AboutJoel S. Teig, DMD, FABOMS Expertise I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.
Experience Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.
Organizations American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons
Education/Credentials BA
DMD
Awards and Honors National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude
Question QUESTION: Can you tell me what you see in these x-rays with regard to the lower wisdom teeth only? My dentist tells me that thee is no rush to remove them, I presume because they have not and/or are not doing any damage to the 2nd molars. But more specifically, I wonder:
(1) About the overlap that can be seen on the bitewings – why doesn’t it also show on the panoramic? Does the fact that it shows on the bitewings but not on the panoramic mean that in additional to growing in mesioangularly, that they are also growing in towards either the left or right side of the 2nd molar in front of them? What can you tell me in general about whether or not these lower wisdom teeth are touching the 2nd molars in front of them?
(2) I have read on the Internet in a few places that if wisdom teeth don’t cause you problems by the time that you are aged 30, that it’s very unlikely that they ever will. Is this true? Can I be fairly confident that if my lower wisdom teeth haven’t already damaged the 2nd molars in front of them, that they probably never will? (I am over 30, by the way.)
(3) I have also read that problems can occur when the sac that the tooth develops in forms a cyst. But, if a lower wisdom tooth is partially impacted in bone, and fully impacted in soft tissue (i.e. the tooth has erupted through the bone, but not at all through the gums)....can one of those cysts that comes from the tooth's development sac happen? I would think that once the tooth breaks through the bone, the sac also breaks, eliminating this particular possibility?
(4) Finally, I’ve read that "just the constant pressure from the impacted wisdom tooth can also lead to destruction of the tooth next to it when the tooth is impacted mesioangular”…but…that this is uncommon and “occurs in less than two percent of those with impacted wisdom teeth.” How true is this?
ANSWER: Robin - Your dentist is a prime example of a doctor who only treats problems when they occur, but does nothing to prevent an definite future problem. What I mean is that you have a bite that is set for a problem in a short time. Throughout our lives, our teeth erupt until they meet the opposing tooth on the opposite jaw. You can see on your panoramic xray that the upper 3rd molars have super erupted. They have erupted beyond the 2nd molars next to them. If you are not biting now, you will soon. You might see an indentation on the lower gum. Well, as the upper tooth begins biting on the lower jaw, it will cause a problem with the lower wisdom teeth (infection due to gum perforation and allowing oral bacteria to gain entrance to the wisdom tooth.
The reason your panoramic xray shows a lack of overlap is because is is a more accurate film. The dentist when he placed the film in your mouth to take an xray of the back teeth, did not line up the camera properly and actually shot through the lower 2nd molar to get to the wisdom tooth behind.
I have removed inflamed and infected impacted wisdom teeth in 60, 70 and even 80 year old patients. Much more difficult surgery, but infected impacted teeth in an elderly person is difficult because the bone is more dense.
The sac around the tooth will not degenerate, but it often gets more fluid with age and become a cystic lesion. These cysts can perforate the gum tissue.
A wisdom tooth, leaning against the 2nd molar in front, can cut into that tooth or more common it causes the bone between the teeth to break down and allow bacteria from the gums around the 2nd molar to gain entrance under the gum into the wisdom tooth area and become infected.
So do yourself a favor and make an appointment with a local board certified oral and maxillofacial surgeon to get the wisdom teeth removed. If you have additional questions, feel free to contact me again.
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QUESTION: First of all, you are wrong about my dentist. He is in fact very attentive to preventing future problems, but he also is similarly attentive to what the patient can and wants to deal with. He tells me what should be done, and we make a treatment plan based on my feelings in combination with as what's needed medically.
Also, just because my question to you asked only about the bottom wisdom teeth does not mean that nothing is being done about the upper ones. In fact, they are being extracted in just a few days.
As for the specific questions that I asked, I don't feel that they were answered. Would you mind addressing specifically the issues of what my x-rays show in regard to the lower wisdom teeth growing in towards either the left or right side of the 2nd molar in front of them? Also, are these lower wisdom teeth currently touching the 2nd molars in front of them?
You did not address my question # 2 at all: I have read on the Internet in a few places that if wisdom teeth don’t cause you problems by the time that you are aged 30, that it’s very unlikely that they ever will. Is this true? Can I be fairly confident that if my lower wisdom teeth haven’t already damaged the 2nd molars in front of them, that they probably never will? (I am over 30, by the way.)
As for my question # 3 regarding the sac, again, I don't feel that it was answered specifically. Does the tooth development sac "break" when the tooth breaks through bone but not gum, or does it not break until the tooth erupts through gum? Does the sac breaking lessen or eleiminate the possibility of a cyst?
Finally, question # 4 was not answered. Can you please confirm whether or not my research findings are true that impacted wisdom teeth damaging 2nd molars is uncommon and “occurs in less than two percent of those with impacted wisdom teeth?"
Thank you.
Answer Robin - I do not want you to think that I think your dentist is not attentive to your needs, but the removal of those upper molars should have been done a number of years ago to prevent any problems from overeruption and biting on the lower jaw. No doctor can predict and a knowledgable and careful doctor likes to prevent a problem and not treat the problem when it arises.
When I said, "I have removed inflamed and infected impacted wisdom teeth in 60, 70 and even 80 year old patients. Much more difficult surgery, but infected impacted teeth in an elderly person is difficult because the bone is more dense", I was indirectly addressing your 2nd question. There is never an age when impacted teeth can never present a problem. That problem can occur from cystic formation, extension of periodontal disease into the impacted tooth or actual ingrowth into the tooth in front. From your films, it is evident that behind the second molars, you have no supporting bone and you have a pocket, where bacteria in your mouth now has access to the impacted tooth. Is that a problem now or has it been, maybe not, but an extension of a simple periodontal problem into the wisdom tooth now or when you get older is a "problem waiting to happen". If the tooth was totally covered with bone, devoid of a possible periodontal connection, leaving the tooth might be more correct, but in your case, the teeth are not encapsulated in bone and a simple periodontal inflammation behind the second molars can lead to a significant problem. I believe in preventing problems and not wait for them and treat them then.
The developmental sac doesn't always break down when the tooth perforates the bone. Sometimes it doesn't even break when the tooth erupts, but in that situation it covers the lateral portion of the tooth and not the biting surface. Even if the sac breaks, a cystic formation is possible with any inflammation.
As far as question #4, I have seen indentation of the impacted tooth into the second molar when the tooth is tipped or horizontal, I have seen infiltration of the impacted tooth even if it is vertical and hits the roots of the second molar and I have seen no invasion of an impacted tooth directly leaning against a second molar. I don't think anyone can give a 2%, 5%, 10% or whatever %. Every case is different and every situation is different. I don't like assigning percentages to this situation. I have seen gross invasion in children, in young adults, middle age and even old age. So if there is a position of the impacted molar that looks like it might invade the 2nd molar space, remove the impacted tooth before a problem develops and the treatment and potential problems is more difficult to treat.
So again, putting off the removal of the upper wisdom teeth, even without biting the lower jaw might seem appropriate, but it is no more appropriate than not slowing down, when driving a car entering a major intersection. Yes nothing will normally happen, but why risk dealing with the potential severe consequences.
If you have more questions, I am always available.
