My wisdom tooth

June 19, 2012 • 5:50 am

Until yesterday I had one wisdom tooth (third molar) left, and on my last cleaning the dentist recommended extraction since it was crowding the second molar.  It was a completely painless procedure including the two injections, the extraction, and post-extraction recovery (there was virtually no pain, and I didn’t take painkillers or antibiotics).  At the end I had this souvenir:

Gross, isn’t it?

After it was out, the dentist peered into the bloody socket and said, “Holy cow, there’s a small abscess in there.” Peering more closely, he said, “Nope, that’s a BIG abscess!” I was a bit unnerved, of course, but he just reached in with some tweezers and, with judicious manipulation, pulled out the abscess as a whole. It was a perfectly spherical capsule, about a centimeter across, filled with fluid, white blood cells (aka “pus”) and granular material.  I much regret not having photographed it, but you can understand that the last thing I was thinking of at the time was my camera. I won’t make that mistake again.

The dentist told me that the abscess wasn’t visible on the X-ray, and asked me if I had had any sinus problems (the tooth was on the upper right side). I said, yes, for a couple of years, and had had an expensive and futile operation to correct them.  It turns out that although they’ve abated, they could have been caused by this undetected abscess blowing bacteria up into my sinuses.

Apart from my personal medical woes, there are two evolutionary lessons here.  The first is that the wisdom teeth are vestigial organs: they are a remnant of the time when our ancestors had larger jaws and needed the full set of 32 teeth to process a diet consisting largely of vegetation.  Our jaws are smaller now and can’t fit those four back teeth, with the result that they are often impacted—that is, they don’t erupt properly.  This can cause a whole host of problems, including infections, cysts, and even tumors.  As Christopher Hitchens used to argue, many of our ancestors probably died from infected teeth, particularly before there was extraction. As the link above notes, “the American Association of Oral and Maxillofacial Surgeons estimates that about 85 percent of wisdom teeth will eventually need to be removed.”  Others take issue with this figure.

Here’s a Wikipedia photo of a severely impacted wisdom tooth (CT scan); I’ve added the arrow:

Finally, like many vestigial traits, wisdom teeth are variable in both expression and numbers. One paper shows tremendous variability both within and among populations:

This study contains information on the occurrence of agenesis of one to four third molars among the population and ethnic groups of Europe, North America, Africa and Asia (Japan), based on the results of investigations carried out by dozens of authors. Recent discoveries have been supplemented with corresponding data concerning the skeletal remains of the jaws of individuals living from the ice age to the middle ages. The results show unbelievably large diversities as regards the frequency of agenesis [non-appearance] of third molars in different populations from practically zero (Tasmania) to nearly 100% (Mexican Indians).

Finally, the abscess. I was amazed that the whole mess was enclosed in a spherical membrane. This was new to me, as I haven’t really paid much attention to abscesses. It turns out that the abscess is a capsule formed by normal tissue to try to prevent an infection from spreading to other parts of the body.  This is almost certainly a result of natural selection. My periapical (root) abscess was completely painless, which is why, combined with its invisibility to X-rays, it was not detected.  Here’s a more severe abscess, again from Wikipedia:

75 thoughts on “My wisdom tooth

  1. My dentist told me that it was reasonably simple to determine when you have an abscess.

    He said that “when you pass wind, it sounds like a Japanese motorcycle”.

    I asked him why this should be, and he replied that “Abscess makes the fart go Honda”!!!

    I’ll get my coat


    1. You’re not alone. I had my four wisdom teeth removed in my early twenties. To my surprise, on a later visit to the dentist, I was told again that I should remove my last two wisdom teeth. I thought he was pulling my leg or that I had been charged for four while only two had been pulled, but it turns out that besides 4 third molars (which is quite common), I also had 2 rather well formed fourth molars (not as common as I understand). My dentist was impressed, and I got to keep them.

      1. Fascinating! Makes me wonder how many dental insurance plans deny claims on the grounds that they already paid to remove the normally expected number of wisdom teeth.

        1. I never had any wisdom teeth, not even tiny ones. But unless “more evolved” means having a squint (fortunately surgically corrected as a child), rabbit teeth (braces), and occasionally having back pains (pain killers and sports), I don’t think I can feel too smug about it.

