Contents: Dentists disagree on when to pull wisdom teeth (this page) What can go wrong? The Surgery

Personal Health /Jane E. Brody

Should wisdom teeth be pulled immediately or only if they cause trouble? Dentists disagree.

Chances are that as soon as wisdom teeth begin struggling to emerge, a dentist will recommend that they come out. But should they?

The wisdom of removing wisdom teeth before they cause trouble has long been debated. In only a small percentage of people do they grow in straight and healthy. The human jaw has been steadily decreasing in size for millenniums and few people have a jaw large enough to accommodate four more teeth in the back of the mouth.

As a result many teeth grow in sideways, emerge only part way from the gum or remain impacted, forever trapped beneath it. According to recent estimated, 80-90 percent of Americans have at least one impacted "third molar," as dentists call a wisdom tooth.

If this were the end of the story, there would be no debate; unerupted wisdom could just sit there in the gums. Unfortunately, in many patients (exactly how many no one really knows), malpositioned or impacted wisdom teeth eventually cause trouble. They may become infected or decayed, or they may damage adjacent teeth. Cysts and even cancers can form.

The debate, then, is whether to remove improperly positioned wisdom teeth before such problems arise or wait until they do.

While some specialists say. "Don't bother them until they bother you," most believe it is better to get malpositioned wisdom teeth out when you are young and healthy, since they are likely to cause trouble eventually.

Both sides have good reasons for their views. The "don't bother them" school cites the cost and discomfort of pulling teeth, some of which will never cause trouble. Those who advocate removal note that as patients age the surgery becomes more difficult, the complications more numerous and the recovery more prolonged.