Wisdom Teeth: Beyond Extraction

Hi, everybody. I'm Dr. Sandhya Moldovan, periodontist and nutritionist. Welcome to the Holistic Dentistry Podcast, the show that gives you the tips and tools to detoxify your mouth for a healthier body. As we explore together the root cause of disease. Remember, you're not healthy until your mouth is healthy, so take care of it in the most natural way.

Welcome to today's show. We're going to talk all about wisdom teeth. I get so many questions from a lot of you asking, well, should I remove my wisdom teeth? Can I keep them? How do I clean it? Why do they feel sore? So I want to dive deep into how can we keep the wisdom teeth whenever possible, and when do we recommend a removal of wisdom teeth? And some tips on how you can take care of the wisdom teeth that you do have so you don't have problems. Problems. What are wisdom teeth? Wisdom teeth basically are the third row of molars that are all the way in the back. Typically, we actually get wisdom teeth right around the age of 16. They might start popping in. It could be a little bit later. But essentially, you start feeling the soreness all the way in the back before your two molars. If you kind of count the two big teeth on the third spot there, you're going to start experiencing some kind of swelling as the tooth actually comes out of the jawbone. Back in the 1930s and 40s, Dr. Western Price actually wrote a book about the degeneration of the jaws in the Western society. What does that mean? Well, our diet has changed a lot, so our ancestors used to eat a lot more fibrous foods. So he actually traveled to observe different tribes in South America that are still very much living like our ancestors used to. And what he discovered is that they didn't actually have any crowding of their teeth. Not only that, but all the wisdom teeth are also called third molars were fully erupted in the jaw, and people were using them like they would normally. And then he started looking at the. Well, I wonder why that is. How come in the Western world, our kids have so much more crowding than the kids and the people in the tribes? Well, it turns out that their intake of fibrous foods are a lot higher than us. We eat a lot of processed food, you know, mashed potatoes, meatloaf. Over. They eat, like, you know, whatever they get from hunting. They eat fibrous vegetables. So they're using their jaws when we put pressure with the fibrous foods. Right. Imagine chewing on a celery stick, for example. Your muscles are really Putting those pressure on the jaw. So when you put pressure on the jaw, the jaw actually develops more, it adds more bone, it becomes wider. So ideally, we would like to get probably four or five times the fiber that you're currently getting. I think the average American is only getting maybe 5 grams, maybe 10 if you're lucky, of fiber a day. We'd like to see more like 60 grams, 80 grams of fiber a day. And that really will help not only with a chewing, the development of the jaws, but also, of course, with digestion. So I actually got my wisdom teeth. They are fully erupted, except for my top ones. My top teeth were actually pointing into my cheek. And it was always annoying to me because I used to bite my cheek quite a bit. And I decided, I think after I went to dental school, I said, you know, I had enough of cheek biting, and I decided to remove only the top wisdom teeth. As a matter of fact, I still have my bottom wisdom teeth, which are actually in contact still very well, and I use them to eat. So for that kind of indication, let's say you're biting your cheeks a lot. I highly recommend that maybe you look into removing maybe just one row of, you know, upper wisdom teeth, one on each side. Not just. You don't have to remove necessarily top and bottom. So as we are in the Western society, of course, we have more crowding and a lot of the wisdom teeth are impacted. And now what do we do with impacted wisdom teeth? It depends on the level of impaction. Impacted means they're actually stuck under the gum. They don't have enough room to come through because there will be hitting the hinges here of the jaw or the ramus of the jaw because of this crowding. A lot of times wisdom teeth don't come in straight. They actually come in at an angle and they're butting right up against the. The teeth in front of the wisdom teeth, the one that you are chewing. We call these second molars. That is a problem. So if you have this kind of impaction that the wisdom teeth are actually butting right up against the teeth in front is a problem for the teeth in front for the second molars. When this impaction is actually causing some of these wisdom teeth to be kind of poking just slowly through the gum. So when you feel you can actually see a white