Why are wisdom teeth considered useless

Dentistry: Experts: Wisdom tooth operations should not be rushed

Just a few years ago, dentists were largely in agreement: wisdom teeth are superfluous and only cause trouble. That is why it is fundamentally right to remove them early on. But this principle has faltered: "In the meantime, there has been a rethink in this area," says Kai Fortelka, spokesman for the National Association of Statutory Health Insurance Dentists. Nowadays people are more cautious about purely prophylactic operations on wisdom teeth that do not cause any symptoms. In particular, it is controversial whether such interventions can really prevent crowding of the incisors.

Wisdom teeth are considered a rudiment: In the course of evolution, the number of teeth and the size of the jaws have decreased in humans because they no longer have to grind and chew coarse food. The eighth tooth in human teeth is a holdover from ancient times that erupts late, usually after the age of 18. In some people, the wisdom teeth are no longer in place. "How often this happens varies from country to country," says Christian Berger, President of the Bavarian State Dental Association (BLZK). Occasionally there are even people who have nine teeth on each half of the jaw.

Controversy: Can Wisdom Teeth Stay?

However, the jaw is often too small to offer enough space for the wisdom teeth. In up to 80 percent of young adults in Europe, they are retained in the jaw and do not break through at all or only partially, as stated in the "Guideline for the Surgical Removal of Wisdom Teeth" of the German Society for Dentistry, Oral and Maxillofacial Medicine. This can easily cause problems, such as foci of inflammation or damage to neighboring teeth. And even when the wisdom teeth erupt, there are often difficulties: "Caries easily forms on them because it is difficult to reach them when brushing," explains Berger.

In addition, many dentists assume that wisdom teeth in a small jaw put pressure on the rest of the teeth and push them forward, causing crowding in the front teeth area. In extreme cases, the incisors are then “criss-cross”. With this argumentation, orthodontists often recommend young patients with small jaws to have the wisdom tooth germs removed as a precaution. They fear that these “pushers” will ruin the success of years of orthodontic treatment.

The need for wisdom tooth surgery has not been scientifically proven

However, there is no scientific evidence that this avoids crowding. The guideline also states that the topic has been "discussed controversially for a long time" and has not been finally clarified. "If frontal crowding occurs, there may be other reasons as well," says Professor Ursula Hirschfelder, President of the German Society for Orthodontics. It is natural that the teeth “wander” to a certain extent and move forward. "If the wisdom teeth have enough space and are well positioned, there is no reason to remove them," emphasizes Hirschfelder.

But that is apparently rather rare. Young adults at the dentist are often confronted with the fact that the position of their wisdom teeth is problematic - for example, because they lie across the jaw and press on the neighboring teeth. Then the patient is usually advised to have an operation. However, when making these recommendations, dentists must primarily rely on experience and common sense. "There are certain prediction factors," says Dr. Andreas Waltering from the Institute for Quality and Efficiency in Health Care (IQWiG) in Cologne. “However, the data situation is relatively weak.” It should not be overlooked that there can be complications during surgical interventions, they say.

Expert: Wisdom tooth operations can also involve risks

For example, nerves in the mouth can be damaged, leaving the patient feeling numb, usually temporarily. In addition, inflammation can develop on the wound. It is unclear how high the risk of complications is. The fact that they are not uncommon is shown by the high number of claims liability cases: "In the centrally managed claims settlement system in the Finnish health care system, one percent of all liability cases concern complications in connection with the surgical removal of wisdom teeth," the guideline says.

Therefore, dentists need to consider all the possible pros and cons before recommending surgery. “With prophylactic interventions, it is always about weighing up the risks,” emphasizes the maxillofacial surgeon Professor Wilfried Wagner from the Mainz University Hospital. In this case, that means: How great is the risk of complications? What are the likely risks of leaving the tooth in place? Age is also an important argument. Hirschfelder says: "If the wisdom teeth have to be removed, it should happen early." The risk of complications is lower in patients under 35 years of age. But BLZK President Berger emphasizes: "Every case is different and must be viewed individually."

Medical professionals: Wisdom teeth don't necessarily have to be removed

Naturopathic dentists are convinced that wisdom teeth are not simply useless. “These are fully valid teeth,” says Professor Werner Becker from the Federal Association of Naturopathic Dentists in Germany. "God didn't put them on for the dentists to pull them out." According to traditional Chinese medicine, wisdom teeth are, for example, connected to the heart and small intestine. Supporters of the doctrine assume that foci of inflammation on these teeth can lead to far-reaching problems. "If wisdom teeth are pulled for no reason, that also has a negative effect," says Becker.

In any case, it is important to think carefully about the decision. Andreas Waltering from IQWiG emphasizes: “The dentist should discuss the advantages and disadvantages of the operation with the patient. Anyone who is not convinced after that can get a second opinion. "