      2. Omg. I am so happy i found this blog. So i had 4 wisdom teeth removed when i was 23!! AND NOW IM 31 AND FOR THE last 4 years the lower right side i felt a new one growing.. and now the lower left as well.
        For various reasons and travelling i have been unable to get an xray..
        So it is possible for more to grow?!! amazing. thanks for sharing.. i need to go find me a new dentist!

        1. I don’t think that’s possible. I think what we think is a tooth (which I first thought until closer inspection in the mirror), is actually our jaw bone protruding out. :/ I’m 23 and I got mine removed a couple of years ago and this year I noticed a yellowish protruding thing poking out from my gums and acute pain every now and then. It really keeps me from enjoying my food and is very uncomfortable as the other teeth stab into the area where the stupid old tooth used to be. None of my family members seem to care or think it’s any cause of alarm but it’s alarming to me as it probably is infected D’:

          It’s worrisome to me. I want to see my doctor ASAP!!

    2. Same thing happened to me. Two days after I had the four usual wisdom teeth extracted–all of which were impacted–the dentist called to inform me I had a fifth one that needed to come out. Was not thrilled at the news. Then when I got braces (age 30), I had to have another four teeth out. Eww.

  2. I always find this sort of stuff facinating (this coming from someone who still has her huge gallstone from 20 years ago). Abcesses are not fun if they are painful. Had one on a first molar and needed a root canal thanks to it. I still have my wisdom teeth which erupted nicely, mostly thanks to expensive extractions in my youth, no tricuspids left. I can see Hitch being right in many people simply died from abcesses, I certainly wanted to considering the pain I was in. If I recall correctly, many ancient skulls have holes in them from abcesses. I am very VERY glad I live in a world with antibiotics and painkillers.

  3. I had supernumeraries in the upper incisors, removed when I was 8 or so. That is only part of my mutant freakishness though. The ones that came through are twisted, like the person to whom they are attached!

  4. I only have 3 wisdom teeth, which are luckily (knock on wood) not giving me issues. I am leaving them in for the tome being, as I can’t get a definitive answer on extraction (one money-hungry dentist said take them out, another in the practice said they’re fine).

    I agree that ancient people probably died from abscesses as well…there is nothing (in my opinion) as agonizing as mouth pain.

      1. I’m in my sixties and never experienced any problems at the time when you most expect it. Couple of years ago, toothache developed in my lower jaw in the molar area and a visit to the Dentist which resulted in x-rays showing wisdom teeth to be the problem. Gives me a letter to take to the Orthodontist to have them removed, but I decided to rather wait – pain went away and only comes back occasionally. I mean, who wants that kind of procedure unless you really are in continual pain!

    1. I learned a new word in German (ekelhaft) when a friend came back from a trip to East Africa.

      She climber Kilimanjaro and froze the tips of her toes and then went to Lamu on the Indian Ocean to relax in the heat. On returning to Germany, her doctor discovered botfly larvae in the damaged toe tissue.

      Ganz und gar ekelhaft!

  5. Reading this over a nice breakast was probably not the best way to start my day. But there is nothing quite so good as a swell science project, is there? By the way, after the horrific torture that dentistry was when I was young, I’ve been amazed at the strides that have been made in alleviating pain. Its gotten so I actually look forward to going to the dentist just to see what cool technology and techniques have shown up. I still marvel at the simple cheek “pinch and shake” technique to short circuit the slight pain from the novacain needle. Who figured that out? Genious!

    1. Brother, you are s-o-o-o-o right. The first dentist I ever went to, abt 55 years ago, would react to my expressions of pain and discomfort while being drilled with “A little dental pain is good for you. Reminds you to brush your teeth.”

      She was a sadistic monster, if you ask me.

      My present dentist rarely has to do anything more than check my teeth after a scaling, but on the few occasions she’s put in a filling, it was painless. And my face doesn’t stay half frozen all day long afterwards, either.

      All hail modern dentistry!

    2. When I was a child it was usual to burst into tears on being told to go to the school dental nurse. Though she did her best to distract us*, she drilled using treadle power. A leather cord belt ran from the big flywheel over a very ingenious arrangement of pulleys at the “elbows” of a series of arms, to the drillhead. Sometimes the drill jammed. Sometimes it fell out of the bit and the nurse worried that I might swallow it. An electric motor – still driving the belt over the pulleys – seemed like a big step forward.

      *Some nurses attached some kind of tiny fluffy thing to the belt for us to watch as it made the grand tour.