cusp or part of your third molar just poking through, but most of it is under the gum, we call this a partial impaction. These partial impactions are actually more dangerous than if the tooth was fully impacted. Why is that because bacteria from the mouth can trickle through this little gum opening where you see the tooth peeking through the gums, underneath the gum all the way up to the back of that second molar. So, so if you have this bacteria that trickles from the mouth under the gum all the way to the molar in front where you can't clean, you can actually develop cavities under the gum most of the time. I recommend that these kind of partial impacted wisdom teeth need to be extracted or removed because of the danger they hold in causing cavities in the second molars. Because if you get a cavity so deep on the second molar, we're going to have to remove now your second molar and your wisdom tooth. So you can end up losing two teeth, not one. Now, if your wisdom tooth, let's say, is all the way impacted under the gum and under the bone, and there's no way for bacteria to get to it, I don't recommend removal. And you know, every doctor is different out there. You're going to see people that say, oh, remove all wisdom teeth whether or not you are chewing on them. I am not of that belief. I always like to look at a situation and say, okay, what's the risk? What's the benefit here? So if it's something that's riskier, we choose not to do it. We always have to choose whichever solution has less risk and more benefit. So in this case, when wisdom tooth is fully impacted, it does not need to be removed. We can just monitor this with time. And what do I mean by monitoring? We really look at it maybe every other year we take a. My recommendation is a cone beam CT scan because now we can see in three dimension. And what could happen with these fully impacted wisdom teeth. For example, the wisdom teeth have a developmental cyst around them. It's essentially like a bag into which the tooth develops. It's kind of the same way that a baby develops inside the placenta. We have the tooth that develops inside its own sacrifice. What happens is this sac can actually start to grow over time and it becomes more like an inflammatory cyst. The problem when the sac actually starts growing and it eats up the bone where the wisdom tooth is sitting and it's inflammatory. Some patients actually feel this, some don't. Then we recommend a removal of this whole sac with a wisdom tooth in it, mostly to decrease inflammation and to biopsy it just to make sure that there's no abnormal cells that develop within this cyst. Another reason sometimes that I don't recommend removal of the Wisdom teeth is when they're sitting on the nerve of the jaw. Coursing through the jaw, starting in the back by the ears and all the way forward to the front teeth is the inferior alveolar nerve, it's called, and it's a pretty thick nerve. The only way to know for sure if your wisdom teeth are intertwined within the nerve is to take a CT scan. The two dimensional panoramic X rays are not sufficient to ensure the position of the wisdom tooth in relation with the nerve. If I see a superimposition on a two dimensional X ray, let's say of the wisdom tooth and the nerve, it doesn't mean it's sitting on it, it means the wisdom tooth can be in front of it, the nerve can be behind it. That's why the three dimensional really confirms whether or not it is safe to take out a wisdom tooth. And any of you considering taking out a wisdom tooth, wouldn't you like to know if you have a high risk of nerve injury? I would. So that's why I highly recommend before deciding or your doctor says, hey, I need to take out your wisdom teeth, ask them to take a 3D CT scan even if they don't read it themselves. You can get a radiology report to tell you if the nerve is actually in between the roots or maybe the wisdom tooth is sitting on the nerve itself. I like to tell my patients, hey, okay, your wisdom tooth is sitting right on the nerve. There's a higher risk of paresthesia. What does that mean? Means a high risk of nerve injury when we remove a wisdom tooth. And then you can make a decision whether or not you want the wisdom tooth removed. Oftentimes I choose to leave them in place unless they're really causing a problem such as inflammation, recurrent infections, or maybe cavities on the tooth in front. Because of this high risk of nerve damage, however, that's a pretty low percentage of wisdom teeth that are actually sitting on the nerve. If they're sitting on the nerve, let's say, you know, you're 16 years old, most likely your jaw will develop more, especially if you're going to start to eat more fibrous foods. We have records to show that jaws can even remodel into their 20s and