for patients or for dentists themselves. The former “run out of steam” in the chair, trying to open their mouths wider, while the latter must show all their dexterity in order to reach the problem tooth. A dentist can even cure a difficult tooth, but the gum pockets around the gums can constantly become clogged with food, then the “carious monsters” again attack the tooth and all efforts are in vain.

If pulpitis occurs, rarely will anyone undertake root canal treatment. Roots in the amount of up to 5 pieces, adhesions, shapes in the form of hooks and squiggles, will become an impenetrable labyrinth for any speleologist dentist.

So, having suffered and spent N amount of money, many come to the logical result - “Delete!”

But removal can be just as scary as treatment. According to studies, complications occur after removal in more than 50% of cases3. They are often successfully treated, but add sick days and discomfort.

After wisdom tooth removal, there is a high probability of encountering complications.

Should I delete or not?

Yes. If diseases or complications have already arisen. Or the situation with 3 molars creates a high risk of diseases and their complications. Such cases include:

• lack of space in the dentition. Crowding – deformity – malocclusion;
• incorrect anatomical position (dystopia). The tooth grows towards the cheek, tongue, throat. May damage mucous membranes and cause ulceration;
• installation of braces to correct the bite. Freeing up space for other teeth;
• destruction of a neighboring tooth. As the tooth grows, it can damage the adjacent molar;
• problems with eruption (retention).

No. The teeth are healthy, there are no problems and no problems are expected.

Special attention. Long business trips, pregnancy, any situations that limit the possibility of providing medical care. Before these events, it is better to get advice and assess the risks, because treatment often requires surgery.

Prevention

The right strategy, starting with teething, will help you worry less and reduce risks:

1. Orthodontic consultation at a young age.
2. The culture of brushing teeth using effective methods in hard-to-reach places, not only with a brush, but also:
   dental floss;
3. irrigator;
4. mono-beam brush.
5. Preventive hygiene and examination
6. Timely removal when problems are inevitable and it is better to prevent them than to treat the consequences.

The wisest decision regarding your health and wisdom teeth would be to visit a dentist in a timely manner. This will help protect you from problems and, most importantly, from consequences.

Literature:

1. Iordanishvili A.K., Korovin N.V., Serikov A.A. ANATOMIC AND TOPOMETRIC CHARACTERISTICS OF THE JAWS DURING ERUPTATION AND RETENTION OF WISDOM TEETH // Problems of Dentistry 2022 No. 3.
2. Iordanishvili A.K., Korovin N.V. et al. AGE FEATURES OF WISDOM TEETH DISEASES//Kursk Scientific and Practical Bulletin “Man and His Health” 2015 No. 4.
3. Iordanishvili A.K., Korovin N.V. et al. COMPLICATIONS AFTER REMOVAL OF WISDOM TEETH AND THEIR TREATMENT//Kursk Scientific and Practical Bulletin “Man and His Health” 2022 No. 4.

Speculation and truth about preserving wisdom teeth

Speculation No. 1. Some people believe that nature has nothing superfluous, which means that third molars are useful for something. But it has already been scientifically proven that our chewing system can cope quite well without these teeth. Now the norm for a person is 28 teeth, not 32.

Speculation No. 2. Sometimes they want to preserve wisdom teeth at all costs in order to use the “eight” in a bridge structure in the future if one of the chewing teeth fails or collapses. But this is a misconception. Firstly, because the “eights”, as a rule, occupy the wrong place, which makes it impossible to install a bridge. Secondly, modern dentistry is trying to get away as much as possible from bridge-like or combined structures in favor of single ones. Today, implantation is the highest quality and modern method of replacing missing teeth.

It is fair to note that a number of scientific and practical works are being carried out in the world, as well as in our clinic, related to the transplantation of eighth teeth in place of lost, damaged sixth or seventh teeth. But at present, such operations are exclusively scientific and research in nature. This technique has maximum observation results of less than 10 years - for dentistry this is still the minimum period of time to be able to talk about some kind of statistics or system. In addition, transplanting such teeth has a lot of restrictions: only an erupted tooth is transplanted, healthy in all respects, without caries, the bone tissue at the transplant site should not be damaged, and so on... This is far from a mass procedure, which is performed only by leading surgeons, very a small number of patients. If you wish to use a wisdom tooth for transplantation, a patient at our clinic must undergo a specialized consultation, following which a council of specialists will decide on the possibility of this type of treatment.

World dentistry has clearly formulated its attitude towards preserving wisdom teeth - they can be preserved only under the following conditions:

— there is enough space on the jaw for their teething;

— having erupted, these teeth did not disturb a person’s bite;

— there are normal conditions for maintaining good hygiene of these teeth.

If a carious process has begun on these teeth, or they in any way interfere with other teeth or the chewing process in general, then this is an absolute indication for their removal. The only reasonable and correct way to treat wisdom teeth is to remove them. World dentistry in this matter is merciless to the “eights” and allows their presence exactly until the moment they do not harm anything. It is difficult to independently assess the destructive ability of third molars, since a person is very adaptive. Only a specialist can identify the disturbances that wisdom teeth introduce into the functioning of the dental system.

Speculation No. 3. Sometimes people think that if wisdom teeth have not erupted, then there is absolutely no need to worry about them. However, unerupted teeth are a kind of cocked spring that is located inside a person’s jaw, and if any unfavorable factor begins to act on this spring, it will make itself felt. Hidden “eights” can provoke all kinds of inflammation of the gums, cause caries, and cause pain. Of course, not all wisdom teeth that remain undetected are dangerous, but in any case they need to be monitored. A person who has not acquired wisdom teeth (one, two, three or all four) often cannot independently understand whether he has them, or whether he is lucky - and they are not even in the rudiments. To determine this, you need to undergo an X-ray examination, at least take a general panoramic image (OPTG), or undergo a modern cone-beam computed tomography (CBCT). Ideally, such images should be taken for diagnostic purposes once every 2-3 years for each person in order to exclude hidden processes and assess the general condition of the jaw. Modern X-ray examinations have ultra-low radiation, so such examinations are as safe as possible.

The eighth teeth are removed if necessary, starting at the age of 12-14 years. This is usually associated with orthodontic treatment. Before orthodontic treatment at any age, two things are mandatory: thorough oral hygiene and removal of wisdom teeth, erupted or unerupted.