Recently, a patient was referred to me for extraction of his lower wisdom teeth because his primary dentist told him they would cause his bottom front teeth to move. Often I will have patients express the same concern to me (or more often their parents.) So where did this idea come from? Does it really happen?
Crowded lower anterior incisors
Wisdom teeth are the third molars, or the very last tooth in the back of your jaw. Back in the 1960's the idea that wisdom teeth cause crowding was introduced by Dr. Leroy Vego in his paper "A Longitudinal Study of Mandibular Arch Perimeter" (Angle. 1961) and launched a rite of passage for generations of orthodontic patients through the 1990's. Dentists and orthodontists began telling their patients that they should have their wisdom teeth out to prevent relapse of their orthodontic treatment. Nobody wanted to see their perfectly straight teeth go crooked. As a result, millions of wisdom teeth saw the light of day by the end of a surgeon's forceps.
Over the next 30 years, dentists started noticing that despite having wisdom teeth out five, or ten or thirty years earlier, their patients were still developing crowding in their lower front teeth. It turns out that front teeth naturally want to get closer together over time, wisdom teeth or not! In fact, I have seen patients with no back teeth at all, just six front teeth, and they develop crowding too. There are many theories as to why.
My favorite is this one: Our primitive ancestors had a coarse diet that caused teeth to wear down and fall out early in life and their jaws evolved so that back teeth would move forward to replace them. The modern diet is softer and causes less wear, people live longer and keep their teeth. Unfortunately, those teeth still remember to keep moving forward causing crowding of the lower front teeth.
So if taking wisdom teeth out won't prevent crowding of the lower front teeth, what will? Orthodontic retainers. Remember those things the orthodontist gave you and told you to always wear or your teeth will shift? That's why.
There are many good reasons to remove your wisdom teeth (to prevent or treat infections, cavities, or to avoid problems with adjacent teeth) but causing crowding is not one of them. If your wisdom teeth are otherwise free of any other problems, it's OK to just leave them alone, with one exception.
Sometimes when a problematic lower wisdom tooth is removed, it is often recommended that the symptomless upper wisdom tooth is taken out at the same time. This is due to a condition called "supereruption." Your teeth function in pairs. As the chewing surface wears down, teeth naturally continue to erupt. That is, they keep actively coming in to your mouth, so that they stay in contact together and you can continue chewing effectively. Supereruption occurs when a tooth is taken out. The opposing tooth will continue to erupt, looking for its partner until eventually you start biting your cheek or the gums which can then cause painful gum infections.
Extracting the potential supererupting tooth prevents those gum problems, and also eliminates a food and plaque trap that can cause cavities and gum disease on adjacent teeth.
So if you are told to have your wisdom teeth out, make sure you know the reason why. It may not be necessary or entirely elective. If you have additional questions about wisdom teeth or other dental concerns, call us today to schedule a consultation. 617-232-7399, firstname.lastname@example.org
Dr. Jason Arandia treats dental patients from Boston, Brookline, Brighton, Waltham, Newton and Watertown. He received his general anesthesia training at Hartford Hospital and is licensed to practice moderate conscious sedation and nitrous oxide analgesia. Dr. Arandia is a member of the Dental Organization for Conscious Sedation (DOCS).