Should I have my child’s wisdom teeth extracted? This is a question I am asked frequently, especially at the end of orthodontic treatment. The question is very logical. We have been working to align the teeth for two years and everyone is excited to unveil their new smile to the world. The last thing that anyone wants is to leave the wisdom teeth to spoil our great work. On the other hand, the extraction of third molars is usually carried out by an Oral Surgeon using some form of sedation. The decision to refer must be thought out and based on science.
According to the American Association of Oral and Maxillofacial Surgeons (AAOMS), the decision to avoid extracting the third molars (AKA Wisdom Teeth) depends on their meeting the following criteria: completely erupted and non-impacted, completely functional, painless, free of decay, disease-free, capable of being properly cleaned. As can be seen from this list, the academy of oral surgery leans heavily toward extraction. This list fails to aid in my decision making in most cases as the average teen completes orthodontic treatment between 13-14 yrs old and the wisdom teeth erupt between 17-21 years old.
What I prefer to use as a guide is the anatomy of the mandible (lower jaw) and the developmental stage of the third molars. For example, there is a nerve that runs the length of the lower border of the mandible called the inferior alveolar nerve. Among other things, this nerve provides for our feeling in the lower lip. The third molars develop right over this nerve and it is not until around 15-16 yrs old that the roots of the teeth tend to approximate and sometimes even wrap around the nerve. I allow the third molar to grow and hopefully find a reasonable eruption path prior to the completion of development of its roots. If I find that there is too much pressure being placed on the 12 year molars, I will refer for evaluation prior to the full development of the roots. What this accomplishes is the removal of the third molars with a much reduced chance of damage to the nerve.
As in most situations, timing is everything. Our protocol consists of consistent retainer wear as soon as braces are removed. We then monitor the third molars until they either come in or are removed. Consistent retainer wear is more than sufficient in maintaining that beautiful smile through the process. In fact, we are recommending long term night time wear of the retainer even if the third molars are removed. As it turns out, the eruption of the third molars is the most well known, but not the only factor which can cause shifting of the teeth over time.
- The office of Dr. Maria Maranzini-Grosman (Board Certified Pediatric Dentist) and Dr. Alon Grosman (Specialist in Orthodontics) is located at South Flamingo Road on the NW corner of Griffin and Flamingo Road. For more information or to schedule an appointment, call 954-236-3434.