grow. So a 16, 17. Our jaw is definitely still growing and remodeling. So you can wait. Essentially we're going to leave the wisdom tooth in place if it's sitting on the nerve. And let's say in a couple of years we're going to evaluate them again. Has the jaw grown more. Has a nerve moved away now from the wisdom tooth? Or maybe the wisdom tooth erupted more? Some oral surgeons like to take on wisdom teeth when they don't have roots yet they're still developing that sac that I mentioned. That approach is a bit aggressive, in my opinion. Yes, it makes the removal of the tooth easier for the surgeon because now you don't have to deal with roots. However, we don't know yet if these wisdom teeth that are undeveloped in the jawbone are actually going to grow up into and out of the jawbone and we can now chew on them. Because again, I was mentioning to you, if the wisdom teeth are perfectly normal looking, like the second and the first molar and you're chewing on them, I don't recommend removal. Oftentimes I have this discussion with dentists and you know, this is always the big debate between dentists. I was working with a dentist early in my career. It's like, remove all wisdom teeth, they're all a problem. Eventually everybody gets cavities. Just remove them. From a meridian perspective, especially as biological dentists, we'd like to keep, as you know, as many teeth as possible. We know the wisdom teeth are on the heart meridian, are on the digestive meridian, are on the peripheral nerve meridian. So if you can still continue to stimulate that meridian, I think that it is important to keep these teeth, especially if you have a room for them. There's always a risk. And also removing teeth, you know, I'm a surgeon, I do remove teeth quite a bit in my practice and there's always a risk associated with it. The risk of, you know, stress on the jawbone, stress on the tmj, the risk of developing a cavitation, the risk of infection, the risk of paresthesia. There's always a risk with removing teeth. So always keep that in mind. Whenever we can do something with the least amount of trauma, it's the best for everyone. If your teeth are actually fully erupted, it's definitely important to clean them well. And I think that's where we run into problems. If they're fully erupted, the best way to reach back there obviously won't be with a floss. A lot of you don't have a hard time flossing as it is now we're expecting you to floss between the back of the wisdom tooth. It is way too difficult. So my recommendation, of course, use a water flosser. And the water flosser, especially the orasana water flosser has a nice tip with tufts that you can easily put the Tufts back there so you can feel where you're at because it's dark back there. How are you going to know if you use your regular, traditional, you know, tip on the water flosser and you're just trying to point it there, you're going to miss the spot. That's why I highly recommend that you use the tufted tip to guide you to feel your way around them back of the tooth so you can clean the plaque. Sometimes the wisdom teeth that are sitting in the back and they're erupted can have extra thickness of gum tissue to the point where even it kind of goes a little bit over the top of the wisdom tooth. It is normal and this can be adjusted easily. You don't have to necessarily take out the wisdom tooth. One of the procedures that we can do today is actually do a laser removal of that gum tissue to get give you better health around your wisdom tooth. If you have one of these gum tissues that kind of grows a little bit over the wisdom tooth, that is a potential trap for food. Especially for those of you that like to eat popcorn, you go, you know, some of you, you've had this happen already. You ate popcorn, a kernel actually got the husk got stuck underneath the gum, and all of a sudden you come up with a gum abscess. Those can be very painful to the point where your jaw actually swells up. The best thing, of course, is to avoid this. How do you avoid it after you eat popcorn? You feel that something got stuck in there. Use your water flosser to just motivate things to come out. If you don't try to visit a dentist as soon as you can so they could scrape off whatever it is that got stuck under the gum. If you wait too long, you are going to develop a gum abscess. You can go see a periodontist. Of course, we specialize in gums and you can actually help. They're going to help you to curette that area, get whatever the culprit was that got stuck underneath the gum and treat it, disinfect it. I prefer ozone water. I prefer, you know, debriding it gently, using some laser perhaps to do the disinfection and also use a mouthwash afterwards. That's aloe vera based with essential oils to help