No Evidence to Support Removing Impacted Wisdom Teeth

Release Date: June 13, 2012 | By Christen Brownlee, Contributing Writer
Research Source: The Cochrane Library

KEY POINTS

  • There is little evidence to support removing or not removing impacted wisdom teeth that are not causing symptoms of pain or discomfort.
  • Currently, dentists can only rely on their experience and patient values for determining whether to remove asymptomatic wisdom teeth.
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Little evidence exists to support removing impacted wisdom teeth that are not causing pain and swelling, aren’t negatively affecting other teeth, and are disease-free, finds a new review in The Cochrane Library.

According to the review authors, led by Theodorus (Dirk) G. Mettes of the Radboud University Nijmegen Medical Center in the Netherlands, wisdom teeth—third molars that typically make an appearance when individuals are between age 17 and 24—often fail to break the gum line, or do so only partially. These so-called impacted wisdom teeth have the potential to cause a host of problems, including swelling or ulceration of the gums around these teeth, cysts or tumors, and damage, decay, or disease in the second molars. However, many people can go their entire lives without these teeth causing any problems.

Though the general consensus among most dentists and oral surgeons is that troublesome impacted wisdom teeth should be removed, Mettes says, there’s a range of opinions on what to do with asymptomatic ones. Some dental care professionals advise patients to have these teeth removed as a matter of course to prevent future problems.

Though such prophylactic removal can avoid problems caused by these teeth, extraction surgery isn’t without risks. At the very least, patients who elect for surgery will have some pain and swelling that requires time off of work, school, and other pursuits and will incur the cost of the procedure. More serious risks include permanent nerve damage, a broken jaw or infections in the bone and surrounding tissues.

As a result, Mettes explains, some care providers prefer a “wait and see” approach, removing impacted wisdom teeth only when problems arise. This approach can have its own disadvantages, such as allowing problems to advance if patients or their dentists aren’t vigilant, or requiring time off and expense for monitoring visits.

To help develop a consensus, Mettes and his colleagues combed medical databases for studies that compared those who had asymptomatic wisdom teeth removed to those who retained them. Their extensive search turned up only a single study. Even this research, meant to determine whether removing these teeth in adolescents prevents future crowding of front teeth, was inconclusive.

Though care providers’ and patients’ decisions on whether to remove asymptomatic impacted wisdom teeth “should be based on the best available evidence and combined with extensive clinical experience,” little evidence exists for or against this procedure at the moment, Mettes says.

Thomas Dodson, D.M.D., M.P.H., an oral and maxillofacial surgeon at Massachusetts General Hospital and a member of the American Association of Oral and Maxillofacial Surgeons (AAOMS), emphasizes that the decision to remove is clear-cut if there’s disease or dysfunction in impacted wisdom teeth. However, he says, it can be a tough call for people in whom these teeth are asymptomatic and disease-free.

“Those tend to be the longer conversations,” he says. “I rely on patients to tell me what they prefer to do.”

He notes that the study designs necessary to help care providers and their patients make better decisions—randomizing large groups of patients into two groups, one which has these teeth removed and one which has teeth retained—are costly and time-consuming.

“In systematic review after systematic review, each says that more research is necessary,” Dodson says. “But so far, no one has had the interest to fund the necessary research.”

TERMS OF USE: This story is protected by copyright. When reproducing any material, including interview excerpts, attribution to the Health Behavior News Service, part of the Center for Advancing Health, is required. While the information provided in this news story is from the latest peer-reviewed research, it is not intended to provide medical advice or treatment recommendations. For medical questions or concerns, please consult a health care provider.

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Reach the Health Behavior News Service, part of the Center for Advancing Health, at hbns-editor@cfah.org or (202) 387-2829.

The Cochrane Library (http://www.thecochranelibrary.com) contains high quality health care information, including systematic reviews from The Cochrane Collaboration. These reviews bring together research on the effects of health care and are considered the gold standard for determining the relative effectiveness of different interventions.

Mettes TDIRKG, Ghaeminia H, Nienhuijs MEL, Perry J, van der Sanden WJM, Plasschaert A. Surgical removal versus retention for the management of asymptomatic impacted wisdom teeth. Cochrane Database of Systematic Reviews 2012, Issue 6. Art. No.: CD003879. DOI: 10.1002/14651858.CD003879.pub3.

