There is mounting evidence that routine wisdom tooth removal is a waste of time

Most of us don’t see our wisdom teeth growing through, but many people in the United States or Australia are advised at some point between middle school and university that they must be extracted.

Depending on whether the teeth are impacted (stuck behind the gum line), the surgery may include general anaesthesia, sutures, and a week or two of bed rest and pudding. It can be a harrowing start to adulthood for many of us.

However, an increasing number of doctors are questioning whether the majority of these surgeries are even essential. And a growing corpus of evidence suggests that we may be placing people at risk of costly tooth removal for no cause.

To be clear, not all wisdom tooth extractions are essential. If wisdom teeth are left in people’s jaws, they might become infected, cause dental rot or cysts, harm neighboring teeth, and cause excruciating agony.

The data is clear in these circumstances that it is considerably preferable for a patient to have their ‘third molars’ – the formal name for wisdom teeth – removed.

However, researchers are beginning to examine the other cases, in which wisdom teeth are impacted but the patient is otherwise healthy or has no symptoms at all.

The United Kingdom abandoned routine wisdom tooth extraction without good evidence in 1998, after a study at the University of York concluded that there was no scientific evidence to support it.

The Royal College of Physicians of Edinburgh stated the same year that removal is “not indicated” for those who do not have a problem related to third molars.

Routine wisdom tooth extraction is still the normal technique in many nations, including the United States and Australia. The explanation offered is that leaving them in just postpones the inevitable, as people with wisdom teeth will experience infection or difficulties later on.

Based on that premise, 10 million wisdom teeth were extracted from American mouths in 2011, and a 2015 study projected that seven times more people are hospitalized in Australia for the removal of impacted wisdom teeth than in the UK.

However, current evidence reveals that it may be overkill

“Everyone is susceptible to appendicitis, but do you remove everyone’s appendix?” According to Rony Carin Rabin of The New York Times, Greg J. Huang, chairman of orthodontics at the University of Washington in Seattle.

I’m not opposed to wisdom tooth removal, but you should do an examination and have a valid clinical rationale.

So, what does the research indicate? A 2014 assessment of seven publications exploring what happened when young adults left their wisdom teeth in found additional recent data to justify getting wisdom teeth out “just in case.” While the study found that leaving wisdom teeth in did increase the chance of difficulties later in life, that wasn’t the whole picture.

The research concluded that the risk of having to undergo removal appeared to increase as participants aged.

“However, at least one of the research in the [review] came to the opposite conclusion. Rather, the British study discovered that 83.13 percent of patients survived the one-year study period symptom-free, with only 5% requiring tooth extraction.”

While several studies have linked keeping wisdom teeth in with ongoing problems, “there does not appear to be a single randomised clinical trial – the gold standard for scientific proof – comparing similar patients who have and have not undergone prophylactic wisdom teeth removal,” writes Rabin in The New York Times.

On the other hand, there is a growing body of evidence that shows the reverse – that removing wisdom teeth is unneeded.

A 2011 research of almost 6,000 wisdom tooth extraction patients in Greece discovered that just 2.8 percent of the teeth contained a cyst or tumor.

In addition, according to a well regarded 1988 study, only 12% of 1,756 middle-aged patients who did not have their impacted wisdom teeth removed reported a difficulty.

Even more troubling, the American Public Health Association (APHA) disregarded several of the common justifications for wisdom tooth removal in 2008, such as surrounding teeth being injured or wisdom teeth harboring bacteria that could cause periodontal disease.

The organization concluded, “The few studies of long-term retention of impacted teeth have revealed low risk of injury.”

The APHA also approved a policy that year stating that the risks of leaving wisdom teeth in do not outweigh the risks of surgery, which are not insignificant. Aside from the hazards of anaesthesia, surgery can result in nerve damage, loss of taste, and, in extreme cases, death.

Given this, why do dentists continue to urge that so many patients have their wisdom teeth extracted? Everything boils down to uncertainty.

“The trick is that clinicians still don’t have all of the tools and data available that would make them comfortable with a sit-and-wait approach,” said Julia Boughner, a cell scientist at the University of Saskatchewan in Canada who has been closely watching the argument.

So, what should you do if your dentist advises you to get your wisdom teeth extracted? Rabin suggests determining whether the danger of surgery is genuinely worth it in your circumstance, and whether there are any less invasive treatments you may try first.

In other words, seeking a second or third opinion before committing to surgery can’t hurt.

But when is it worthwhile to take the risk?

“Among critics of regular extraction, the general view is that chronic gum infection, or pericoronitis; irreparable tooth decay; an abscess; cysts; tumors; damage to neighboring teeth and bone; or other pathological conditions warrant the treatment,” adds Rabin.

Whatever you pick, the most important thing is to visit your dentist on a regular basis for checkups and cleanings, because dental health is serious business. Especially for young folks just starting out in life.