Indications for Removal of Wisdom Teeth

These days in 2019 the American Association of Oral and Maxillofacial Surgeons (AAOMS) has a page on their website titled “Third Molar Research News” that contains information on how to manage wisdom teeth, see https://www.aaoms.org/media/third-molar-research-news. How to manage wisdom teeth continues to be contested when wisdom teeth are healthy and not causing symptoms, see for example http://www.teethremoval.com/controversy.html. One of the documents AAOMS provides is titled “The Management of Impacted Third Molar Teeth” and contains a long list of what they consider as medically necessary and valid reasons for surgical removal of wisdom teeth, see https://www.aaoms.org/docs/practice_resources/clinical_resources/impacted_third_molars.pdf. However at least two of these reasons seem to be unsupported by current scientific evidence and thinking.

The first reason in doubt given by AAOMS as a valid reason which seems to lack evidence is insufficient space to accommodate erupting tooth or teeth. This reason seems to get at the question of if wisdom teeth cause crowding. However as discussed in the post Do Wisdom Teeth Cause Crowding? and at http://www.teethremoval.com/wisdomteeth.html there is not any evidence to support the theory that wisdom teeth cause crowding. According to a systematic review by da Costa et al. titled “Is there justification for prophylactic extraction of third molars? A systematic review” appearing in Brazilian Oral Research in 2013 (vol. 27, no. 2, pp.183-188) the authors state

“…scientific proof points to the non-indication of prophylactic extraction for the purpose of preventing late crowding of the lower incisors.”

Thus the authors in the article by da Costa feel that extracting wisdom teeth to prevent late crowding is not justified and does not have any scientific base. Furthermore removing a wisdom tooth because their is insufficient space to accommodate it is not listed as a valid reason in the guidelines provided by National Institute for Health and Clinical Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN), see http://www.teethremoval.com/wisdomteeth.html. Results of reviews from the study by da Costa and others have consistently shown that there is no evidence one way or the other to support or refute removal of asymptomatic wisdom teeth. Just because a wisdom tooth does not have sufficient space to erupt does not mean it is diseased, will cause symptoms in the future, and needs to be removed.

wisdom teeth pain - Indications for Removal of Wisdom Teeth
This image is from Edward Webb on Flickr and has a Creative Commons license

The second reason in doubt given by AAOMS as a valid reason which seems to lack evidence is the general term of pain. According to the document provided by AAOMS just because a wisdom tooth is causing a bit of pain they are saying it can be medically necessary to remove it. However, any reasonable person knows that wisdom teeth cause a bit of pain when they are erupting which is normal and does not mean they should be removed. According to the NICE and SIGN guidelines when there is atypical pain from an unerupted wisdom tooth and removing the wisdom tooth can remove the possibility that the atypical pain is not from muscle dysfunction or the temporomandibular joint than this a valid reason for removal. However, one should note the use of the term atypical pain and again when a wisdom tooth is erupting normally this is typical pain and not atypical. Just by checking Twitter we can see that lots of people have experienced pain from wisdom teeth lately but lots of this pain is just part of the normal eruption process of the typical course.

It is noted that in the 2016 Management of Third Molar Teeth White Paper by AAOMS, see https://www.aaoms.org/docs/govt_affairs/advocacy_white_papers/management_third_molar_white_paper.pdf, it states

“Predicated on the best evidence-based data, third molar [wisdom] teeth that are associated with disease, or are at high risk of developing disease, should be surgically managed. In the absence of disease or significant risk of disease, active clinical and radiographic surveillance is indicated.”

However it just seems that at least two of the reasons AAOMS gives that are medically valid and necessary to remove wisdom teeth including 1) pain and 2) insufficient space to accommodate erupting tooth or teeth should be reconsidered. Neither of these reasons necessarily equates to a wisdom tooth being diseased or at a high risk of developing disease.

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