By Alexander Germanis
A trip to the natural history museum, followed by a trip to the zoo, might illustrate an interesting shift—from the elongated tusks of the woolly mammoth, to the more conservative ivories of the modern elephant. Modern humans and our distant ancestors have likewise shown a curious dental parallel in the growth of our own “ivories”—specifically, wisdom teeth.
Called “wisdom” teeth because they do not erupt until a person is leaving adolescence and entering the wiser years of adulthood, the third molars at the very back of the mouth are, “an evolutionary byproduct,” explains Dr. David Efaw, M.D., D.D.S.
In the past, the average diet consisted of very coarse food, wearing the teeth down on the top and sides. Evidence of this dental wear is still seen in some third world countries today. As the teeth wore down in the first 20 years of life, “there was room for the wisdom tooth to come in. So, it’s a replacement tooth,” says Dr. Efaw.
But, for the most part, “modern diets are much more refined than they used to be,” adds Dr. Thomas Ocheltree Jr., D.M.D. “[Food] is essentially ground up and stuck back together again. Our water’s fluoridated; we have good dental care. Healthy teenage kids right now have no cavities, have straight teeth, and there’s simply not enough room for a replacement part—because we don’t lose our teeth as often.”
No room means some teeth have to go; and more often than not, the way wisdom teeth come in makes the choice as to which teeth to get rid of an obvious one. “They often come in crooked, angling into the second molar,” Dr. Efaw says. “They cause pain, infection, and problems with adjacent teeth. So, most often we remove them prophylactically, to get them out before they cause trouble.”
Trouble can come in many forms. Infection caused by wisdom teeth can lead to greater problems. “Prior to antibiotics,” Dr. Ocheltree points out, “an infected wisdom tooth carried devastating consequences. There was a 50 percent mortality rate from infection.”
Although the infections can now be managed, there is still the threat “to adjacent teeth, cysts that form in the jaw, and quite frankly, just cavities,” the doctor continues. “A cavity can form in the wisdom tooth, or in the tooth next to it, that can’t be repaired by your general dentist because the position is low, and it decays down deep.”
Fortunately, advancement in the fight against infection has been joined by advancement in the field of oral surgery. “25 or 50 years ago, to have our wisdom teeth out was a much more difficult procedure,” states Dr. Efaw. Now, however, as removal of wisdom teeth is the most common procedure performed by most oral surgeons, there is a decided need to make said procedure less unpleasant.
“The anesthesia is ultra light, ultra short acting,” Dr. Efaw adds. “So, while the patient is under the anesthesia, we give them local anesthetic drugs. Then, the wisdom teeth are removed, and we have a gel we use to prevent the most common side-effect, which is a dry socket. Those two things have made wisdom teeth removal far, far easier on the patient population.”
That patient population may be shrinking. According to the doctors, “We have patients that don’t have any [wisdom teeth], some have two, some have one. They’re the most anomalous teeth, [meaning] there are extra sometimes, there are none sometimes. When you see that repeated over a long term, it means there’s pressure for those teeth not to be there. That tooth is not so critically important for the human to survive.”
Furthermore, “Not every wisdom tooth needs to be removed,” Dr. Ocheltree admits. “The patient should be evaluated to determine if they need their wisdom teeth out. [For instance], some of the patients who might not need them out are people with the adequate jaw length for wisdom teeth to come in.” In other words, “there’s no reason to have them out just because they are wisdom teeth.”
Drs. Doran, Capodice, Efaw, and Ocheltree provide a full scope of oral and maxillofacial surgery with expertise ranging from wisdom tooth removal and dental implants, to bone grafting procedures, corrective jaw surgery, and cosmetic facial surgery. Their office is located at 109 Regency Drive in Bloomington, with satellite offices in Watseka and Lincoln. For more information, you may call 309-663-2526, or visit them online at www.dceooms.com.