Guess who wants your wisdom tooth out? The tooth in front of it.

Patients sometimes say: “Why should I get my wisdom tooth out?  It doesn’t hurt.  I think I’ll just wait until it causes a problem.”

There’s many patients that think this way that don’t realize two important things.  The first, of course, is Murphy’s Law, which states that wisdom teeth only bother you when you’re about to take finals or get married or start a new job, and the pain usually starts on Saturday nights.  The second is that the “problem” they were waiting for is often more complicated and costly than simply removing the wisdom teeth.

Mesially Inclined Partially Erupted Third Molar That’s some dental speak for what’s  going on in the case I have drawn above.  Let me walk you through it.  In the first frame we have a second molar with a partially impacted wisdom tooth leaning forward and touching the back of the second molar tooth.  If you have your wisdom teeth, perhaps you’ve seen your x-rays or your child’s x-rays at the dental office and noticed this.  Sometimes, you can even see the back cusp of the tooth poking through the gums.  Brushing and flossing this area adequately is impossible, and as you can see in the second frame, food has a tendency to get stuck in there.  

If you can’t clean the bacteria and plaque and tartar out of the area, you have a perfect opportunity for the decay process to start, which you can see it the third frame.  In the fourth frame, the decay has gotten large enough to be close to the nerve of the tooth, and now it is likely starting to bother the patient.  

Time to get the wisdom teeth out! So what’s the problem?  Just take the wisdom tooth out, right?

Not so fast.  In this type of case depicted above, which is quite common, the wisdom tooth usually isn’t the source of the pain.  Usually it is the second molar.  As you can see, there’s a large amount of decay on the tooth.  The decay is in a very difficult place to fix, too, all the way down the back root.  Decay travels faster when it gets on the root because the root is softer, that’s usually why this tooth ends up causing pain before the wisdom tooth does.

Several procedures like a root canal and crown and perhaps crown lengthening may save this tooth, but it’s in really bad shape and taking both teeth out might be the best thing to do.  Replacing it with a dental implant is usually the treatment plan that produces the best outcome in this case.  The other option is just removing the tooth and living without it.  Chewing function will be greatly compromised and additional stresses will be placed on all remaining teeth, increasing the chance of other dental problems in the future, but at least you’ll be out of pain.

In summary, waiting for a situation like the one depicted above to start hurting can prove to be quite costly in more ways than one.  Financially speaking, taking out one wisdom tooth is always going to be less expensive than extracting two teeth and placing an implant.  Until further notice, you can’t get a tooth back once you lose it.  Dental implants are an excellent solution for patients that are losing or have lost teeth, but there’s nothing quite like the teeth you were born with.  More often than not, the least amount of dentistry is the best dentistry.  In the case described above, prophylactically  removing the wisdom teeth before the decay process gets going is the best dentistry, the least costly, and the least amount of dentistry.

If you or your child has impacted wisdom teeth, have your dentist evaluate them and advise you on the best route to go based on your individual needs.  Every case is different, but every case deserves attention and care.

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