Should You Remove Your Wisdom Teeth?

As a mean young man with shit insurance and what I thought was a pretty decent set of helicopters, I once missed a decade between dentist visits. I’m cleaning. I floss. I thought everything was more or less cool.

I have never had tooth decay so far, even after succumbing to Human pressure (and getting decent insurance) and becoming an obedient dental chair visitor twice a year .

But since my wisdom teeth erupted, when I was in my early 20s – during my oral health break – every dentist I visited has at some point talked about how I really needed them. delete.

Removing a wisdom tooth or third molar is a common procedure. According to a widely cited 2007 study published in the American Journal of Public Health , ten million of these are pulled out of five million heads a year. This is practically a rite of passage for people between the ages of 20 and 20.

I only have a few weeks left until 39, but I still have all four, which makes me something of a rarity. I’ve always thought, why would I voluntarily remove a perfectly healthy part of my skeletal system? No thanks.

At my last check-up, the hygienist said that she would not be able to completely remove the pharynx from the back of my mouth without causing me severe pain and bleeding from my half and half open third molars – a new problem for me. … So after a few weeks I had to go back for a very deep cleaning, excruciating despite the two syringes of anesthetic.

In the backseat of Uber, after this terrific procedure, after sampling my own blood and responding to the driver’s small talk attempt with a still face, I began to rethink my lifelong stance against wisdom teeth extraction. In the end, my theory that they never cause problems was disproved.

As common as it is, the procedure is not without controversy – and not only among conspiracy theorists like me. And the longer you put it off, the riskier it is.

All of these surgeries cost $ 3 billion a year and result in 11 million patient-days of discomfort or disability, according to a study by the American Journal of Public Health. The study found that more than 11,000 people suffer from permanent numbness of the lip, tongue or cheek as a result of surgery.

According to statistics, there are not many people – less than a quarter of a percent. But the horror of potential failure – the constant numbness of parts of the face – is unpleasant enough to make some patients (me) become obsessed with risk, no matter how small. In another estimate, published in the British Dental Journal , the risk of irreversible problems is about 20 percent in high-risk cases, such as those with impacted teeth or multiple gray hair and wrinkles.

And there are those who say that the risks outweigh the benefits, that the procedure is the solution to the problem.

Yoink …

Extraction advocates say that since teeth can ultimately cause problems, it is best to simply complete low-risk surgery before they do – and before those risks increase, which they will inevitably do. with age.

A white paper from the American Association of Maxillofacial Surgeons argues for removing them before you are old enough to rent a car with ease . Adverse reactions to surgery have occurred twice as often in patients over 25 years of age in the literature cited in the white paper, and the risks continue to increase with age.

“We generally recommend removing teeth during adolescence before the roots of the wisdom teeth are fully formed,” says Thomas B. Dodson , professor and chairman of the Oral and Maxillofacial Surgery Department, and Acting Chair of Pediatric Dentistry and Associate Research Fellow. Dean of Hospitals at the University of Washington School of Dentistry in Seattle. Dodson is also Associate Editor of the Journal of Oral and Maxillofacial Surgery.

“Younger patients recover faster and have a lower risk of postoperative complications than older patients,” says Dodson.

“Third molars are not like other teeth,” says Louis C. Rafetto , a private oral and maxillofacial surgeon in Wilmington, Delaware. He is also the Director of Surgical Implantology and Alveolar Reconstruction in the Dental and Oral and Maxillofacial Residency program at Christiana Care Health Systems and past. President of the American Association of Oral and Maxillofacial Surgeons.

He says that these teeth are more susceptible to disease than other teeth and we don’t really need them for food or anything else. And because they are the last to erupt, they clench in a tighter space than any other teeth, he explains, which can cause crowding. So, in spite of everything, they need to be watched.

We usually seek medical attention when we are worried about something. But for wisdom teeth, this approach does not work. “Asymptomatic does not mean no illness,” says Rafetto, “but simply no symptoms.” This means you cannot rely on the oops factor to make sure your wisdom teeth are okay. In fact, by the time they bother you, things can really be in bad shape.

Dodson says that of patients over 20 who choose to retain their third molars, more than 60 percent of them will need to have at least one removed over the next two decades. Rafetto says that given that teeth move “frequently and unpredictably,” if you do hold them, your dentist will have to look after them.

Wisdom teeth pose an increased risk of tooth decay and gum disease. But in the end, we are good at avoiding these kinds of problems by brushing and flossing our teeth. Isn’t brushing your wisdom teeth something we civilians can handle alone?

“Usually not,” Dodson says. “It is difficult to access the back of your mouth to brush your wisdom teeth. And if access is possible, it can be nearly impossible to completely clean partially erupted teeth. ”

… Or not to fuck

This study by the American Journal of Public Health , even though it says how low the risks are, contains a rather strong condemnation of the practice of removing wisdom teeth as a matter of course, and not in response to adversity. He calls the practice a public health hazard and states that two-thirds of the annual surgeries are unnecessary.

“Most of the pain and disease associated with third molars is caused by surgery, not teeth,” it said. Its author, Dr. Jay W. Freidman, has led a crusade against routine disposal for decades. In an interview with a dental blog in 2013, he said the surgery was meant to provide funds at risk to the patient’s health.

I don’t want to face nerve damage and long recovery times, and given my age, I risk both. But I don’t want to end up withLisa Simpson’s projected future without braces either . And while my teeth don’t hurt, this horrible scraping session certainly hurt – and the hygienist made it clear that there will be more in my future if the landscape of my mouth doesn’t change.

My reluctance, of course, baffled me. By not admitting them as an undergraduate, I firmly placed myself in the high-risk category – avoiding risks when they were comparatively unlikely led me to enter a population group where they were far more likely.

How to solve

Treatment is not always a simple binary task of pulling or not pulling. Rafetto points out several treatment options that may seem more acceptable to people who are reluctant to part with their choppers.

Coronectomy – partial removal – can keep your mouth healthy. In this procedure, the crown of a tooth is sawed off, but the root remains, preventing the crown from crowding other teeth, but avoiding the possibility of nerve damage that occurs upon contact with the root. Sounds funny. Also, the terrible deep cleaning that I have undergone is often repeated. Or your dentist may just want to keep a close eye on them during examinations and more frequent x-rays, which may or may not be covered by insurance.

I can discharge mine now as a high risk patient. I can keep throwing the dice and maybe (probably according to the docs) I will have pinching or cavities problems as I get even older and the surgery becomes even more risky.

Or I might just stop thinking about it for six months until my next date with the hygienist’s keen arsenal.


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