Third Molars Myths & Realities

SHOULD THEY BE REMOVED?

When and Why?

  • Wisdom teeth or third molars are the teeth furthest away in the dental arches and they are usually the last ones to erupt… if they ever come out!

  • For their eruption to occur normally, there must be sufficient growth at the back of the jaws to accommodate these teeth. For most people who have all their permanent teeth, this happens rarely and wisdom teeth fail to erupt.

  • Growth of the lower jaw occurs mostly at the back and this growth is essential to allow the eruption of the third molars. If growth is inadequate, wisdom teeth will remain impacted.

  • It is very rare to see someone with the maximum possible of 32 teeth in the mouth (including wisdom teeth) that are optimally aligned and functional.

  • Teeth that have not completed their eruption within a reasonable time are called “impacted” if they are completely submerged under the gum and “semi-impacted” if they pierce through the gum only partially.

  • The dental community agrees to recommend the extraction of third molars that are symptomatic or cause problems (pain, infection, damage to other teeth, etc.)

  • What about impacted teeth that are asymptomatic? Wisdom teeth have historically been blamed for many problems. They are accused, among other things, to cause tooth movement by exerting pressure on other teeth when trying to erupt. Studies have shown that, although they may play a small role in these tooth movements in late adolescence and later, they are not the main cause and several other more important factors, such as residual growth must be considered.

  • Even when third molars are extracted, it is common to see anterior dental movements occur thereafter.

  • Removing third molars will not prevent lower anterior dental crowding.

  • However, a semi-impacted tooth or a tooth presenting signs of pathologies represents a risk of serious problems.


EXAMPLES OF THIRD MOLARS ERUPTION PROBLEMS

PREDICTING THE ERUPTION OF WISDOM TEETH

  • The main way to assess the presence and position of third molars is to take a panoramic radiograph and evaluate certain factors, such as the size of the teeth, the formation of their roots, the direction of eruption, the available space, the jaw bone, etc.

  • In an attempt to predict the eruption of third molars, several methods have been developed. Some are very ingenious and original, but none has proven to be accurate every time. Some are very simple while others rely on fancy calculations of tooth position and evaluation of future growth.

  • But… despite the availability of several analytical methods, predicting which teeth will erupt adequately or not is sometimes just a lucky guess!

Look at the following examples of radiographs that show the behavior of wisdom teeth over many year


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