"Badly" impacted wisdom teeth, but no pain and no eruption through gum. Should they be removed?

[shak_ka]

My bottom two Wisdom teeth are impacted, see below image link.

I have already been to two different oral surgeons to enquire about whether they should be removed, and they both recommend it, but they were unable to estimate whether it would cause me problems in the future if I decide against having them removed.

These impacted teeth have never caused me any pain or discomfort. I heard that the main reason people get them removed (don't quote me on source) is the difficultly of brushing them, however, as my Wisdom teeth are not poking through the gum (and I assume never will?) I guess this wouldn't be a problem for me?

About me: 27 years old, somewhat poor history of dental hygeine - i.e. lots of cavities and fillings. Oral surgeon says my removal would be "difficult" due to the close proximity to nerves.

Looking for opinions. Thank you! Only reason I'm asking is that I don't want to spend the thousands of dollars on extraction if it's really unnecessary.

xray image

P.S. This article states: "Little evidence exists to support removing impacted wisdom teeth that are not causing pain and swelling, aren’t negatively affecting other teeth, and are disease-free, finds a new review in The Cochrane Library." which makes my decision even more confusing.

 

[shak_ka]

Bump, please, anyone?

 

[Zuri Barniv]

The reason to remove your wisdom teeth has nothing to do with how easily you can brush them. The problem with your wisdom teeth is that they press up against the second molars in a way that can create a pocket in your gums. Bacteria can enter that pocket and potentially cause an infection. Yes, the key word here is "potentially". Also, decay can more easily form on the back side of your second molars when a wisdom tooth is pressed up next to it. The bottom line here is risk. There exists risk in removing your wisdom teeth, but there is also risk in leaving them. No one can tell you precisely what will happen. It comes down to the opinion of the surgeon you talk to, but most surgeons recommend what they do best...surgery. Keep in mind that as you get older (especially over age 35) removing wisdom teeth becomes harder and more risky. It is better to deal with them early if possible. Looking at your x-ray, I think your risk is moderate for a problem over your lifetime. I would recommend a cone beam x-ray (3D x-ray) to better evaluate the situation and the proximity of an important nerve they seem to contact. If you find a highly skilled oral surgeon who takes the time to review such an x-ray and who takes the time to explain things to you, that is a good start. It sounds like the surgeons you saw didn't have the time to educate you and that's not a great sign, in my opinion. I would remove them if it was me, but only with a conscientious and careful surgeon who has weighed all the risks, benefits and alternatives with me. If nothing else, you don't need to rush into it and you can take your time to figure it out. Hope that helps.
Dr. Barniv

 

[shak_ka]

Thank you so much for the detailed reply! I went to get the opinions of two oral surgeons, and only one of them suggested that I get a CT Scan done, so I will likely go with him has he seems more careful.

 

[shak_ka]

I've attached a few snippets from my CT Scan that my surgeon had requested. http://i.imgur.com/OmpUlL4.jpg (Topogram) http://i.imgur.com/GTFSlXV.jpg (Mandible Axial) http://i.imgur.com/w2T0rg3.jpg (Mandible Axial) Sorry, I'm certainly no radiologist or oral expert, so I'm not sure if these shots are actually helpful.

After any opinions. Thank you very much!

 

[Zuri Barniv]

Unfortunately, these are not useful slices. You would want to show images that display what it would look like if someone was facing you and they peeled back the jaw bone in the area around the wisdom tooth. Either way, it is a moot point because the oral surgeon that ordered it is the best qualified to interpret the results and convey the info to you.
Dr. Barniv