Print journal: Time to remove your wisdom teeth!?

By: Michelle Tran, writing for The Science in Society Review

Evolutionists postulate that the diets of our more primitive ancestors were largely based on hard grains, seeds, and other forms of vegetation. As such, early humans were adapted to their lifestyle, sporting larger jaws and more teeth to aid in grinding down tougher vegetation. However, the advent of cooked foods was followed by a reduction in jaw size, and turned wisdom teeth into a redundant structure; those unfortunate enough to be a part of the 85% of human beings who still develop wisdom teeth [1] must contend with smaller jaw bones and superfluous teeth. Thus, wisdom teeth need to be removed, especially if they become impacted and don’t grow out properly.

Or so they say.

Dental literature has long been trending towards less invasive approaches when dealing with wisdom teeth, but one study found that the incidence of dentists recommending tooth extractions has stayed the same [2,3]. So why are third molar extractions still commonplace? Somewhere along the line, there is a disconnect in the information that flows from researchers to practitioners to patients.

The redundancy of third molar extractions can be seen even from older studies. According to researchers at the University of Florida, half of the wisdom teeth that are diagnosed as impacted will end up developing normally, and only 20% of truly impacted teeth may become diseased [4]. Almost 4 million people don’t actually need this surgery, and thousands of people have to suffer complications that are associated with removing wisdom teeth [5,6]. Accordingly, the American Public Health Association “opposes prophylactic removal of third molars, which subjects individuals and society to unnecessary costs, avoidable morbidity, and the risks of permanent injury” [7].

Furthermore, a study conducted by Yonsei University and Ewha Womens University showed that a lack of third molars is linked to condylar fractures, or breaks in the hinge joint of the jaw [14]. This discovery is one among many that establishes how wisdom teeth may not be as vestigial as many claim. And what about increased odds of pathology? Another study by Lysell et al. found that an average dentist considers cyst formation and root reabsorption as significant risks [16]. But in regards to impacted third molars, the prevalence of cyst formation is about 2-4%, and that of root absorption is less than 1% [16]. Thus, there is research that refutes the necessity of third molar extractions.

However, this is in direct conflict with what is being disseminated by dentists. Although more conservative dentists suggest that wisdom teeth do not recommend extracting healthy third molars [8] and some suggest that they can help shoulder the impact of tooth loss [9], most dental practitioners will still support wisdom tooth extraction. This is because wisdom teeth can be blocked by succeeding teeth, and are difficult to clean. Impacted wisdom teeth can also lead to gum infection and extensive tooth decay, and must be removed [10]. Removal may also be advisable to prevent pericoronitis and cysts, which are detrimental to nearby tissue or bone.

Since most dentists recommend it, most people also believe that third molar extractions are mandatory. This view can be seen in personal blogs and forums, where those considering tooth extractions post their inquiries. Responders usually offer words of encouragement and push for extractions, parroting the reasons provided by health professionals [11]. However, there are a handful of respondents who deviate from the norm, and profess to retaining their wisdom teeth with no difficulties [12]. Other uncommon posts include skeptics who post questions such as, “Do wisdom teeth really need to come out, or is my dentist trying to hustle me?” [13].

And so, it is as if the community of researchers, doctors, and patients are sequestered on their own islands with differing viewpoints on the same issue. Thus, information concerning third molar extractions is not necessarily available to everyone. Information from researchers is usually found exclusively in specialized journals, of which the general public does not frequent.

Informational discrepancies may stem from internal shortcomings; inconsistencies within research or in a failure to draw concrete conclusions [17]. For example, the American Association of Oral and Maxillofacial Surgeons (AAOMS) examined statistics and written sources to gain a better perspective on the wisdom tooth debate, but ended up with mixed results [18]. Thus, the stance that AAOMS takes on wisdom tooth removal remains ambiguous. The conflicting conclusions of their paper only serve to demonstrate how information from primary sources can be quite muddled.

Such inconsistencies may only serve to confuse dental practitioners and oral surgeons, hindering their ability to do what is best for patients. This was seen when Almendros-Marques et al. [16] conducted a study to gauge how dental specialists decide when to remove wisdom teeth. Four dental specialists were presented the records of forty patients with impacted but asymptomatic third molars and asked for a diagnosis. Overall, the participants rated that 95% of the third molars should be extracted, and seemed to put special consideration into the patient’s age and third molar impaction type. These factors seemed to feed into concerns that included unpredictable eruption, damage of adjacent teeth, infection, and the crowding out of other teeth. However, all of these concerns are not exactly evidence-based. As previously stated, the aforementioned conditions are often associated with wisdom teeth, but are not very common [6]. These well-intentioned but possibly misguided associations are then passed down to the patients. But what about the not-so-well-intentioned dentists?

Money could be another reason for dentists and oral surgeons to push for extractions. The cost of extracting wisdom teeth depends on the complexity of each case, but extraction of a single tooth can range from $100 to $400 [6]. Thus, money could be a reason for dentists to push for extractions.

Thus, there are disconnects between all levels of the informational flow. With something as simple as better communication, people can come to their own informed conclusions about wisdom teeth, and possibly save themselves from unwarranted expenses, groundless suffering, and adverse health issues. Being in the age of the internet and still not being able to clearly convey ideas to each other shows that there is much room for improvement. With people becoming more and more health conscious, it is imperative to root out misinformation lest the public be forced to deal with the consequences.

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2. Zadik Y, Levin L. Decision Making of Israeli, East European, and South American Dental School Graduates in Third Molar Surgery: Is There a Difference? J of Oral and Maxillofacial Surgery 2007; 65:658-662.
3. Guidance on the Extraction of Wisdom Teeth. London: National Institute for Clinical Excellence; 2000.
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13. Katala. Do wisdom teeth really need to come out, or is my dentist trying to hustle me? [homepage on the Internet]. 2008 [cited 2012 Apr 18]. Available from: http://ask.metafilter.com/105996/Do- wisdom-teeth-really- need-to-come-out-or-is-my-dentist-trying-to-hustle-me
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17. Mettes DTG, Nienhuijs MMEL, van der Sanden WJM, Verdonschot EH, Plasschaert A. Interventions for treating asymptomatic impacted wisdom teeth in adolescents and adults. The Cochrane Library 2010; 2008(4):1-16.
18. White paper on third molar data. American Association of Oral and Maxillofacial Surgeons. [serial on the Internet]. 2007 [cited 2012 Apr 15]. Available from: www.aaoms.org/docs/third_molar_white_paper.pdf
19. Weisheitszahn2. [homepage on the Internet]. 2005 [cited 2012 Jun 21]. Available from: http://commons.wikimedia.org/wiki/File:Weisheitszahn2.JPG

This is an excerpt of an article that was originally published in The Science in Society Review, a sister publication of The Triple Helix Online. Michelle Tran is a student at University of California, Davis. Contact us to read the original article, and follow us on Facebook.