Many patients who come to our office to seek advice on their orthodontic treatment remark that their wisdom teeth are crowding their other teeth.
One patient blamed her wisdom teeth, convinced that removing them would stop the process. We took a panoramic X-ray of her teeth and saw that she had no wisdom teeth. Clearly, wisdom teeth, also called third molars, were not to blame.
A review of a number of articles that examined the relationship between wisdom teeth and crowding of front teeth came to the following conclusions:
1. There is no scientific evidenceto demonstrate that wisdom teeth play a decisive role in lower front teeth crowding, although they do promote its onset or worsen an existing problem.
2. Lower front teeth crowding is amultifactorial problem, since many factors are involved in causing it.
3. Due to thelack of scientific evidence, the removal of wisdom teeth to prevent crowding is not justified. (It may be justified by other reasons such as infection or cysts.)
4. The removal of wisdom teeth is only justified when it is necessary to distalise (pull pack) the back parts of the arch and thus avoid the removal of premolars.
The preventive removal of wisdom teeth to avoid lower front teeth crowding does not have a scientific basis, since it cannot be demonstrated that there is a direct cause/effect relationship between wisdom teeth and lower front teeth crowding. Rather, such crowding is a multifactorial problem, since many other factors are involved. Therefore, wisdom teeth should be understood to have a secondary role as factors that contribute to or worsen crowding.
Why are my teeth moving?
This is a very common question. The different factors associated with crowding (not counting wisdom teeth) include:
1. Growth of the lower jaw:due to a significant increase in the length of the lower jaw not accompanied by such an increase in the length of the upper jaw, causing misalignment of the teeth and crowding of the lower incisors. (Class III)
2. Arch width and length: due to a decrease in length and width in adulthood. This decrease in arch width is linked to misalignment of the incisors. It is also known that, starting at age 45, the changes that occur in the lower jaw are not significant.
3. Decrease in mandibular intercanine width: this is a physiological process that occurs during the ageing of the dental arches and that will cause crowding if left uncompensated.
4. Lower rotation:the rotation pattern of the jaws influences the direction of eruption and the ultimate front/back position of the incisors.
5. Soft-tissue ageing: the pressure exerted by the lips, cheeks and tongue may play a role in lower front teeth crowding if the balance between them is disrupted.
6. Dental structure:it is unclear whether this is a significant factor in causing crowding. Slight differences in tooth size have been found, with larger teeth seen when wisdom teeth are kept.
7. Bite factors:the vector resulting from the forces that occur because of tooth-to-tooth contact in a habitual bite is mesial (forward). These forces are transmitted through the points of contact towards the front parts of the arch, but these forces, though intense, are unlikely to be a significant factor since they are brief. It should be noted that an imbalanced bite may cause wear between the teeth (there may be some correlation between crowding and lack of wear of the incisors due to the current diet), loss of teeth, cavities between the teeth, inclined incisors or movement of the incisors due to gum disease..
8. Connective tissue changes: bone loss as a result of age or gum disease may make it easier for the teeth to move under pressure that they could resist before.
9. Extra teeth:these may cause crowding due to the lack of space they create.
10. Genetics:for some authors, this is a fundamental factor, since the most significant factors have genetic origins (dental and maxillofacial changes, tooth size [macrodontia] and lower jaw length and width); other factors such as extra teeth, inherited facial patterns and tooth fusion may also have a genetic component.
11. Environmental factors:some studies have suggested that certain types of crowding may occur as a result of various environmental factors in combination with other factors.
12. Habits: such as sucking have also been reported as factors that cause crowding.
Therefore, it may be concluded that wisdom teeth are not responsible for crowding, and that the exact cause of crowding is unknown.
Removal should not be done to prevent crowding; rather, it should be done for other reasons such as infection, cysts, poor hygiene due to limited access to care, damage to adjacent teeth, etc.
Gómez S, López C, Leco I. ¿Son los terceros molares capaces de apiñar los dientes anteroinferiores? Valoración de las exodoncias de los terceros molares [Are Wisdom Teeth Capable of Crowding the Lower Front Teeth? An Assessment of Wisdom Teeth Removal]. Cient Dent 2007;4;2:171-175.
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