DC Child Accident & Safety Blog

That could be the modern parent's mantra, faced with the too common advice from dentists that a teenager should have healthy wisdom teeth removed "before they cause trouble."

Trouble is that the best evidence is that most wisdom teeth, impacted or not, never cause trouble to a young adult. And if and when they do, there is plenty of time to remove them when they send pain signals or show other signs of a real problem, and no downside to waiting until that day. Taking out healthy wisdom teeth causes, at a minimum, days of pain and need for heavy duty medications like Tylenol with codeine, and at a maximum, complications like loss of smell or taste.

Not to mention the considerable cost of paying oral surgeons and dentists to extract wisdom teeth.

The American Public Health Association says prophylactic removal of wisdom teeth injures tens of thousands of patients a year at a cost of billions of dollars. That's billions with a B.

Here is the APHA statement reviewing the scientific evidence on removal of wisdom teeth.

The only health group that supports removal of wisdom teeth before any pain arises is, you guessed it, the association of surgeons that do all the work: the American Association of Oral and Maxillofacial Surgeons.

Read more in a recent New York Times article by a thoughtful parent who ultimately concluded, after doing her own research, that "watchful waiting" was the way to go for her teen daughter.

And here are two dentists writing letters to the Times saying they agree based on their own experience that it's better to hold off and not rush into removal of wisdom teeth before you really need to.

Pop quiz: Which of the following promote tooth decay?

(A). sugar;
(B). genetics;
(C). low immunity;
(D). watching "American Idol."

The correct answer, of course, is "all of the above" ... with a qualifier for (D). (You have to be snacking on Raisinettes or another sticky fruit while watching the show.)

Although sugar remains the primary suspect in the creation of cavities, people can be genetically disposed toward tooth decay, and low immune function can contribute, as can dietary habits generally considered healthful--sticky fruits such as raisins, although preferable to sucking on a Popsicle, also leave teeth vulnerable to the ravages of sugar residue.

So what can a concerned parent do?

It's hard enough for parents to control so many factors conspiring to turn their kids' mouths into a gaping maw of dental disaster, but now there's something else to consider. According to the Los Angeles Times, several studies have shown that cavity-causing bacteria can be passed from primary caregivers to wee ones.

Children are most susceptible as infants and toddlers, when their immune systems are works-in-progress. But any age before children have the motor skills necessary to brush well by themselves requires parental invervention for maximum protection.

If you want to hold the line on sharing the bacterial love that can compromise your child's oral health not only as a youngster but after the arrival of permanent teeth and into adulthood, first take care of yourself. Expectant mothers should address any dental decay or gum problems before Junior arrives to reduce the likelihood of transmitting disease. And the use of an antibacterial mouthwash during the lower-immune period of infancy and toddlerdom might be wise.

In addition, the dentist should become a close, personal friend of your child probably earlier than you expect. Measures you should take include:

• schedule the first visit to a pediatric dentist at the time the first tooth appears or by the first birthday;


• limit the contents of bottles and sippy cups to water except at mealtime;


• limit snacking to a short interval--bacteria like any kind of sugar, whether from fruit, milk, honey or the refined white sugar in candy;


• assist your child with tooth-brushing until he or she is old enough to tie shoes or write cursive--generally 7 to 9 years old.