Dear Dr. Hall,
I read with interest your comments regarding wisdom tooth extraction. I have had my wisdom teeth for my whole life (I am 34 now), as they did not cause me any problems growing in. Unfortunately, I did not care for them properly and, although the rest of my teeth are in pretty good shape, my wisdom teeth have all started to decay, to the point that they are basically about half gone. For some reason, the process of this decay has not caused me very much pain or discomfort.
My question relates to the fact that I would prefer to just let them decay on their own until they are gone, rather than risk the complications inherent to wisdom tooth removal at my age. I assume the surgery would be all the more complicated by the fact that there are bits and pieces of the teeth for the surgeon to pull on rather than the full teeth. What are the potential consequences of simply allowing them to decay on their own? Is it possible for this to happen without experiencing infection or complications? Would it be less dangerous than the surgery? Keep in mind that, thus far, one of them seems to be almost completely gone (although there are a few pieces still there), and the other three are half gone. So far, no sign of infection or pain. Thank you so much for your time and insight. I really enjoy perusing your web site.
– Jeremiah from California
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You raise some interesting questions. Yes, decayed teeth do eventually crumble and go away. There is some risk in letting that happen, though. Let me help you understand that risk, and then you can figure out what you want to do.
If a tooth appears to be intact but yet has deep decay, that decay will reach the living pulp tissue of the tooth, cause it to become infected, and that infection will spread through the end of the tooth, through the root, and deep into the jawbone. When these infections are encased either in bone or in a relatively intact tooth, that causes pressure to build up and pain. If the infection breaks through the bone and starts to drain, that relieves the pressure and thus relieves the pain. That will also tend to slow the advance of the infection in the bone, because the infection has an outlet. If the infection doesn’t find an outlet, though, it can get very nasty. For example, infections of lower teeth can cause swelling on the inside of the mouth. This swelling can move down the throat and threaten to close off your windpipe. Also, upper molars are not that far from the brain and there are blood vessels present that can carry the infection to the brain. So this isn’t something to mess with.
If a tooth breaks off, it does two things that help make the infection less serious. First, it creates a wide open situation where the infected, inner portion of the tooth becomes exposed, which gives the infection an outlet and helps prevent its spread down into the bone. Second, every tooth has slight eruption forces that are always operating. These forces tend to push the tooth further out into the mouth until it meets an obstacle, which is usually the opposing tooth in the opposite jaw. When the tooth breaks off, it no longer has contact with its opposing tooth, and those forces will tend to push the tooth out of the jaw a little. If it keeps decaying, then little pieces will continue to break off. Eventually, the tooth could be completely pushed out.
But be careful about judging just by what you see. Sometimes you can just see a small portion of the root, and it looks like nothing important is happening, but an x-ray will show that this root is quite long and goes down deep into the bone.
Another problem is that if you have one badly decayed tooth, you can have decay bacteria spreading over all your teeth and accelerating decay everywhere in your mouth.
As far as comparing the risk of letting your wisdom teeth fall out on their own versus extracting the wisdom teeth, I believe having them extracted would be less risk, no matter what the condition of the teeth. If they have started to push themselves out, making it so there is less risk for the infection getting deep into the bone, that also makes for fewer complications if you have them removed. But then extracting them is a whole lot more expensive than letting them fall out.
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