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The wisdom of having wisdom teeth out


Ah, summer vacation. Time for college students to take a break, hit the beach, get a job -- and, for more than a few, have their wisdom teeth removed. Though it may not be as anticipated as other summer traditions, college students have for years scheduled wisdom-tooth surgery to coincide with summer break.

"It's the busiest time of the year," says Towson oral surgeon Dr. John Emmett. "If I take out two sets of wisdom teeth a day in the dead of winter, I may do five to six of these surgeries a day in the summer. It's a two- to three-fold increase per day."

Summer is convenient because students have extra time, and those who attend schools out-of-state can recuperate at home with their parents. Although not everyone needs to have his or her wisdom teeth removed, studies have shown that even those whose wisdom teeth came in with no trouble may have problems with them later in life.

Jeremy Rexrode, 21, a senior at the Community College of Baltimore County's Essex campus, saw Emmett for a consultation this spring and scheduled surgery to coincide with the start of summer vacation.

"I can't miss school time," Rexrode says. "The way he did the surgery was so easy, I only needed a weekend for recovery."

Wisdom teeth, also called third molars, were once a vital tool for humans, used for eating uncooked prey. But human jaw sizes have shortened, leaving inadequate space in most people for the four teeth located farthest back in the mouth.

Wisdom teeth erupt in most people between the ages of 17 and 25 -- "when wisdom is attained." Those that remain completely buried or that emerge in a normal position may not cause harm. However, if X-rays show that the teeth may grow in at an angle, dentists often advise patients to have them removed -- usually all four at once -- before problems such as pain and bacteria buildup occur.

Nicholas Merchant, 21, who will be a senior next year at Essex Community College, gave a lot of thought to picking a date for his surgery. He balances being a full-time student with two jobs: one detailing cars, the other cooking for Applebee's restaurant in Towson.

Two months ago, he scheduled his surgery to fall on a Monday during the last week of spring-semester classes. He completed his final assignments the week before, in case there were any complications from surgery, reported to Applebee's for the night shift the day after surgery, and went to school that Thursday to hand in his already-completed work.

Many practitioners consider scheduling the surgeries to be part of good preventive dentistry, says Owings Mills oral surgeon Dr. Barry Berman.

"If you're not sure the teeth will come in correctly, you might as well get rid of them," says Dr. Alexander Pazoki, an assistant professor of oral and maxillofacial surgery at the University of Maryland's Baltimore College of Dental Surgery. "It's a question of access. If the teeth erupt and you can clean them, OK. If you can't floss back there, you're going to get cavities and decay."

"I'm not saying everyone should be getting their wisdom teeth out," says Dr. Daniel J. Daley Jr., president of the American Association of Oral and Maxillofacial Surgeons, an organization that represents more than 7,000 oral surgeons nationwide, "but in recent years a number of studies have shown the downside of keeping them."

Dr. Raymond White, a professor of oral and maxillofacial surgery at the University of North Carolina's School of Dentistry in Chapel Hill, has been directing a study of adults who have kept their third molars.

"If an 18-year-old comes into the office inquiring about wisdom teeth, he should be told that two out of three people will have problems with them" later in life, White says. "There are more chances than not you'll have a problem."

Since the study's inception 2 1/2 years ago, White and colleagues have found that adults ages 52 to 74 with visible third molars are 1.5 times more likely to suffer periodontal disease in the area of their second molar than those who have had their third molars removed. In other findings, one in three adults with an impacted tooth (one that will erupt at an angle) had a tumor or cyst in the soft tissues deep in the jaw surrounding the teeth. And two out of three adults had at least one deep pocket of bacteria near a third molar when they enrolled in the study.

It's problems like these that caused Dr. Anthony Silvestri, director of dental anatomy at Tufts University's School of Dental Medicine in Boston, to speculate that it might be wiser for people not to have wisdom teeth at all.

In a laboratory study, Silvestri successfully used a laser to prevent the growth of half of upper wisdom teeth and 80 percent of lower wisdom teeth in rats. Though he and his colleagues also have had some success preventing third-molar development in dogs, their funding has run out. Silvestri said he hopes to continue his work.

"Prevention of third molar development early in life, even before tooth bud initiation, could dramatically improve health care outcomes for millions of people," he wrote in a recent article for the Journal of the American Dental Association.

Until the profession is able to figure out a way to keep wisdom teeth from growing, college students -- and others -- will continue having them removed, and oral surgeons will continue having busy summers, which may not be such a bad thing. As Dr. Barry Berman notes, "This is when you make a living."

The basics

Removal of wisdom teeth is a common operation. Patients are usually sedated for the hourlong procedure, which is generally done in an oral surgeon's office, but may take place in a hospital.

Recovery time is typically two to three days. Patients may be prescribed anti-inflammatory medications or narcotics to take during the first 48 hours after surgery to help control pain and prevent infection.

Oral surgeons' advice regarding wisdom teeth:

Get X-rays at your dentist's office on a regular basis to follow the progression of wisdom tooth growth and to check for cyst development.

If you change dentists, take a copy of your X-rays with you.

If you decide to keep your wisdom teeth, periodically ask your dental hygienist to check for bacteria pockets, and schedule regular cleanings to keep bacteria levels down.

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