Tags for this article:
Oral Health   Evidence-Based Medicine  



Comments on this article
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MISTAKE says
October 15, 2013 at 1:31 PM

DONT LISTEN TO ALL THE SWEET WORDS. IMPACTED WISDOM TOOTH EXTRACTION IS A TERRIBLE DANGEROUS PROCEDURE THAT MUST BE BANNED. MY TOOTH WAS ASYMPTOMIC BUT THE DENTIST TRICKED ME INTO TAKING IT OUT. AND YES I HAVE PAINS FOR YET ALMOST 3 MONTHS AND YES JAW PAIN, AND YES DRY SOCKET, AND 2 MONTHS ON DIFFERENT TOXIC PILLS THUS EVEN STOMACH PAIN, RECEIVED IBS AND LIVER ENZYMES INCREASED. SO DONT BELIEVE THE SWEET WORDS! THE PEOPLE LIKE ME WHO HAD A BAD EXPERIENCE ARE HERE TO WARN YOU OFF. I ACTUALLY HAD READ THAT BEFORE I DID IT BUT I DIDNT BELEIVE, I BELIEVED IN THE SWEET WORDS AND NOW I SUFFER.

THE DENTIST says
October 29, 2013 at 2:57 PM

to MISTAKE, not all dentists are the same. not all cases of impacted teeth are the same. not all patients are the same. dont generalize! unfortunately for you, the one who did your wisdom tooth was, i would say, very inexperienced, for that to happen. hoping for the better for you, though.

THE DENTIST says
October 29, 2013 at 3:03 PM

and i might add, i dont believe the 'wait and see' approach. why wait for problems to arise while you can eliminate it at the best time now? its like waiting for a cyst to grow inside a patient's mouth caused by an impacted tooth. or an adjacent molar to decay caused by the impacted wisdom tooth.

Curious George says
November 1, 2013 at 12:32 AM

This message is for THE DENTIST, if 4 impacted wisdom teeth are to all be removed why would the surgeon opt to do one side and then the other side later? Is it a matter of milking the insurance company or is it really best for the patient to suffer the same thing twice?

Curious George says
November 1, 2013 at 12:55 AM

This message is for THE DENTIST, if 4 impacted wisdom teeth are to all be removed why would the surgeon opt to do one side and then the other side later? Is it a matter of milking the insurance company or is it really best for the patient to suffer the same thing twice?

The Breathy Midgit says
November 16, 2013 at 4:37 PM

Right so, what is the fixed price for 3 impacted wisdom and 1 broken, boney wisdom tooth (previous needle nosed)? No insurance. None. I understand that this question answers none but that's how it is with impacted sh*t. Now, onwards, how much will it cost to pull these babies outa ma jaw Doc.?

Tot Dental says
November 21, 2013 at 8:58 AM

As well explain the opinions are diverse.
Preventive So we could extract to prevent shifting of teeth in their first symptoms is not painful and may go unnoticed.
Best wishes from Tot Dental.

Elizabeth brown says
December 24, 2013 at 2:44 AM

I also was a victim of a tooth extraction! The dentist I was a patient of insisted of removing two wisdom teeth at once...on right side of mouth. They were ninety percent through and raised above my gums just about the same amount of other teeth in my mouth not too painful.looked like they were coming in straight also..had them removed and it was worse then child birth! Had a horrible Infection after, in pain for months. Now the dentist wants to take one more out....ooh heck no! I'm a second year law student and what comes to my mind foremost in reading this matter is dental malpractice! I decide for my own health matters in regards of my mouth, I'm not going to be manipulated by a doctor again! Talk I was told of nerves and risk of being paralyzed, infections..after being pulled, sounds to me the risks with them in or out of your mouth are the same!

Chetan Raikwar says
August 15, 2014 at 12:00 PM

Strange opinions in USA. We never have any such extraction procedure recommended in India. Wisdom teeth don't usually cause problem. Hardly peoples in India get them extracted, 99% keep them as it is a part of dental line :) full 32 teeth pack. Rest 1% get them removed in old age when those get rotten :p.

Salma Hayek says
August 21, 2014 at 8:26 PM

The people who claim to be a 'victim' of the dentist who was clearly "posessed by the devil" and 'sweet talked them' into the extraction of the third mollar make me laugh. I'm sorry folks,I feel with you,I've been thru this and must say that it is what it is-pain and disconfort and a lot of it! But honestly,you're behaving like Peter Griffin when he's had a common-standard prostate check performed for the first time in his life. Seriously,watch it on youtube and you'll see your self in that style of behaviour thats described by the creators of the Family Guy cartoon. LOL My advice: get those teeth out,the sooner the better. The dentist will take out 2 teeth at one side (this is in every country all around the world the same) because it lowers your risk of food related infection as you're able to chew your food on the unaffected side of your mouth. Dont be paranoid nor little children. Its got to be done. You have like 12% chance that you wont get wisdom tooth related problems..and the number is going down with age. When you get an infection in you 60's..then your chances of pre-during and after surgery priblems as well as an extremely dificult recovery are quite high. Not even talking about the hidden cysts and infections that might be poisoning your system for years uniticed.



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