Blogs from our resident Doctors and Practitioners
Why Remove Wisdom Teeth?
My often-sarcastic insight.
by Dr. Michael Webster
Why Remove Wisdom (Teeth)? My often-sarcastic insight.
Is it really necessary? (Duh)
They don’t bother me. (If it ain’t broke don’t fix it)
They grew in just fine. (Nice try at taking my money)
There’s room for them. (Again nice try you greedy Dentist)
My last dentist said I didn’t need to. (He/she can’t possibly be wrong – again you must be greedy)
And, if I keep them, will they cause crowding? (Okay, you win, this one definitely hits the greedy button).
Without a doubt, these are the most common questions, concerns, and comments I receive on the topic of wisdom teeth removal. As is in many cases concerning the human body the answer is not always straightforward, and really comes down to YOU as an individual. Weird, we can’t just simply standardize everyone?
Why are we even in this situation in the first place? Why would biology provide us with 3 sets of molars and ask us to remove 1 set of them? The answer lies in human evolution and the phrase ‘Use Them or Lose Them.’
Many moons ago, several million actually, we required massive teeth to chew the harsh uncooked diet that nature reluctantly provided us to survive. Advances in diet and food preparation techniques allowed for softer diets, unless your mother cooks like mine. Over evolutionary years, jaw size has shrunk in response to this softening in diet and has resulted in a situation where 3rd molars, also known as wisdom teeth, don’t always fit.
So what does this mean to us?
Poor-fitting wisdom teeth, also known as impacted wisdom teeth, can result in the following:
• Gum disease
• Tooth decay
• And even cysts and tumors.
When any of the above conditions exist, removal is the obvious choice. However, it is less obvious when they grow in without any drastic complications. Some questions that may arise are “What about cases in which wisdom teeth fully erupt in the correct position?” or “What if they can be cleaned properly as part of daily hygiene practices, and therefore can remain a healthy part of dentition?” In some cases, wisdom teeth are fine to remain in. The real question is should we proactively remove them to prevent complications from happening in the future?
The answer to this is hardly clear, as we can’t always predict the future. A guiding factor in this decision is age. Between 15-25 years old, the mandible is relatively soft and wisdom teeth removal is easy, uneventful, and has a low risk of complications. As we age the density of the jaw increases, resulting in a more challenging removal. This is associated with a higher morbidity rate and higher risk of complications, one example being that 0.35- 8.4 percent of patients experience permanent nerve damage and numbness.
To clean or not clean, that is the question. Or in other words, can you clean, or do you clean? The percentage of people that brush their teeth twice a day for two minutes at a time, floss daily, and visit their dentist twice a year for checkups and cleanings… well let me just say it is quite an elite group. In fact, the odds that you make this dental royalty group puts you at the same odds as getting struck by lightning. Does that mean that if you’re not “dental royalty” you’re going to have problems? Not necessarily. Let me be honest, it simply is not always a fair world. Dental diseases are often described as disease of susceptibility, not neglect. What this means is that some people will do just fine ignoring their dentist’s recommendations and will cruise through life with a relatively boring dental history. Some on the other hand will be dental advocates, fighting for their dental rights, and simply find themselves sitting in a dental chair more often than a hairdresser’s chair. In my opinion, dental diseases are a combination of susceptibility and neglect, with internal and external factors constantly tipping the scale in an epic battle of playground see-saw.
So, I decide to keep them, does that mean I’m doomed? Is dental death inevitable? No, not necessarily, you’ll likely be fine, or not, I can’t predict the future. You might just plug along through life easily reaching the backside of your third molars with your toothbrush, delicately flossing your wisdom teeth while tickling your tonsils at the same time, and gently pass away in your sleep at the age of 100 with all your dentition intact, the only human appendage that is incapable of regenerating, pleasantly satisfied with yourself that you defied the odds and kept those pesky wisdom teeth.
Or suddenly, you’ll develop pain… or not-so-suddenly. Pain is often the end of a very long destructive process, and it is an evolutionary way of telling you to get your ass in gear and do something about it. If this occurs in your 30s, 40s, 50s, or so on, be prepared for a tougher recovery, higher incidence of complications, and potentially not having your mom around to look after you, or your parent’s insurance plan to cover the bill.
What if my wisdom teeth are under the gums sitting there doing nothing, should I get them removed? Maybe, maybe not. Under the gums doesn’t mean that they can’t still cause problems. Have you heard of Microbes? Specifically, bacteria? The little organisms we can’t see can pretty much get anywhere, and, if and when they get into the wrong spots can wreak havoc on the human body. Yes, don’t forget about these microscopic, little angels and demons. Even if they are fully encased in bone, with little risk of bacterial invasion there still is the rare and improbable, but still real possibility, that wisdom teeth can develop cysts or even tumors.
And NO you don’t lose wisdom. If I had a dollar for every time a patient cracked a joke about this, I wouldn’t have to be writing this blog. Third molars historically received this entitled name as a result of developing or erupting at a more mature age, an age in which people are ‘wiser.’ Yes, it’s a stretch but I’m not responsible for this weak correlation.
Do wisdom teeth cause crowding? No, they do not. The current literature does not support this. We can’t blame everything on wisdom teeth.
Can wisdom teeth wreck other teeth? Heck ya, we see it all the time. Incorrect alignment and even correct alignment can result in bacterial collection between 2nd and 3rd molars, which can lead to decay, gum disease, and periodontal disease.
