Too Many Teeth, Not Enough Jaw

Extracting wisdom teeth has become one of my favorite dental procedures. It is challenging and invasive, but with proper technique and a lot of practice, it can be done safely, efficiently, and predictably. I’m grateful for talented surgeons who took me under their wing years ago and mentored me as I sought to become not only proficient but expert in third molar extractions.

A question that I get a lot is why we even have wisdom teeth to begin with. This is a fairly recent change in human anatomy, and one we’ve brought upon ourselves. For most of human history, there was plenty of room for third molars, and they were greatly needed for proper function. Up until this modern era, our ancestors consumed foods that were harder and more fibrous. Very little of what was eaten was processed. This mechanical loading, particularly during childhood, stimulated jaw growth, resulting in broader, longer arches with room for all 32 teeth.

A harder diet consisting of coarse foods such as grains and seeds contributed to tooth wear. As other teeth decreased in size, it left more room in the dental arch for wisdom teeth. Also, having an extra set of molars was a great insurance policy. Though it’s likely that people suffered less from dental decay because they weren’t eating all the sugar that we eat today, having an extra set of molars come in when an individual was a little older would have been a huge benefit if function had been compromised because of tooth damage or loss.

Today, softer, processed diets mean kids don’t chew hard enough during jaw development to stimulate full arch growth. The jaw ends up smaller than the genetic blueprint calls for, and the wisdom teeth have nowhere to go. This is sometimes referred to as “jawtooth discordance.”

Encouraging your children to eat a diet rich in fresh fruits, vegetables, and grains is a great way to help their bodies develop properly. We are learning more and more about how essential good nutrition is, not only for maintaining our health, but also for proper anatomical development.

Research today shows that even when there is anatomic space for third molars, it is still indicated to have them removed because they are so hard to maintain. It is more likely you’ll have problems, such as increased plaque accumulation, pericoronitis, and damage to adjacent teeth, if you leave them in place than if you have them removed. That includes the risk of complications associated with wisdom tooth removal surgery.

In my opinion, there’s an ideal time to have them removed. The difficulty is that people develop at different rates, so the ideal time varies for each individual. The key is to have regular dental visits with radiographs to monitor third molar development. I prefer extracting the teeth when the crowns of the molars are fully formed but the roots have not fully formed. This usually happens around age 18, but there is a lot of variability. The procedure becomes more difficult at around age 26. By that point, the teeth are fully formed, the bone is mature and less flexible, and I think that makes recovery a little harder.

One more thing worth considering is sedation for this surgery. The lower wisdom teeth tend to be positioned closely to the inferior alveolar nerve, which is the main nerve for the lower part of your face. Even when the area is numbed using local anesthetic, there is still a lot of pressure experienced because of the IAN’s proximity. Sedation allows you to be relaxed and comfortable during the procedure.

Wisdom teeth are a fascinating window into how profoundly our lifestyle shapes our biology. While we can’t undo thousands of years of dietary change, we can make smart choices, for our children’s development and for our own dental health. If you have questions about your wisdom teeth or your child’s, don’t wait for a problem to arise. A proactive conversation with your dentist, paired with regular monitoring, is the best path to a comfortable and timely outcome.