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Winter Park Dentistry-Wisdom Teeth Podcast (part 1)

 

 

 

Dr. Ramzi Matar (Winter Park Dentistry): Hello everybody, welcome to this episode of our podcast. Today’s episode is about wisdom teeth, or third morals, certainly a lot of nicknames, they seem to be a rite of passage for everybody, growing up. Today’s guest, I have Dr. Jeff Beattie, he’s an oral maxillofacial surgeon, he’s one of the certified specialists in the dental field here in the US, and I’m really excited to have you on to talk about wisdom teeth. You handle wisdom teeth probably every day, and I really want to get your thoughts, what you suggest, and kind of how people manage wisdom teeth, because there’s a lot of people that ask me questions and I have a lot of questions for you today. So let’s just get right into it here. Tell me briefly, wisdom teeth, what are they, how many do we have, any reason why we have them?

Dr. Jeff Beattie: The main question that I normally get asked is why we get them out. There’s actually a number of reasons. The first and most common reason is when there’s pain. And that happens when wisdom teeth are trying to come through the gum tissue. So the gum tissue gets inflamed, something called pericoronitis, but it creates a lot of tenderness and discomfort to patient. Another reason is if there’s not enough room for the wisdom teeth to erupt, so there can be issues if they’re not going to be functional, if the tooth above them won’t function, or vice versa the tooth below them, that’s another reason to get them out.

Other reason is if the teeth is at a less than ideal angle, if they’re horizontal, if they’re 45 degrees instead of being straight up or down, then there can be a risk of damaging the second molars, which are the teeth right in front of them, and you don’t want to worry about hassles with those teeth if you can. Cyst on wisdom teeth can be an issue, and even if they don’t erupt there can still be periodontal disease or gum disease, and there can be decay that occurs in those teeth. Those can be the reasons why people have wisdom teeth removed.

Dr. Ramzi Matar (Winter Park Dentistry): I know the most common thing for me is people that do have them in, they can’t keep them clean, they’re gagging, choking themselves. It’s constantly an area that I see decay in adult patients. So more or less what percentage of people, I hear a lot from patients “well, I’ll just wait, I think they’re going to be fine, my mom was okay”, is there a certain number as far as statistics as to what percentage of people can keep them lifelong?

Dr. Jeff Beattie: That’s a great question. I don’t think there’s a definitive answer, but I do know that studies have shown that there’s 80% of the population that have all 4 wisdom teeth. There’s 5% that have zero wisdom teeth, and that’s what I call evolution in progress. Those studies have shown that the 15% in between have either 1, 2, 3 or more than 4 wisdom teeth, and of those 95% that have one or more wisdom teeth, I would speculate, and studies have shown, that around ¾ or 3/5 people needed at least one or more of the wisdom teeth out. Which means that 75% to 80% of the population will need at least one or more of their wisdom teeth out.

Dr. Ramzi Matar (Winter Park Dentistry): So if you’re watching this and you want to play the odds, the odds are against you, and you could say that conservatively 70% or so of people will end up having, whether it be cyst, or they decay, or they are sideways. So that’s what you see, in practice you see 7 out of 10 people are having problem.

Dr. Jeff Beattie: On a daily basis. And quite often we do get patients that come in and ask “hey, do I have problem with wisdom teeth?” and in many cases, they don’t apparently have at that particular time, but as we mentioned before, as their general dentist, they can identify there’s going to be a problem, and it may not be happening now, but the problem could develop.

Dr. Ramzi Matar (Winter Park Dentistry): It’s like vaccines as a kid, wait to have measles and morbilli… So, in an ideal world, again, you’re a parent watching this, what age are you seeing, because normally I see it as a rite of passage in high school, they have the SATs, they want to graduate, they have to get their wisdom teeth, it all goes along that time. But what is the ideal age for men and women, boys, girls, whatever, the sweet spot, if you had to kind of draw some sort of broad stroke?

Dr. Jeff Beattie: Great question, that I get asked a lot. Especially by parents who have been referred by their general dentist. There is no perfect age. Actually, ideally, the best time to consider patients having their wisdom teeth, is when their general dentist has identified a potential issue, whether there’s symptoms or not, but especially if there’s not, and that can be anywhere when the roots are one half to two thirds of the way formed. So developmentally, when you really want to identify when an issue is going to happen, is if there’s no room for it to come through, and that can happen from 16 to age 21. Everyone develops at a different age, a lot of time patients will ask me, or the parents will, “okay, do girls have to have their wisdom teeth out before boys?”. There’s no difference, it’s all developmental. It depends on what the x-rays shows, whether they are having symptoms or not, whether there appears to be enough room or not, and then you move forward from there.

Dr. Ramzi Matar (Winter Park Dentistry): Cool, I did not know that! That’s great. And the other big question is, can they crowd your teeth? A lot of people are coming out of braces, and they say “I want to get my wisdom teeth out because I don’t want to make my teeth crooked”, or vice versa they have crooked teeth and they say “boy, my wisdom teeth came and made them crooked”, tell me what signs are out there for that.