So, at this point, I’ve either convinced you or you’re a life-long skeptic. Another common question is: why extract all four wisdom teeth at once? Simply put, one surgery means one recovery, which means one chance for complications such as infection. Why go through the same surgery 4 times? It’s simple math and probability.
Next question I get: “Do I need to be sedated? I’m not nervous. My friend just had theirs out without sedation.”
The answer: No, but yes.
When I began removing wisdom teeth 12 years ago fresh out of dental school, I used to give the patient’s the option. ‘Patient-centered care’ was what I advocated for and what I thought I was accomplishing. However, as I became more experienced, I realized the sedation element was for both the doctor as well as the patient. I get nervous too… JK. Sedation allows the doctors to control the surgical setting as much as possible so we can minimize and control complications, and safely perform the surgery. I wonder why pilots sit in a cockpit. Why can’t they sit back in economy and chit-chat with Gran about the weather as they land the plane? To answer this question, some might remove wisdom teeth without sedation, however, my standard of care consists of doing whatever it takes to minimize the risk of complications. This to me is ‘Patient Centered Care.’
If it is not apparent already, it is my humble and professional opinion that you would be doing yourself a huge favour to get those potentially troublesome molars removed as soon as possible. This is as early as 15 and ideally before the age of 30 when the human body has the ability to recover. As you head North of 30, the decision becomes less clear, and the benefits might just not outweigh the risks.
To wrap this up, my team and I will help guide you in making the decision that is best for you, based on your specific situation and risk factors. The decision is yours.
Dr. Michael Webster
How Do I Prepare My Child for Dental Treatment?
Hey, we are parents too! At Kelowna Dental Centre, our number one goal is to treat your child the way you would want them to be treated. We want to give your kids the best possible experience because we know that if they enjoy coming to the dentist, they will be more likely to take good care of their teeth and develop healthy oral habits into adulthood.
It is an honour to be your trusted dental providers for your family and this is something that we do not take for granted. Many parents have questions about how we approach dental treatment, so hopefully, we can break it down for you here:
1. The cleaning or exam visit: Do I come into the operatory with my child?
Whether or not dental treatment is needed is often identified during a cleaning and checkup appointment or a specific exam. Parents are welcome to accompany their children into the operatory during these visits, but it is also not always necessary. Unless the child is too shy to even sit in the dental chair without help from mom or dad, the visit can often be more fun and efficient if the parent doesn’t stay for the whole visit. Since our office is very “open concept,” a lot of parents will come back to the operatory to get the child settled, but then say “Ok, I’ll be out in the waiting room if you need me!”
Remember, we want the clinician’s focus during the visit to be on your child, and the conversation often isn’t focused on them if the parent stays in the room.
“Are they going to get a needle!” (Hint: Not a great question to ask us right in front of your child)
If your child requires dental treatment and you have questions about specifics, we are happy to answer any questions that you may have. This can be either in an area of the clinic away from your child or on the phone before the treatment appointment. We can often make their treatment visit more seamless if they don’t know every intimate detail of what we are doing and how we plan on executing it.
Most children adapt very well to new surroundings and new things. Children are often at ease immediately upon entering the clinic because the staff at our office all love children and do an excellent job of highlighting the fun parts of the appointment and explaining our procedure in a kid-friendly and fun way. Parents try their best to prepare their children for the first visit, and although they mean well, parents can often dishearten their children based on the way they describe dental treatments to them.
Parents often don’t know the particulars of the appointment and end up unintentionally highlighting the wrong things when describing dental procedures. Parents often say things like: “Don’t worry, it won’t hurt.” Children immediately think “Should I worry, is this going to hurt? Why would they say that?” “You are so BRAVE!” (again, most kids then think, “brave?” is something bad going to happen!?”)
2. Treatment day:
For many children, we recommend the use of Nitrous Oxide (laughing gas) during their dental procedures. Nitrous Oxide is a safe, effective form of minimal sedation that patients inhale through their nose during dental treatment. Nitrous Oxide is paired with oxygen during administration and when titrated to an effective level, it will give the patient the feeling of a warm hug during their procedure.
“Should I come to the operatory with my child or stay in the waiting room?” When parents are in the operatory during dental procedures, this can also have a negative effect on the child’s experience. Parents often feel that when they stay in the room for their child’s visit, they are being supportive. Sometimes the child will then be focused on mum or dad rather than just relaxing back in the chair and allowing us to guide their experience. Most visits are more efficient and seamless for the patient if we can just have a two-way interaction between the dentist and the patient. We want your child to be our number 1 priority during the visit!
3. Referral to a Pediatric Dental Specialist
In certain instances, we will recommend that your child be seen by a pediatric dental specialist for dental treatment. We work closely with several incredible specialists in the Okanagan to deliver the best treatment possible for your child. Ultimately, if we feel that your child’s experience would be better with the adjunct of their additional services, we will recommend this to you.
In closing, we love seeing kids at Kelowna Dental Centre. Dental treatments can be really fun and exciting for your child and we understand that you can have many questions, we are parents too! When explaining dental treatment to your children, try to use really positive and fun descriptions and leave the rest to us. If you struggle with finding positive ways to describe the dental treatment, it is probably best to let us describe the treatment to your child instead. Remember, most kids really enjoy their dental visits at our office! There are a lot of gadgety things that they don’t normally get to see, and the entire appointment is about them and only them!
At Kelowna Dental Centre, our #1 priority is to provide excellent care and give them the best possible experience. We try to make our patients feel at ease in the dental chair regardless of their age, and we will do everything possible to let them have a great experience when they come to see us!
Jennifer Drever, DDS
Kelowna Dental Centre