treat these gum abscesses around the wisdom teeth. Now, upper wisdom teeth can also cause some issues with the sinus and this might be new to a lot of you. If you have sinus problems, I highly encourage you to visit a biological dentist to do a cone beam CT scan to check to see if your impacted wisdom teeth are affecting your sinus. I've had some patients that have come in and said, yeah, I have this chronic sinus problems. And when I do a CT scan, even though the wisdom teeth of the upper arch were impacted, I saw a swelling of the sinus right around where the wisdom teeth were sitting in the jawbone. And after the wisdom teeth were removed, the sinus significantly improved or symptom, even completely resolved for patients. So how do we treat these? Essentially we have to remove the wisdom teeth, we have to ozonate the side and ozone in the form of a gas. It could actually penetrate through the floor of the sinus into the sinus to disinfect it. I don't have anything else that does that in the practice except for ozone gas. And of course, course I love to use PRF or platelet rich fibrin, which for which we take blood, spin it down in a centrifuge and use those growth factors to put it back in the hole where the wisdom teeth just came out of. I had a patient who asked me, well, it's a wisdom tooth, so why do you need to put PRF up there? Well, to prevent bacteria from crawling in there, to prevent cavitations from happening. Prf, we don't put it there just to bring the bone back, we really put it there. It's a great prevention. It helps you heal faster and definitely I recommend it for every single tooth removal. So there you have it. This is pretty much all about wisdom teeth. If you have them and they're erupted and you're chewing on them, then definitely keep them. If you can't keep them clean, you might be better off removing them. If they're angled or impacted, partially impacted especially, you can go ahead and remove it. It will be better for you, for your overall health. If you're fully impacted wisdom teeth, then perhaps it's best for you to leave them in place. Of course. I want to share some tips for holistic and healthy recovery after you have them removed. I love homeopathic supplements. Arnica Montana 30x is great for the recovery of wisdom teeth. I love also the Orasana enzyme support port. We know that one of the enzymes that's in that supplement has been studied side by side with ibuprofen in wisdom tooth removal. So in particular study, basically they split the group in half. One group got enzymes, the other one got Advil or ibuprofen. And they found that there was the same recovery, the same pain relief with both. So what are Enzymes. Typically enzymes are plant based, especially the orasana enzyme support plant based enzymes that actually help to reduce inflammation. It helps to reduce the bruising or eat up the hematomas. If you do get that and you have to take it on an empty stomach, I would recommend two tablets on an empty stomach. You can take it three times a day to help the pain. You don't necessarily need to take ibuprofen. Red light therapy, hugely important and recovery after surgery. Also, a balanced diet with lots of antioxidants. Why? Because when we actually removing wisdom teeth, we're creating a lot of oxidative stress. So you will need a lot more antioxidants, a good amount of protein in order to be able to heal well. It is difficult to eat when you're having wisdom teeth removed. A lot of you might already know. That's why because you had all four wisdom teeth removed and now it's hard for you to even open your jaw because the swelling that actually happens in the back affects actually the TM joint and the muscles. And with that difficulty, now your only option is perhaps maybe drinking through a straw. Not the same day, but the second day or just drink your meals. And that is totally okay. For that I actually designed the veggie meal out of the Orasana line. It really is a full spectrum meal with antioxidants, fiber and macronutrients. Everything you need for you to heal well in a liquid meal, essentially. Don't forget to get regular checkups if you do have wisdom teeth to make sure that these stay healthy. And you can get especially some advice from the hygienist on how to clean these in the best possible ways. And with that, please send us any questions. You can go to our YouTube channel where the podcasts are actually being posted and you can comment underneath the video if you have any questions or if you have any topics that you'd like to hear in any future podcast.

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Doctorsanda.

This is Dr. Sandha and remember, your mouth is the gateway to your health, so take care of it in the most natural and best way possible.