I can see my wisdom teeth, do they need to be examined & removed?
Yes!
They need to be evaluated because a healthy dentition requires several conditions:
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| Normal gingival anatomy |
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| Mucogingival junction, Attached gingiva, Free gingival margin |
1. The tooth needs to be fully erupted into the mouth which means none of the gum tissue that surrounds the tooth can be too close or covering the biting surface of the tooth. The Free Gingival Margin must be around the perimeter of the tooth. If you notice as you move from the upper front teeth and look to the upper back teeth the height of the tooth, from the gum to the biting surface, shortens. Therefore eventually running out of enough space for tooth or gum. This is because of the anatomy of the maws and how they function in an arc.
2. The biting (occlusal) surface of the tooth must be level with the second molar or tooth directly adjacent to it when viewed from the same side or laterally. Teeth that aren’t functioning and actively engaging their biting surface during use have a tendency to decay due to the lack of wear and use. Actively chewing with the biting surface has the same effect on the tooth as cleansing, it removes pulverized proteins and sugars and pushes them off the tooth and onto the tongue. When a tooth is not engaging the opposing arch it does not naturally cleanse itself.
3. Attached gingiva. Compare the different soft tissues adjacent to the other teeth and in the rest of your mouth and you will notice there are 2 types. One is loose tissue like that on the cheek. Then follow that tissue towards the teeth and you will notice a spot where the tissue is attached to the bone right next to the teeth. That is the point where the tissue type changes and is called the Mucogingival junction in addition to how it’s attached to the underlying bone whereas the unattached tissue of the cheeks have no bony base to attach.
4. If all these requirements are not in order there is a high probability that pathology associated with the inability to maintain the tooth will result in the need to have it removed. There are then two choices to make. Wait until there are significant symptoms to remove the tooth or remove the tooth as we find out it doesn’t meet these conditions. We know that with increased age generally the health status changes with more risk of chronic illness and patients healing capacity declines after age 40. Therefore, having teeth extracted that may not be painful but aren't maintainable or in ideal situation are a ticking problem. We know that the risks of extraction are significantly less with younger age.
5. If a patient is young and healthy clinically or less than 40 years old, consider removal or treatment of the third molars. If a patient is older, then consider removal in the presence of active pathology. Make this an informed decision between the patient and their Oral & Maxillofacial Surgeon. Having an informed consent conversation about the risks benefits and alternatives of treatment.
The Girldoc😉
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