To Pull or Not to Pull?

Wisdom teeth can be troublemakers in the mouth

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Very few people have room for their wisdom teeth, according to Beau Kapp, a dentist at Larson Creek Dental in Medford.

While it’s often a case of case-by-case, current wisdom about wisdom teeth tends toward removing them. An adult whose wisdom teeth are fully in place and not causing any issues might not need to have them removed. However, if those last molars are half-in/half-out, they can be a recipe for decay trouble. Many dental professionals recommend removing wisdom teeth even if they’re not problematic.

Why keeping teeth may not be wise

“Very few people have room for their wisdom teeth,” says Beau Kapp, a dentist at Larson Creek Dental in Medford. “Humans have evolved to a point where we don’t need them, and they can cause potential problems.”

Kapp said that most dentists evaluate each case individually. “In the past, there may have been dentists more proactively taking wisdom teeth out; it varies among dentists, and some are more conservative,” he says. “It’s sort of a philosophical issue for dentists.”

However, Michael Doherty, an oral surgeon at Rogue Valley Oral & Maxillofacial Surgery in Medford, explains that current research indicates it’s better to remove them even when all seems well.

“For patients with wisdom teeth in their mouth, periodontal disease develops and has been shown to spread to the adjacent teeth,” he says. “Patients are also at risk for cavities in these teeth that are hard to keep clean. For wisdom teeth that are not visible in the mouth, evidence-based medicine demonstrates a significant number of patients develop pain, infections and symptoms that affect quality of life. In clinical practice, this is what is seen every day in dental and medical offices and, unfortunately, in emergency rooms.”

Teens versus adults

Wisdom teeth are easier to remove in teenagers because the roots aren’t fully formed and the bone around them is softer. Dentists need to start looking at their patients’ wisdom teeth in between the ages of 12-18 to weigh the pros and cons of removing them.

“At that age, the wisdom teeth are like little seeds that pluck out with very little trauma,” Kapp says. “Many times they might be covered over by gum and sometimes bone, but once you can grab hold of them, they pluck out like a watermelon seed.”

But in adults, both the process and recovery are tougher. Recovery time for a teenager is about a weekend, according to Dyan Dalton, surgery manager at the Oral and Maxillofacial Surgery Center of Oregon. Post-op swelling can last a week. Their pain lasts one or two days and is easily managed by medication, she says.

“Kids heal a lot faster. The sockets where the teeth used to be fill in gradually from the bottom up, and for most kids, the sockets are closed between four and eight weeks.”

Adults, however, usually will experience more pain, longer, Dalton says. Swelling still goes away in about a week, but the sockets often can take six months to close fully because adult bone regenerates more slowly.

And caring for those open sockets for six months can be an annoyance.

“It can be a rather large hole,” Dalton says. “We do give them a syringe that’s curved and angled so they can get back there to clean it. It doesn’t cause a problem as far as eating, but you do need to clean it out. It’s more of a nuisance than anything else. But it does feel like a long time.”

Removing wisdom teeth that aren’t problematic in teens comes down to a judgment call by the dentist or oral surgeon. But sometimes parents seek to have them taken out to avoid having them disrupt expensive orthodontia that they have been paying for over the years, Dalton says.

“Many orthodontists recommend extraction of wisdom teeth after completing orthodontics to eliminate a possible cause of future crowding,” Doherty adds.

Pain is sign to pull

But no matter what the patient’s age, if wisdom teeth are causing problems, they should come out.

“One thing to watch for is infection,” Dalton says. “Or sometimes cysts can develop and that can destroy bone. That can cause problems in the jaw or the destruction of other teeth. And if it’s an upper tooth, it can affect the sinus cavity.”

Doherty, Kapp and Dalton agree that the best course for wisdom teeth in children and teens is to have the dentist take annual X-rays to keep an eye on them and how they are developing. In adults, if you have any doubt about your wisdom teeth, discuss it with your dentist.

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Extraction Action

Legally, all dentists are able to remove wisdom teeth, says Beau Kapp, a dentist at Larson Creek Dental. And a dentist will make the call based on his or her personal experience and training.

“There are many general dentists that do it and are good at it,” Kapp says. “They might refer patients to an oral surgeon if the teeth are near a nerve or a sinus, as that could be a situation where you don’t want a bad result.”

Most wisdom teeth extractions are covered by dental insurance, whether performed by a dentist or oral surgeon.

“Fees are determined by whether a tooth is impacted (covered by bone) and to what degree,” explains Michael Doherty, oral surgeon at Rogue Valley Oral & Maxillofacial Surgery. “Fees also vary due to anesthetic options. It is very difficult to give patients an idea of fees without a consultation, as the range for four wisdom teeth can be from $600 for lidocaine and teeth in the mouth to $2,500 for going to sleep and complex full bony extractions. Usually the costs are around $1,600 to $2,000 for most patients.”

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