Periodontics/Wisdom teeth extraction/dental implant inquiry
Hi Dr. Hormia,
I was wondering if you could provide some insight on a concern I'm having over my wisdom teeth removal. I got my wisdom teeth removed 5 years ago, at the age of 19. Since then, I think I have noticed slight facial changes such as a narrower jaw/face and flatter cheeks and profile. I've since done research online and inquired with doctors and have had two international dentists tell me facial changes are likely. One, in Korea, said the mandibular angle changes, bone remodeling occurs, and Korean women commonly get them extracted for a "tapered" face. The other, in London, said a slight facial collapse will usually occur. To say I'm despondent over this would be putting it lightly..but all the more befuddling is the fact that many American doctors say facial features will not be affected. My intuition is telling me that whenever you remove a bone (your tooth) you are taking away some of the structural support in your face/shrinking the jawline and what I've observed is consistent with this theory. I guess what I'm asking is: 1) Which doctors are correct? & 2) would dental implants help in restoring fullness/support? I have done extensive research on implants and know they're rarely done for wisdoms but am guessing they would provide similar results to 2nd molars being replaced and could only be beneficial esthetically? Also, cost is not really an issue, as I'm a woman and my looks are extremely important to me. Thanks so much in advance for your time and expertise.
Also, if I could add one more query, wouldn't there have to be an esthetic change if, as many doctors admit, tooth grinding or wear over time shrinks the teeth which in turn shrinks the face? How would removing wisdom teeth be any different if they come into occlusion and then are removed? Wouldn't the jawbone atrophy/the face slightly narrow just as it does when you get older and the teeth become smaller? (because you now have less teeth space stimulating the jawbone)
Thanks so much again,
The changes that you see on your face are due to age, not the removal of your wisdom teeth. The American doctors are right.
The shape of the face is determined by the muscle-bearing outer surfaces of the bones and those are not affected by the removal of teeth. If a tooth is removed, the tooth-supporting part of the bone (the so called alveolar process) gets reshaped but the outer surfaces of the jaw bones remain as they were.
Bone is a living tissue that reforms after it is broken, gets thicker under strain and becomes thinner if the muscles that attach to it are not used.
The skull and the jaws change shape throughout life. And so do muscles, other soft tissue and skin. This starts as soon as we are born and continues to the end of life. Because of the changes that occur in bones, even the best plastic surgeon cannot make a middle-aged person look like a 20-year old.
The height of the lower face is maintained by the teeth and the jaws. If the teeth wear down as a result of excessive grinding, the tooth supporting parts of the jaw bones grow higher. If a tooth is broken and nothing is done, the alveolar process with the shortened tooth will eventually grow so that the teeth are in contact again. Thus, unless all the teeth are removed (and no dentures are made), the age-related changes in the height of the lower face do not depend on the shape or size of the teeth (Moreover, the teeth do not get smaller when you get older unless there is pathological grinding of the teeth or incompetent dental work).
Putting implants to replace wisdom teeth is malpractice. I advice you not to let your oral health in the hands of a dentist suggesting implants for wisdom teeth.