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   Simon W Rosenberg, DMD

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All about Wisdom Teeth -- Third Molars
Wisdom of the Ages is Like Money in the Bank

Have you considered putting your wisdom teeth in a safety deposit box? If you are like most people, then likely not. However, it may be possible in the future for people to have stem cells taken from their own wisdom teeth and saved. The stem cells would be used to help regrow teeth, to restore nerve cells, to correct a cleft palate or periodontal defects, to regrow jawbone and to save teeth, according to Pamela Gehron Robey, Chief of the Craniofacial and Skeletal Diseases Branch for the National Institute of Dental and Craniofacial Research at the National Institutes of Health. This type of stem cell harvesting is non-controversial because the cells are removed from a person’s healthy teeth, not from a fetus.

Robey advised attendees at a recent American Dental Association conference that jawbone grown from bone marrow has already been used to replace lost jawbone in a patient. She hopes that stem cell technology can be used to regrow teeth for patients who have been in car accidents or suffered some other trauma that caused them to loose teeth and to help people whose nerves have been damaged from Parkinson’s disease.

Some get them, some don’t; some are fine, some aren’t

When we are born we usually come into the world toothless, but as we age, teeth appear in our mouths on a somewhat regular schedule. For example, our first molars (large grinding teeth at the back of the jaw) usually appear when we are 6 or 7 years old, our second molars when we are 12 or 13, and our third molars (wisdom teeth) when we are typically between 18-20 years old*-when we are much “wiser.” Many people have four wisdom teeth, one on each side of the upper and lower jaws, while others have only 1-3 wisdom teeth.

Unfortunately, not all wisdom teeth erupt correctly (grow out from under the soft tissue-gumline-covering the jawbone), if at all. The tooth may lie sideways in the jaw, either pointing inward toward the back of the mouth (distoangular impaction-least common), outward toward the cheek (mesioangular impaction-most common) or pointing directly at the second molar (horizontal impaction). The wisdom tooth might only partially break through the soft tissue, which is called vertical impaction.

X-ray of Unerupted Wisdom Tooth

Unerupted Boney Impacted Wisdom Tooth

Angular Vertical Impacted Wisdom Tooth which has caused Decay in the Second Molar in Front of it.

Horizantal Full Boney Impacted Third Molar
Horizontal Impaction

Erupted Third Molar
Erupted Third Molar

Various sources list the age range from as low as 15 years old to as high as 25 years old.

Pericoronitis -- a Painfull Inflamation, Infection around the Third Molars

Pericoronitis -- a Painfull Inflamation, Infection around the Third Molars

Impaction is not a good thing

Impaction, simply stated, means that the wisdom tooth has either not erupted at all or has not fully pushed up through the gumline. An impacted wisdom tooth can cause serious-and even deadly-health problems. For example, the person can experience pain, get jaw and gum infection (pericoronitis), a tooth abscess**, have crowded or crooked teeth, or the nearby teeth and roots can be harmed. One of the more serious problems is the development of a cyst. If not treated, the cyst can form a tumor or cause jawbone destruction; it can move other good teeth out of position or damage nearby teeth.

It is more difficult to reach, brush and floss a partially erupted wisdom tooth. Bacteria can creep down into the soft tissue surrounding the impacted tooth. The resulting infection can produce pain, swelling, a stiff jaw (difficult to fully open the mouth) and bad breath. The infection can spread to the cheek and neck. Now for the really scary part: Older adults can experience life-threatening problems when the infection causes the other soft tissues in your mouth and throat to close off the windpipe, you can develop heart disease, diabetes complications, or the infection can travel to your brain!

In late 2005, a late 1990s study was made public that showed that 60 percent of the pregnant women in their twenties who participated in the study already had early gum disease around their wisdom teeth. The study’s position is that pregnant women who have their wisdom teeth are at a risk of having complications with their pregnancy and other health issues. The women who had the most serious gum disease were twice as likely to have a premature baby, according to the American Association of Oral and Maxillofacial Surgeons. The most significant aspect of the study is that in the 1990s, it was thought that only adults 35-40 years old suffered from complications caused by gum disease, and now professionals know that age is not a factor.

Sometimes, the person is unaware that any damage has occurred, which presents an even more dangerous situation.

The good, the bad and the ugly

Here is the good and the bad about impacted wisdom teeth. If treated early-early teen years-complications from impacted wisdom teeth seldom arise. If not treated until later years, after 20 years old, serious complications may occur. During the teen years, the jawbone is not as dense and hard as it is when the person ages, and the tooth root is comparatively short; thus, extraction of a wisdom tooth is a relatively uneventful procedure. A teen also heals more quickly than an older person. Once the jawbone is hardened and the tooth’s roots have grown longer, one might as well loop a 1-inch cable around the tooth and hook the other end of the cable to the bumper of the family sedan, figuratively speaking of course. Older adults can suffer nerve damage from a difficult extraction. The American Association of Oral and Maxillofacial Surgeons and the Oral and Maxillofacial Surgery Foundation recommend that wisdom teeth be removed while the patie nt is still a teenager, which brings up an on-going controversy: The Ugly.

It has been a customary practice to routinely extract wisdom teeth at an early age. However, there is a growing body of research that shows that there is no substantial evidence to either support wisdom teeth removal or to leave them in place (Refer to link below to the Cochrane Collaboration.). Their position is that 60 percent of wisdom tooth surgeries are unnecessary.

From statistics the other side of the fence, however, show that about 85 percent of wisdom teeth will need to be removed. These contradicting ideas and statistics might indicate that there is a substantial amount of subjectivity in deciding whether or not to remove wisdom teeth.

So, what is a person supposed to do?

As usual, good oral health care is the Golden Rule. Dr. Trey Petty, a spokesperson for the Academy of General Dentistry , advises people to take good care of their erupted wisdom teeth. “…the key to preserving them (wisdom teeth) is maintaining good oral health by brushing twice a day and going to see the dentist twice a year,” states Dr. Petty.

If you are concerned about your wisdom teeth, talk to your dentist. Your dentist will advise you about the risks, complications and outcomes related to keeping or removing your wisdom teeth.

Keep your teeth healthy; your future dental needs and your health are depending on you. You can take that to the bank!

For more information, you may find the following Web sites useful:

Academy of General Dentistry http://www.agd.org/

American Association of Oral and Maxillofacial Surgeons http://www.aaoms.org/wisdom_teeth.php

Cochrane Collaboration http://www.cochrane.org/

National Institute of Dental and Craniofacial Research http://www.nidcr.nih.gov

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