Dr. Jeff Beattie: Well, there’s a lot of controversy about the crowding issue, and there’s one study done by an orthodontist back in 1961, and that had a particular cause and effect that showed there’s some horizontally positioned wisdom teeth, and we’ve noticed it, and the patient started having crowding. Since then, there were subsequent studies, actually by orthodontists too I think, that refuted that and showed that no, there is no correlation between wisdom teeth and crowded teeth. Be it bottom teeth, be it top teeth. What I like to consider myself, and I give you a personal example in second, I think that lip and tongue posture and muscular issues, and habits that may occur with the tongue and the teeth and the lips, probably contribute more to crowding lower front teeth than horizontal wisdom teeth.

There’s a personal example, I had my wisdom teeth out thirty years ago, over thirty years ago. I don’t remember exactly how old I was. Ten years ago, my lower front teeth started to crowd, what was causing it? Obviously not wisdom teeth. So I am a personal believer in the fact that getting wisdom teeth out for crowding issues, is not a good reason to it. There’s much better reasons to get wisdom teeth out, than to worry about crowding of your lower or upper front teeth.

Dr. Ramzi Matar (Winter Park Dentistry): Sounds like the orthodontists can’t make up their mind anyway, they have different studies. So now, you’re past 16, 21, certainly there’s a lot of people out there that are watching this that are just “you know, I want to keep them”, I know even culturally I guess, certain cultures they feel against taking out your teeth, this is something that’s given to you by nature or whatever. So you wait until it hurts, you wait until you’re thirty or forty, is there a drawback to that?

Dr. Jeff Beattie: Yes and no. To be honest with you, I see patients daily in their thirties, forties, fifties, even in their sixties, and heaven forbid, we haven’t handled many patients in their seventies or eighties, but there are a few. Patients in their thirties or fifties who never got around to getting their wisdom teeth out, and because of whatever reason they came through, they were fine at the time, or they just ignored it or they didn’t have any symptoms, but symptoms did develop, and especially in the lower region teeth, the top ones not so much unless you have periodontal issues or gum issues, especially those lower teeth, the older we get, the much harder it is to heal from a procedure to get those wisdom teeth out. So it’s much more difficult and much more challenging for patients to deal with it in their thirties, forties, fifties, than it is in your teens. So it’s important that patients follow to their general dentist, and evaluate them, and make sure those teeth are not going to cause an issue.

Dr. Ramzi Matar (Winter Park Dentistry): So the risk isn’t so much the challenge you have getting it out per se, but it’s more as you get older you have more health problems, that’s the risk you take in your sixties, seventies, fifties, it doesn’t heal well. So I’ve got to brag a little bit, I know you’re a big Florida State guy. Recently Google, I don’t know if you know this, but Google came out with its top searched universities, Harvard was 15, guess who was 14?

Dr. Jeff Beattie: I’m guessing FSU.

Dr. Ramzi Matar (Winter Park Dentistry): Florida State. Harvard 15, FSU 14. That’s crazy, I think now we can officially call Florida State the Harvard of the Southeast. That said, here’s one more piece of trivia. Can you guess the number 1 searched school in the nation, on Google?

Dr. Jeff Beattie: Please don’t say FSU, I don’t want FSU to be searched, and if it is it’s only because of Jameis Winston.

Dr. Ramzi Matar (Winter Park Dentistry): No, no. Florida State was 14. So Florida State edged out Harvard, so that’s huge. Who do you think was number one? Did not see it coming myself.

Dr. Jeff Beattie: Number one? Wesley College? I don’t know.

Dr. Ramzi Matar (Winter Park Dentistry): University of Phoenix. Two out of the top five are online universities. Anyway, so that’s that. Maybe soon enough you can just take out wisdom teeth online.

Dr. Jeff Beattie: FSU being on the top 15, I’d like to say it’s a little school but it’s a huge school.

Dr. Ramzi Matar (Winter Park Dentistry): Yes, Top 15. So, let’s pass forward. We’ve talked about the pros and cons of wisdom teeth, and now I want to talk about… now I’m a patient, I am a parent taking my kids to get their wisdom teeth out. Taking them to an oral surgeon such as yourself. Most of the time, do your put your patients asleep, is that your common wisdom?

Dr. Jeff Beattie: That’s a great question. The majority of patients who come into our office, we’ll talk about how they want it done. And the best way to have it done. Patients, as far as I’m concerned, can have it done any way they want. They can be awake, they can have nitrous oxide, they can have sedation. The challenges are, if you’re awake to have it done, which is probably less than 5% of the patients, it’s not a very enjoyable procedure, it’s a sit through if you’re awake. There’s lot of shots that you have to put up with, there’s lots of pressure, lots of noise, lots of sensations, so the whole concept of sitting there and kind of waiting up during the whole process is not great. So the vast majority of patients prefer to be sedated, which I think is the best way to do it.