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 WHEN CONSULTING WITH PARENTS ABOUT planning surgery for their teenagers I am often asked, "Why do we have third molars when it seems every one has to have them removed?" I enjoy retelling this story about our "vestigial third molars".
The American College Dictionary defines vestige as "a degenerative or imperfectly developed organ or structure having little or no utility, but which in an earlier stage of the individual (read: species) performed a useful function." A third molar fits this definition perfectly.
Third molars are the last teeth to erupt and are due at about 18 years. I guess some of us used to become wise at age 18, as they are commonly known as "Wisdom Teeth". Preceding the third molars are the second molars, age 12, the first molars, age 6, and the primary teeth. When the jaw does not develop to be large enough to allow eruption of the third molar it becomes "impacted" and surgical removal is usually recommended.
Lets go back to the time when third molars were useful. Before civilization, humans did not live very long, and did not live very well. They hunted for meat and fish, and gathered fruit and roots. Along with that food came dirt that abraded and sometimes broke the teeth.
The first molars, age 6, are in the mouth the longest time of all teeth. They are the principal grinding teeth, and are the most subject to wear. As tooth structure was lost the second and third molars naturally drifted forward toward the first molar position. We still observe this tilting and drifting of molars today. The diet was raw and required much chewing, causing the muscles of the jaws and the jaws to develop to a larger size than today. (Look at a picture of a caveman.) All this resulted in the eruption of third molars to provide needed grinding surface.
Then we invented things like milk chocolate and Big Macs! The modern diet is excessively refined and processed to the point that we don't really need to chew because the factories do it for us. This diet is so full of tasty high calorie fats, and refined sugars that it leads to obesity, heart disease, tooth decay, gum disease and many other infirmities.
We also invented a thing called Modern Dentistry, which has been extremely successful in its mission. With water fluoridation, daily brushing, regular dental cleanings and fillings, many retain all their teeth well in to middle age and beyond.
But without all that grinding, abrading, fracturing and jaw developing that used to go on - we now find ourselves with a lot of teeth and not enough jaw. 32teeth and a size 28 jaw! The third molars are often stuck under the bone with nowhere to go.
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“So, what?” you might ask If left in place the impacted teeth can occasionally cause no problems for years or decades. But when they do it can be very serious.
Any tooth that is not fully erupted into the mouth and used for chewing is defined as impacted and is a candidate for removal. If it cannot be used for chewing this is often reason enough for removal. More commonly, if it can't be brushed it should be removed because the plaque that is brushed off the erupted teeth also forms on the partially erupted or impacted tooth. When it is not brushed off, the bacteria present in plaque leads to a painful gum infection. Other consequences are: infection of the bone, cyst or tumor formation, the destruction of adjacent teeth, and possibly headaches.
Why does the American Association of Oral and Maxillofacial Surgeons recommend removal in the teenage years? Kids are generally healthy and tolerate surgery well. They have fewer organic diseases to complicate surgery and because a higher level of growth hormone is present they heal much better. Often, high schoolers are back in class a few days after surgery. Removal in the middle age years is associated with a higher rate of complications.
With advances in local and general anesthesia and modern surgical practices the risks of third molar removal is low, and are generally outweighed by the benefits.
Read more in the article featured in the
Somerset Daily American:
"Wisdom Found; Wisdom Pulled"
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