The removal of mandibular third molars frequently results in associated morbidities, the most concern is about paresthesia or permanent numbness from nerve damage. I have also frequently seen patients with TMJ disorders (TMD) such as joint locking, clicking or pain after removal of wisdom teeth. Chronic headaches and migraines may occur as a secondary result of trauma and TMD. My letter to the editor of the Journal of the American Dental Association (JADA) concerning these issues is reproduced below. I thought this issue was important enough to post regardless of whether it is published in JADA. Patients who have had chronic pain, headaches and TM Joint disorders after third molar surgery can frequently find relief thru Neuromuscular Dentistry. There are articles on neuromuscular dentistry in Sleep and Health Journal and an article about Temporomandibular disorders Suffer No More: Dealing with the great imposter. The website http://www.ihateheadaches.org has extensive information about eliminating and alleviating migraines, chronic daily headaches and episodic tension type headaches. RSD or CRPS can be a secondary long term pain condition related to damage caused in extracting wisdom teeth.
My letter to JADA editor follows.
“I would like to thank the authors of “Cortical integrity of the inferior alveolar canal as a predictor or paresthesia after third molar extraction”. Their use of cone beam radiology to predict which patients have the greatest risk of paresthesia should help clinicians be aware of which extractions are most likely to cause paresthesia due to loss of cortical integrity of the canal. Cone beam 3-D imaging will hopefully reduce the incidence of future paresthesias.
This study reported on 179 participants, average age of 23.6 and 4.2% developed paresthesia in spite of use of cone beam radiology. I believe these statistics clearly point out it is time to re-evaluate the primitive approach that is still considered standard protocol for managing third molars.
A more rational approach would be the utilization of early prophylactic minimally invasive dental surgery to remove the developing tooth bud prior to calcification thereby reducing the risk of paresthesia to zero. There are numerous other advantages to early prophylactic removal of mandibular third molars. Ideally the removal should be planned between the ages of 8 and 11 (prior to eruption of second molars.) the uncalcified tooth bud is readily accessible for easy removal. There is less than one millimeter of bone covering the tooth bud which is located just beneath the crest of the ridge. The major advantage to early removal is that it will eliminate 100% of paresthesia cases as well as reduce overall post-operative morbidity associated with third molar removal. The procedure will require only a small amount of infiltration anaesthesia and will have virtually no post-op complications. It will eliminate periodontal defects caused by the presence or removal of third molar, eliminate and decay problems on the distal of the second molar from the wisdom teeth and will prevent damage to the TM Joints and lingual nerve during surgery.
Stem cells are currently being studied and collected from extracted wisdom teeth and from deciduous teeth upon their removal. Stem cells are found in the pulp and periodontal ligament tissues. These are sites that have stem cells but they are of marginal value compared to stem cells that can be harvested from the developing tooth bud.
The developing tooth bud offers an excellent source of high quality stem cells at a much earlier stage of development. The stem cells that will eventually form enamel, dentin, pulpal tissue, periodontal ligament tissues, blood vessels and nervous tissue including at least 29 distinct types of nervous receptors found in the periodontal ligament. This tissue has already been shown in Japanese studies to be capable of developing into liver and cardiac tissues.
The minimally invasive surgical approach to removal of tooth buds and collection of stem cells from the bud and from the surrounding bone will only take about 2 -3 minutes per site after infiltration anesthesia. Because the nerves are not yet connected to the CNS there is only minimal need for anesthesia to the overlying mucosa.
I currently have method and device patents on instruments to allow prophylactic minimally invasive removal of the developing tooth bud and collection of stem cells from the developing tooth bud and surrounding tissue eliminating future problems associated with mandibular third molars.
Ira L Shapira DDS, DABDSM, DAAPM, FICCMO”
EARLY PROPHYLACTIC MINIMALLY INVASIVE REMOVAL OF THIRD MOLARS IS POSSIBLE IS NOT CURRENTLY A ROUTINE PROCEDURE. HOPEFULLY, IN THE FUTURE THIS WILL BECOME A NORMAL PROTOCOL. THE COLLECTION OF STEM CELLS FOR PERSONAL USAGE IS GROWING IN POPULARITY. I WOULD PERSONALLY RECOMMEND THAT EVERYONE SAVE UMBILICAL CORD BLOOD AT BRTH IF POSSIBLE. THIS IS AN ALTERNATIVE FOR PARENTS WHO WERE UNABLE TO SAVE CORD BLOOD AND A VALUABLE ADDITION FOR PARENTS WHO HAVE SAVED CORD BLOOD.
IT IS ALSO AN EXCELLENT PUBLIC SERVICE IF PATIENTS CAN BANK CELLS FOR PERSONAL USE FROM ONE TOOTH BUD AND PROVIDE THE OTHER FOR PUBLIC USE SIMILAR TO CORD BLOOD BANKS.