Why experts now say not to remove wisdom teeth

Research has shown up to 1 in 3 people with wisdom teeth never experience problems from them, thats why experts now say not to remove wisdom teeth.

Some dental experts have revised past recommendations about routinely removing wisdom teeth. This is because in many cases, wisdom teeth may not actually cause issues or problems if enough room exists in the jaw. 

As long as the teeth are not impacted or erupting improperly, and no dental health issues are present, leaving the teeth alone avoids unnecessary surgery risks and costs. 

Unless signs of crowding, infection or damage to other teeth occurs, monitoring the wisdom teeth initially through X-rays may be a safer option than automatic extraction. 

Removal should now only occur if clear dysfunction arises, reducing unnecessary extractions and complications.

Table of Contents

• Are wisdom teeth a modern problem?
• Why experts now say not to remove wisdom teeth
• When did wisdom teeth become unnecessary?
• Benefits of keeping wisdom teeth
• Disadvantages of removing wisdom teeth
  • Surgical Risks
  • Financial Costs
  • Sequelae
  • Future Issues
  • Quality of Life
• Key takeaways

Are wisdom teeth a modern problem?

Some researchers believe that wisdom teeth becoming impacted or problematic is more common today than in the past, and partly attributable to modern habits. 

As populations transitioned away from hunter-gatherer lifestyles over thousands of years, human jaws have become smaller through nutritional and dietary changes. Anatomically modern humans from as recently as a few centuries ago appear to have had larger mouths relative to their skulls. 

With less chewing stress on the jaw muscles from softer foods, wisdom teeth had more space to erupt naturally back then. However, in industrial societies with processed foods, smaller jaws are now more prevalent. 

This lack of sufficient room is a main driver of wisdom tooth impaction issues that seem to plague more people compared to ancient humans and non-industrial populations, making it a problem that emerged with modernity.

Why experts now say not to remove wisdom teeth

• Many people have sufficient room in their jaws for wisdom teeth to erupt normally with no issues. Up to 1 in 3 may never experience problems even with their wisdom teeth.
• Leaving them in avoids potential surgical risks like infection, dry socket, damage to neighboring teeth. Surgery also costs money and takes time to recover from.
• Recent research found monitoring non-problematic wisdom teeth first through x-rays is a safer option than automatic extraction in case issues never develop.
• Extraction should only be considered if signs of pathology emerge, like tooth decay, gum disease, cysts or infection around the wisdom tooth.
• Minor problems like slight tooth crowding may not warrant removal if the teeth are otherwise healthy and not causing pain.
• Removal should no longer be the default just because of their presence. Only if the tooth is clearly impacted, unlocking jaws, or damaging other teeth is intervention definitely needed.
• A less invasive approach reduces the number of unnecessary extractions and associated health risks young people may face.

When did wisdom teeth become unnecessary?

Wisdom teeth have been gradually becoming unnecessary over thousands of years as the human diet has changed. 

In ancient times when our diets primarily consisted of tougher foods that required extensive chewing, early humans tended to have larger jaws that could accommodate all 32 teeth including wisdom teeth with adequate room for proper eruption. 

However, as agriculture developed around 10,000 years ago and societies shifted towards softer agriculturally-based diets that did not require as much chewing, human jaws steadily began to shrink in size over many generations. 

This trend accelerated further during the Industrial Era when processed foods became widespread. By the 20th century, most individuals living in industrialized societies had significantly smaller jaws than their prehistoric ancestors that could no longer properly accommodate wisdom teeth. 

It was at this point as jaw sizes continued to reduce that orthodontists started recommending routine prophylactic removal of wisdom teeth, since they were less likely to have sufficient space and more prone to issues like impaction. Wisdom teeth had essentially become an evolutionary remnant left over from earlier times.

Benefits of keeping wisdom teeth

• By keeping wisdom teeth, the full dental arch is preserved which is important as the jaws continue developing and growing in width and thickness throughout late teens and early twenties. 
• Having all 32 teeth maintains structural alignment and guidance for proper positioning of other molars and premolars as they move into place. This growth process can be disrupted if back teeth are surgically removed too early.
• Additionally, wisdom teeth provide valuable extra chewing surfaces and tooth structure. They come into use especially when chewing tough foods like fibrous meats or vegetables. This plays an important role in proper breakdown of foods to aid digestion. 
• For individuals who are missing other molars due to decay or prior extractions, keeping wisdom teeth helps compensate and maintain enough surfaces for chewing.
• Keeping wisdom teeth also allows for the possibility that they may ultimately erupt and function normally over time in some cases. Even if coming in slightly tilted, they still contribute usable structure as future prosthetics or implants are considered if other teeth wear out or are lost in later life. 
• Prematurely extracting leaves one fewer natural tooth options.
• Avoiding oral surgery minimizes risks of post-operative complications from the procedure like infection, nerve injury, bleeding or dry socket formation that can result in severe pain for weeks. 
• It also eliminates costs, time off work/school needed for recovery, and risks of exposing vulnerable jawbones and sinuses unnecessarily through surgical intrusion.
• Retaining teeth maintains the bony architecture underneath and between the roots which provides structure and stability to the entire dental arch.
• This is important for preventing shifting of neighboring teeth and subsequent risks like periodontal disease. It also helps preserve jaw width long-term which is beneficial for aspects like smile aesthetics or supporting dentures if worn in future.

Disadvantages of removing wisdom teeth

Surgical Risks

Dry socket occurs in 1-3% of extractions when blood clot is dislodged, exposing bone. It is extremely painful for weeks.Nerve injury risk is higher for lowly placed/impacted teeth. 

The inferior alveolar nerve or lingual/buccal nerve branches may be damaged.l Risk of sinus perforation if tooth is near maxillary sinus. Grafting may be required increasing risk/cost.General anesthesia used carries 0.01% risk of cardiac/respiratory issues.

Financial Costs

Average total extraction cost is $200-400 per tooth for surgery alone in the US.Additional costs for post-op appointments/medication easily add another $100-300.Healing times of 2-4 weeks mean missed earnings or need for sick leave absorbing income.

Sequelae

Around 30% of patients report moderate-severe pain up to 7-10 days post-op.5-10% develop alveolar osteitis or dry socket releasing bone fragments prolonging pain.Facial swelling and trismus can occur 1-2 weeks interfering with daily habits.Rarely, alveolar abscesses or oro-antral fistulas requiring hospitalization develop.

Future Issues

Neighboring tooth roots may be damaged during surgery raising risk of late complications.Loss of ridge integrity from extraction leads to 10-15% reducion in vertical bone height.Remaining dentition is now unsupported raising chances of periodontitis/caries.

Quality of Life

Eating is difficult due to jaw stiffness, pain risking malnutrition during healing.Social engagements may be canceled or enjoyment reduced due to discomfort.Irrigation/cleaning of sockets post-op is painful increasing distress levels.Psychological impact of invasive oral surgery can induce long term dental anxiety.

Key takeaways

• Not needed . Jaws shrinking over generations mean wisdom teeth often don’t fit properly now.
• Risky removal . Surgery introduces risks like infection, nerve damage even if teeth appear fine.
• Costly procedure . Extraction is an unnecessary medical expense if teeth never cause issues.
• Recovery time . Healing from oral surgery takes weeks, costs missed work/school time.
• Watchful waiting . Monitoring through regular x-rays is a low risk option before extracting asymptomatic wisdom teeth.