Dentist said 80-90% of children nowadays need to have 3rd molars removed. True o!


Question:

Dentist said 80-90% of children nowadays need to have 3rd molars removed. True or false?

X-ray showed that my kid's 3rd molars are more likely to grow towards the 2nd molars. Two options were given: First - have the 2nd molars remove using ordinary extraction now (since the size of 3rd molars are more or less the same as the 2nd molars they can be a good replacement for the 2nd molars) or Second - wait for the 3rd molars to come our later and most likely have to undergo surgery and the teeth will be crowded. Which of the two options is better?


Answers:

The question does not stipulate whether the teeth are "healthy and intact" or decayed. This is a danger in answering questions on the internet. We really don't have all of the information needed to answer intelligently. That never stopped me before, though...

Removing second molars and "allowing" third molars (wisdom teeth) to come into their place is called "second molar replacement." This is a valid technique with a few considerations. First, you would have to do this by age 14-15 in most cases to stand a chance of a decent position for the second molar replacement. This varies according to individual development. I have done this in some cases where there is anterior crowding and the patient will be having the other teeth moved orthodontically using fixed appliances or (more commonly) functional appliances. I have done this a few times (like less than 10 in 33 years) when the second molar is so decayed that it would need a root canal and crown to fix it and the patient (or family) has other dental needs. To save a badly broken down second molar would cost in the $2,000 neighborhood. This would deplete the budget of many who would then be unable to afford fixing the 5 or 6 or 10 other cavities the child has. It's better to take out the 2nd molar and let the 3rd come into its place and spend the money fixing the rest of the teeth instead of blowing the whole budget on one tooth. Remember that this is only advisable if the patient is under 14 or 15. Maybe 16...

I would not generally advocate just removing the 2nd molars to see what happens when the 3rd molars come in. There must always be conditions to dictate this choice, but it is sometimes a valid choice.




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