Question:
I am 33 years old. I have three impacted wisdom teeth (1 upper and 2
lower). Every time I go to the dentist for a checkup they always say
'oh, you've still got your wisdom teeth...'. I have never had any
problems with these teeth, but decided to go to an oral surgeon for a
consult anyway.
I spoke at considerable length with the oral surgeon. He explained
that there was a possibility of sinus problems (that could be repaired)
and a possibility of numbness due to extraction of the lower teeth. He
said that he couldn't tell for sure if the nerve was close to the roots
by the panex and really you would need to have a CT scan to get a good
3-D image and even then you wouldn't be able to tell for sure. He also
said that I appear to have a thin layer of bone over the teeth, under
the gum, that provides an extra protective layer. He said that if I
was a teenager he would recommend removing them, and if I was over 40
he would recommend not removing them since they are not currently
causing problems and the recovery would be significant due to age. But
he really struggled with me because I am right in the middle.
I do trust this oral surgeon. He has taken out the teeth of several
people I know.
I have a serious phobia about my teeth. If I have them taken out and
have numbness for the rest of my life I am really going to regret it.
If I don't have them taken out now it will be a worry in the back of my
mind that something really bad might happen later in life.
If it weren't for the permanent numbness thing I would probably just
have then taken out so that I never had to think about it ever again.
Answer:
This is generally the call of the oral surgeon. Of course you don't
wish the cure to be worse than the disease. I've sent patients to oral
surgeons with a request to remove wisdom teeth, and they not
infrequently decline. This is definitely their prerogative to do.
If the teeth aren't removed, they should be followed periodically by
x-ray--maybe a film every couple of years, just to make sure there is no
evidence of a cyst. If there is x-ray evidence of a problem, the
surgeon can more easily rationalize taking the small but real risk of
nerve damage from the extraction.
The problem is that the oral surgeon couldn't make the call! He even
said that if it was his own teeth he wasn't sure what he would do. He
said that the decision is mine to make.
Bit of a cop out. But if the oral surgeon seems uncomfortable with
either the surgery or guiding you to what would be the optimal decision,
I'd probably go for a second opinion.
I would also probably solicit the first surgeon's feelings about
watchful waiting in your case.
