The third molars, commonly known as wisdom teeth, are the final set of teeth to develop, typically emerging in the late teens or early twenties. Orthodontics is the specialized field of dentistry focused on correcting malocclusion (improper bite) and aligning teeth and jaws. While both relate to oral health, they are distinct areas of practice. The relationship often causes confusion due to the common belief that third molars can undo alignment achieved through braces. This issue is primarily about managing the presence of these late-developing teeth within overall dental health.
Distinguishing Orthodontic Treatment from Third Molar Management
Orthodontic treatment aims to move teeth into optimal positions using appliances like braces or clear aligners to improve function and aesthetics. An orthodontist diagnoses and corrects issues such as overbites, underbites, and dental crowding. This discipline focuses on the biomechanics of tooth movement and jaw alignment.
Third molar management is primarily concerned with the health status of these specific teeth and surrounding tissues. The decision to monitor or remove a wisdom tooth is typically based on pathology, not alignment correction. Surgical removal is generally performed by an oral and maxillofacial surgeon, not the orthodontist.
The orthodontist monitors the development and position of the wisdom teeth, often using panoramic X-rays. They determine if the third molars pose a risk to completed alignment or complicate other dental issues. If removal is necessary, the orthodontist refers the patient to a surgical specialist.
Addressing the Crowding Misconception
The widespread public belief that erupting wisdom teeth physically push the front teeth, causing crowding or relapse after orthodontic treatment, is largely a misconception. Research has shown that the force generated by developing third molars is insufficient to move the entire dental arch forward. This force is not strong enough to overcome the dense bone structure and the collective resistance of the other teeth.
Late-stage crowding seen in the lower front teeth, which often occurs when wisdom teeth emerge, is instead attributed to natural physiological changes. This crowding results from forces from the lips, cheeks, and tongue, combined with the normal, subtle forward movement of the teeth that occurs throughout life. This phenomenon, called mesial drift, happens even in people missing their wisdom teeth or who had them removed years earlier. Therefore, removing third molars solely to prevent aesthetic crowding is not supported by modern scientific consensus.
Clinical Reasons for Third Molar Extraction
While preventing crowding is not a valid reason for extraction, there are clear, pathology-based clinical indicators that warrant the removal of wisdom teeth. The most common reason for surgical intervention is impaction, which occurs when the tooth cannot fully erupt due to a lack of space or an improper angle. Impaction creates a high risk of local complications.
A partially erupted third molar can lead to pericoronitis, a painful infection and inflammation of the gum tissue surrounding the crown. The positioning of the wisdom tooth often makes it impossible to clean properly, leading to decay in the third molar itself or the adjacent second molar. Impacted teeth are also associated with the formation of cysts or tumors in the jawbone. When these problems are present, extraction is indicated to protect the patient’s overall oral health, independent of orthodontic concerns.
Timing of Third Molar Evaluation
The evaluation of third molars is a strategic part of dental care, typically beginning in the mid-to-late teenage years. Most dentists and orthodontists recommend an assessment between the ages of 16 and 19. This timing is selected because the crown of the wisdom tooth is usually fully formed, and its position and angle within the jaw are clear enough to predict its potential for eruption or impaction.
The initial assessment involves a clinical examination and the use of a panoramic X-ray, which provides a full view of both the upper and lower jaws. This imaging allows the clinician to determine if the tooth is likely to erupt into a healthy, functional position or if it should be monitored or removed.
For patients undergoing orthodontic treatment, this evaluation is often done before the retainer phase, allowing necessary extractions to be completed to prevent future complications. Early identification allows for planned surgical removal when the tooth roots are less developed, often resulting in a simpler procedure and faster recovery.