dental health

The Age Old Question

How to Treat Asymptomatic, Disease-Free Wisdom Teeth
By Larry Otte, DMD, Associated Oral & Maxillofacial Surgeons of Peoria
uring routine dental checkups, patients are often confronted by their dental care provider concerning their retained wisdom teeth. The answer is quite obvious if the patient reports symptoms or the dental care provider discovers disease related to their wisdom teeth. Patients are usually referred to an Oral and Maxillofacial Surgeon for consultation and extraction in regards to their symptomatic diseased wisdom teeth. The dilemma comes into play when the wisdom teeth are asymptomatic and free of disease. If the wisdom teeth are asymptomatic and disease-free, options need to be discussed including potential future outcomes when deciding the method of treatment. The definition of an asymptomatic wisdom tooth is one that is absent of pain. If the patient reports pain in the area, the dental provider must rule out an ear infection, glandular involvement, muscular tenderness, atypical facial pain, referred pain from another tooth, or TMJ disease. If the pain is associated with any of the above and not the tooth, the wisdom tooth is considered asymptomatic. A disease-free wisdom tooth is one that has the absence of dental caries, fully erupted and in occlusion with the opposing tooth (functional), without infection, periodontal pocketing less than 4 mm and absence of a detectable lesion on radiographic exam. If it is discovered that the patient has asymptomatic, disease-free wisdom teeth, options must be presented to the patient by the dental care provider. The first option is to monitor the wisdom teeth with routine clinical exams every year and record subjective data from the patient. Then every two years the patient will need a panoramic radiographic exam to rule out developing lesions in the maxilla or mandible. Periapical radiographs (figure 1) allow visualization of the tooth structure but are of limited value when evaluating the maxillary sinus

Larry Otte, DMD

Figure 1

Figure 2

Page 40 Healthy Cells Magazine Peoria February 2014

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and posterior maxilla and mandible where lesions in the bone tend to develop in relationship to wisdom teeth. If the patient develops symptoms or the wisdom tooth becomes diseased then a decision to extract the wisdom tooth needs to be made. The second option concerning asymptomatic disease-free wisdom teeth is planned surgical extraction. Multiple prospective and retrospective studies have been performed revealing that 80 percent of patients with asymptomatic disease-free wisdom teeth will need their teeth extracted before the age of 65. Many practi-

tioners are advocating the extraction of asymptomatic disease-free teeth in early adolescent between the ages of 13-20 years of age. This is based on the premise that the vast majority of wisdom teeth will be extracted in the patients lifetime. Early intervention results in decreased recovery time, which translates into less school and work days missed. Advocates for early extraction of asymptomatic disease-free wisdom teeth state a decrease in dry socket, infection, nerve injury, damage to adjacent teeth, sinus violation, and minimizing unwanted tooth movement such as crowding of the anterior teeth due to lack of space. Whether the wisdom teeth are asymptomatic, disease-free, impacted (figure 2), or erupted (figure 3), the patient and dental care provider should discuss potential advantages and disadvantages in the treatment of wisdom teeth during routine dental examinations. For more information on wisdom teeth extractions, contact the Associated Oral & Maxillofacial Surgeons of Peoria, located at 2807 N. Knoxville Avenue, Peoria, IL. Call 309-682-1213 or visit www.aos.peoria.com.

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February 2014 Peoria Healthy Cells Magazine Page 41