A long time ago, people grew up faster than they do nowadays. That is, if they were lucky enough to grow up at all. By the age of 20, a person was taken as a full-fledged adult. There wasn’t much choice. Life was a lot tougher then. Lifespans were shorter. Parents expected their offspring to become economic producers at ages we’d think today were terribly young. That’s why Aristotle, writing 2,400 years ago, called the third molars “wisdom teeth”, in Latin dens sapientiae. He’d observed that these teeth generally erupted at around age 20, when a man or a woman had achieved full adult wisdom.
Today, when most people think of wisdom teeth, it’s in connection with some kind of problem with them. This isn’t too surprising when you consider that these are the teeth most commonly missing in American adults. Missing, yes, a dentist having extracted them. Nowadays that’s generally not all that uncomfortable a procedure. Still, it’s not something a person is likely to forget about. Thus, the association of “wisdom teeth” and “problem” and “treatment”.
It’s kind of an unfair shake for these magnificent ivories! Nobody ever has anything positive to say about their wisdom teeth. Okay, so they don’t actually make us smarter or wiser, as far as we can tell. Still, they have a long and distinguished history and do fine duty today.
Picture a stereotypical Cave Man. Heavy brow, bandy legs, and – big lantern jaw. That stereotype is, broadly speaking, quite informative. Human beings did use to have significantly bigger jaws than we have now. While this kind of heavy equipment may not be considered attractive by our peers, it was just right for those long-past days.
Our distant ancestors’ diet was, of course, very different from ours. Before farming was invented, we lived by hunting and gathering. Fire was pretty much a high-tech novelty people were still trying to get their heads around, so cooking was not the norm. You’ve heard about the current trend for “paleo” diets? Well, the real paleo menu featured things like raw meat, raw roots, raw leaves. Raw. The raw meat, too, was from wild animals. Not tender like our present-day industrially-produced meats.
Hence, chewing was much more of a contact sport. High impact, so to speak. Human jaws are still quite capable of biting with forces in the range of 170 lbs, on average. The strongest bite measured was 270 lbs. No doubt our distant forbears’ jaws were much stronger. In any case, survival depended on eating, and eating depended on chewing power. Hence, the big jaw and – massive back molars.
WISDOM TEETH LATER ON…
As we struggled, innovated, and introduced agriculture and cooking, food became more tender. And, not surprisingly, over many generations jaws got smaller. Living things are very careful with their resources. They tend not to have parts or systems that are bigger than need be, which is to say, more costly to feed and maintain than necessary. Those third molars, though, the ones way in the back, apparently didn’t get bred out of us. Unlike the lantern jaws, there’s no significant “expense” in keeping them, so Nature shrugged and said “sure, stick around”. They’re still excellent grinders, and it’s not like we live on diets of mush.
WISDOM TEETH: IT’S THE FIT
That’s when things started to get a little dicey. The number of teeth stayed the same, the wisdom teeth stayed big. The jaws got smaller and smaller. Pretty soon, it got to be something of a square-peg-round-hole scenario.
Increasingly, the teeth didn’t fit into the available space. This is the typical, common, basic problem with wisdom teeth. When they finally try to erupt, sometime around age 20 plus-or-minus, they bang into their neighbors. Whereas chewing raw meat used to be the contact sport, nowadays it’s simple erupting that’s become high-impact. That’s exactly what dentists call it when an erupting tooth bumps into a neighbor. The tooth is said to be impacted. Impacted wisdom teeth – the most common problem with those big third molars.
Our wisdom teeth are very creative when they try to find a place for themselves in our small, sleek, modern jaws. They try all kinds of maneuvers. Sometimes this results in them impacting a neighbor below the gumline, invisibly, and so getting stuck there. One dental school professor joked that the problem today is dental care has become too good for the sake of the wisdom teeth. Not enough of our other teeth fall out in time to make room for them!
LOCATION, LOCATION, LOCATION
But impacted wisdom teeth are no joke. There can be complications, some quite serious. Cysts, for example, tend to form under impacted teeth. These, in turn, can cause loss of jaw bone mass, and damage to nerves in the area. Not good. The impacted scenario is by far the most common issue with wisdom teeth. Even when things don’t worsen to the point of cysts, any impacted or crowded tooth is nearly certain to cause a chain reaction of movement and adjustment. In short, orthodontic issues, big time.
Another consequence of our present-day small jawbones is that those third molars, the wisdom teeth, are way back in there. This tends to thwart our modern practices of oral hygiene. Wisdom teeth are hard to keep clean. No surprise, then, that they’re especially prone to decay and gum disease. They’re useful, but potentially a problem even if they don’t become impacted. What to do?
LET’S DO NOTHING!
In some patients, the best thing to do about wisdom teeth is…nothing special. Your Royal Palm Beach dental office monitors their development even before they erupt, by x-rays at regular checkups. As long as the wisdom teeth are on track to erupt politely, not impacted, there’s no urgent need to act. Monitoring continues during and after eruption. If there are no orthodontic or dental issues, the patient has a fine set of third molars and all is well. From this point on, they’re checked and treated like other teeth.
Wisdom teeth that have grown in straight, making no trouble for the neighbors, can still suffer all the conditions other teeth do. We did note that their position makes them hard to clean. Still, if a wisdom tooth’s only issue is a minor carie (cavity), a filling might be the way to go. Some places on wisdom teeth are as hard for the dentist to reach as it is for the patient. Unfortunately, these are the locations where decay is most likely to develop, as they’re the hardest to clean. There’s certainly room for discussion of this conservative treatment option.
Sometimes, though, the right course of action is to extract a problematic wisdom tooth. If this is to be done, sooner (younger) is generally better than later. For one thing, it’s a less traumatic experience extracting a younger person’s teeth. Youth also speeds recovery from sedation and anesthesia. Moreover, early extraction is generally called for by the way wisdom teeth are erupting. Those orthodontic issues, crowding and misaligning. Again, sooner is better than later. Better to prevent or lessen orthodontic problems than to let them fully develop.
Extracting wisdom teeth isn’t as scary as it may seem. Thanks to modern sedation, anesthesia, technology, and methods it’s generally not painful. Complications are relatively rare.
PARTING WORDS ON WISDOM TEETH
We don’t really need our wisdom teeth. We can get along just fine without them. As long as they aren’t causing any trouble, and don’t seem like they’re going to, keeping them is fine. The kinds of trouble they do cause, when they do, are often serious enough to call for extraction. Some cases are crystal clear, others on the boundary and call for a discussion between patients and dentists. The extraction procedure is so low-risk that it may be better to err on the side of caution by extracting.
The one thing we don’t want to do is ignore these four big grinders, our third molars, our wisdom teeth. If we do, we risk them becoming impossible to ignore, and that’s never good news.