Teens' wisdom teeth: Should they stay or should they go?

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Some common dental questions parents have as their children take the joy ride into adulthood include: Should my teenager have his/her wisdom teeth taken out? Will leaving them in cause the lower front teeth to crowd? Is this really my child?

And occasionally this interesting question: "Cavemen survived without having their wisdom teeth removed so why do we need that done now? Is it because of our soft diet?"

To evaluate whether or not wisdom teeth need to be removed your dentist will assess a number of factors.

First they will take an X-ray that shows where the wisdom teeth are positioned. Is there enough space in the jaw for the new teeth to come in completely? If the wisdom teeth can only poke their heads part way out of the gums because of a lack of space, they will almost certainly get infected as bacteria and food particles climb down under the gums.

Is the person taking good care of the teeth they already have or will the new teeth be as neglected as the current tenants? Are they coming in straight or are they lying sideways in the gums with the biting surface of the new tooth pressing against the root of the tooth ahead?

These teeth are referred to as impacted and need to be removed so they don't ruin the root of the tooth in front.

The dentist will also look to see how developed the roots are and their shape. Do the roots look like an ice cream cone or the talons of an eagle? The curved roots tend to hang on for dear life while the cone shaped ones usually slide out peaceably.

As people get older, into their mid-20s for example, the roots become more developed and the bone gets harder making removal increasingly interesting. As far as wisdom teeth causing crowding, the standard answer is probably not. Peoples lower teeth tend to crowd whether or not they have wisdom teeth present.

There are of course many colorful stories out there about wisdom tooth removal. A dentist on a cruise vacation who announces his occupation will have a line of people waiting to tell him their wisdom tooth story.

These stories have a common theme revolving around an old dentist who in one very athletic move placed a knee on the person's chest, a hand on their forehead and commenced the proceedings without so much as a "good morning."

He would stop every now and then for a leisurely cigarette break, talking about fishing as ashes fell lazily on his smock while the unlucky patient waited for him to resume.

Fortunately the dental school teaching this technique closed long ago when it's most famous graduate, Don Knotts, headed out to become "The Shakiest Gun In the West".

Your dentist will decide based on how difficult the wisdom teeth will be to remove and his/her enjoyment of said procedure whether they will remove the teeth or refer your young adult to an oral surgeon.

If you decide to have your family dentist do the procedure she/he will probably offer either laughing gas (nitrous oxide) or a sedative like valium to make the process more relaxing. If you go to oral surgeons Dr. Caso or Dr. Ash at Walla Walla OMS, you can choose how deeply you want to be sedated in order to make the procedure more forgettable. Your dentist and oral surgeon work very hard to make you as comfortable as possible and make the wisdom tooth experience as easy as they can.

I guarantee that no one will put their knee on your young person's chest!

So what about that caveman myth?

For some ethnicities, there can be a poor match between the size of the teeth and available space in the jaw.

If the teeth are too big or the jaw is too small the late-arriving wisdom teeth are crowded out. Take the crooked teeth of the British, for example.

In London around turn of the 20th century the most common cause of death in young men was from infections around impacted wisdom teeth.

This was of course before the age of antibiotics and the ability to predictably and safely remove these problem makers. Other ethnic groups seem to have little trouble with wisdom teeth, so it may matter what geographic region your various ancestors came from.

In any case your dentist will be happy to talk to you about what's best for your little caveman.

Dr. Eric Gustavsen practices dentistry at Southpoint Dental Center, 1129 S. Second Ave. More information on his practice can be found at www.southpointdentalcenter.com.

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