Does the early extraction of a wisdom tooth create space in the jaw?

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Watch Dental Video about Premature Removal of Wisdom Teeth

At the end of their second decade people often develop a lack of space, particularly in the front teeth and especially in the lower jaw.

The result is that the teeth are squeezed in front of each other and this is both annoying and disturbs brushing. In former times many people had a brace. These so-called badly-placed teeth can be seen either as a relapse after previous ortho-mandibular treatment or, independently of this, in young people who never had a lack of space for the front teeth.

The chronological relationship of the formation of this so-called ‚tertiary‘ lack of space with the eruption of the third molars (wisdom teeth) is noticeable and the influence of these wisdom teeth fighting for place amongst the teeth and thereby seemingly shoving their neighbours forward and thus causing a lack of space in the front teeth seem to be plausible. Many patients are advised to have the lower wisdom teeth extracted (and generally the top wisdom teeth too) in order to reduce the chances of having a lack of space.

This preventative measure can only be effective when the eruption of the wisdom teeth is in fact responsible for the lack of space. This is however still a matter for discussion in the profession. Investigations which confirm the lack-of-space-causing influence of the third molars are faced with contrary results which show no difference in connection with the cause of lack of space in patients with third molars sited or those without sited third molars. Not sited? – Not everyone has wisdom teeth but even in those without, space problems can occur.

Wisdom Tooth

Wisdom Tooth

Many scientists consider growth-related changes as having a considerably bigger influence than that of the erupting wisdom teeth on the lack of space present at this age and point out that at this particular age the lower jaw is still growing whilst the upper jaw has reached or almost reached its limit of growth. This is particularly applicable to males as can be seen from the more frequent occurrence of a ‘tertiary’ lack of space in young men. Furthermore at the end of the growth phase one can observe a backward movement of the lower incisors which, along with the growth of the lower jaw and a consequential strengthening thereby of the over-bite, could contribute to an increase in the lack of space.

Many little mysteries, observed by scientists but still not yet solved, may have something to do with the lack of space. It’s interesting that in patients with third molars wider teeth can generally be observed whilst in those without their wisdom teeth the remaining teeth have a slimmer shape. As an explanation of a tertiary lack of space the discrepancy in the width of teeth, or an uneven load on the lower canines during sideways movement of the lower law, a strong over-bite, an insufficient brace or torsion in the canines may all play a part.

Orthodontic treatment doesn’t always manage to affect the spacing in the lower jaw positively. Extraction of the small molars provides more space and the eruption of the wisdom teeth is thereby facilitated but the likelihood of a lack of space in the front teeth remains undiminished.

The variability of the possible factors clearly shows that the connection between the eruption of wisdom teeth and the occurrence of lack of space in the lower front teeth are in no way directly directly attributable to each other although a superficial approach could give this impression. The development of a tertiary lack of space shows itself much more to be a very complex occurrence in the way there are many other factors apart from the wisdom tooth which may play a role which is extraordinarily difficult to predict. The question a dentist must ask himself is what final consequences will result from the various examinations in connection with the possibilities of avoiding a tertiary lack of space by extracting wisdom teeth?

Orthodontic Treatment

Orthodontic Treatment

From an orthodontic point of view this operational intervention can nowadays only be indicated when a clear problem with space exists. Prevention of lack of space is not an indication. When advising the patient about the indication, possibility, timing, risks and chances of success of the extraction of a wisdom tooth, it is a good idea, in relation to the tertiary lack of space, despite the various evaluations in medical literature, to go through the following principles in summary: the existence of a frontal lack of space in the lower jaw long after the completion of the second dentition, which can also be described as tertiary or adolescent lack of space, must be evaluated as a very complex event. This form of a lack of space is often not a relapse but rather a new anomaly. The eruption of wisdom teeth may have something to do with its development; it may however develop in the absence of or despite the extraction of wisdom teeth.

The early removal or extraction of the third molars will not lead to a reduction or solve the problem of a tertiary lack of space. In the best case it will help to ensure that it doesn’t get worse. The extraction of wisdom teeth which are positioned correctly and in enough space in cases which the existence of a tertiary lack of space is considered possible can only be described as controversial.

The indication to extract must be thought about very carefully, especially in patients where the opinion is that the condition of the 1st or 2nd molar does not indicate that they will be there for very long. In every case, before a wisdom tooth is extracted a thorough check of the durability of the remaining molars is recommended. A definitive assessment of the situation conditions of a correctly located 3rd molar is first possible at (largely) completed growth, so extraction of a wisdom tooth before the 14th year is not much use; it should only be carried out at or towards the end of the skeletal growth phase as a rule, due to the clearly defined anatomical situation after that time and the limited possibilities of assessment of location circumstances before.

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