An interesting article titled “Wisdom teeth, periodontal disease, and C-reactive protein in US adults” appears in Public Health written by Y. Zhang and et al. (vol. 187, pp. 97-102, 2020). The study sought to evaluate the associations among the presence of wisdom teeth, periodontal disease, and serum C-reactive protein (CRP) in the US adult population. Periodontal disease is a chronic gum disease which has been linked to many systemic diseases. An elevated level of CRP indicates systemic inflammation as it is a sensitive non-specific biomarker and has been linked to risk for cardiovascular disease. The end goal of the study was to generate population-based evidence to inform heart disease prevention and dental care.
In the study the authors performed a secondary data analysis using the National Health and Nutrition Examination Survey (NHANES) 2009-2010 data from the national cross-sectional survey conducted by the Centers for Disease Control and Prevention. A total of 3752 adults aged 30 and older completed a periodontal examination, 3703 adults had their wisdom teeth presence recorded, and 3602 adults completed serum CRP testing. The results showed that 39% of the US population aged 30 years and older retained at least one of their wisdom teeth, 41% of the population had periodontal disease, and 19% had elevated serum CRP levels. As one would expect the researchers found that the presence of wisdom teeth decreased with advancing age. The authors state:
“Our study findings show that nearly 2 out of 5 US adults aged 30 and older have at least one [wisdom tooth] M3 present.”
The researchers found that 52% of adults with the lowest incomes had presence of wisdom teeth while a 30% of adults with the highest incomes had presence of wisdom teeth. It was found that the presence of wisdom teeth was also more common among men, Blacks and Hispanics, and those with less education. Among US adults aged 30 and over with periodontal disease, half were found to have visible wisdom teeth, while those without periodontal disease had 32% of visible wisdom teeth. The presence of a wisdom tooth was associated independently with a 61% greater likelihood of having periodontal disease. Periodontal disease was independently associated and thus a risk factor for elevated serum CRP. The researchers did not find wisdom teeth presence to be associated with elevated serum CRP. The authors state
“Our study was an examination of the proposed causal pathway whereby [wisdom tooth] M3 presence leads to periodontal disease, which, in turn, leads to increased inflammation contributing to both local (further periodontal infection) and systemic health risks….Although [wisdom tooth] M3 presence was associated with periodontal disease, we did not find an expected relationship between M3 presence and elevated CRP.”
The authors feel that their findings that a visible wisdom tooth is a risk indicator for increased periodontal disease and gives supports to the notion that wisdom teeth can be removed preventatively when asymptomatic. The authors also comment on the racial and socioeconomic disparities in the retention of wisdom teeth in the US that they found. The authors state
“Many more people who were black or Hispanic and those with poorer socioeconomic status have retained their [wisdom teeth] third molars, likely related to lack of access to or unaffordability of professional dental care.”
They believe that those that are better off can more easily afford to have problematic wisdom teeth extracted. The authors point out several limitations with their study. The authors say that due to the cross-sectional design they could not claim a causal relationship between periodontal disease and elevated serum CRP or between wisdom teeth presence and periodontal disease. Even so they speculate that wisdom tooth presence comes before periodontal disease develops. Another limitation is that the data they examined included patients 30 and older and no data was included among those ages 18 to 29. The authors also note that they defined periodontal disease as having a periodontal pocket depth (PPD) of at least 4 mm at any tooth site although there might be some debate as to the exact definition. The authors feel that additional longitudinal studies are needed to explore if keeping wisdom teeth contributes to periodontal disease and other possible health consequences such as cardiovascular disease.
Excellent research well done. There are so many avenues for follow up research off this one topic.
The wisdom teeth bring the worst kind of pain. It sometimes rushes people to emergency dentists just to alleviate the pain. It really needs immediate extraction once impacted. Awesome reading this post!