  6. Having read this post before the one preceding it, I can only conclude that Deepak Chopra relates to wisdom in exactly the same way as “wisdom” teeth: in name only, and through the crassest misattribution.
    Is it a step too far to assume that Deepak Chopra, like “wisdom” teeth, is also vestigial, painful, and rendered useless by evolution?

  7. I was going to thank you for not photgraphing the abscess, but your post kind of went south from there, so never mind.

    I never had lower wisdom teeth, so I just consider myself 50% more evolved.

  8. As a dentist i’m glad you posted that. As added information, in certain locations where stronger “aboriginal” traits can be found, it will not be uncommon to see the fully erupted third molars with sufficient space, all nice and straight (by my own experience, unfortunately I have no data to back it up). These people also have very big jaws. At the same time, there are people who barely have space for their second molars.

    Evolution is awesome.

  9. Yes, like my 2nd to last extraction, though the infection broke loose and they saw it first on x-rays.

    The effect on my sinuses is that on that side I have more effluent, but it is way easier to remove. So it is the side with unaffected sinuses that invariably gets a (nowadays very rare) sinus infection first and worst.

    I’m leading the average – 100 % extraction!

  10. I had my only 3 extracted last year. Extraction of the upper-right created a dime-sized (I was later told) communication with the sinus that had to be sewn closed. The surgery took twice as long as expected, and when I later went back for a check-up, the surgeon said it was his most memorable extraction in the past two years. Awesome.

  11. Fascinating that the ancestors who had larger jaws needed these for plant eating. I had always assumed that the wisdom teeth were once a useful adaptation, but for replacing teeth lost to decay before oral hygiene, flouride and fillings were common. Could that be a factor as well?

  12. Let me say up front that the following comment is hearsay (but from dental professionals) and I’m in no way an expert in this area. But…

    At Dr. Coyne’s age, one should have one’s wisdom teeth removed (and only if necessary) by an oral surgeon and not by a dentist. It’s a delicate procedure and not a mere extraction. From what I understand, as you get older, the wisdom teeth fuse with the jaw bone and there is some sort of nerve that gets closer to the tooth. Basically, you’re chiseling it out and if the nerve is damaged, it can lead to partial paralysis on that side of your face.

    My oral surgeon wouldn’t remove mine unless they start causing problems, too risky. His advice was to have them out when you’re young, because then it is a simple extraction (even if they’re not causing you problems).

    For what it’s worth.

  13. My 2 lower wisdom teeth were extracted last year. The extraction itself wasn’t bad. However, afterwards I experienced excruciating pain. I was on narcotics & NSAIDs for about two weeks. Then the pain subsided somewhat so that I only needed NSAIDs. Oy vey. I was miserable for about a month.

    Several years ago I had an abcess in a front lower molar. Again, it was excruciating. My dentist said it was the worst abcess he had ever seen. I needed a root canal because of it; during the procedure my dentist kept sucking crap out of it. The abcess continued to drain for about a week afterwards so that I could not have a temporary crown, and it tasted like raw meat. Disgusting!

  14. Am I the only one who had pre-molars extracted as a teenager so my wisdom teeth would have room to grow without messing everything else up? I thought that was the standard anymore.

  15. Sound like I should be glad I have a big mouth – or summat.

    But your mention of your appointment, did remind to look at my x-rays today, and sure enough, the wisdom teeth are slightly angled compared to the rest of the molars, as if there’s too little room for them.

  16. I had 6 wisdom teeth: 2 each at upper and lower left and one each at upper and lower right. All removed when I was 18. Sodium pentothal, oh yeah! And some novocaine. I was eating my normal diet in two days.

    They never gave me any real trouble; but the extra two on the left (further aft and growing almost perfectly outwards towards my cheeks) would have eventually given me a lot of trouble. The other 4 were errupted and somewhat tilted (mainly inboard or outboard.) I am a very large male with a large head and maybe that’s why they didn’t cause any trouble (yet, at age 18.)

  17. I only have one wisdom tooth which isn’t moving and is behaving itself, if does start to to will have to get it out as I’ve spent far too much money replacing the milk teeth I have with implants as I didn’t have Adult teeth, so the question is hypoplaceny and advantageous mutation, neutral or disadventagous. It runs on the fathers side of the family but rarely is it expressed.

    1. Or the disgusting stuff has an abnormally high tolerance for biologists coming up close and personal.

  18. “I was amazed that the whole mess was enclosed in a spherical membrane. This was new to me, as I haven’t really paid much attention to abscesses. It turns out that the abscess is a capsule formed by normal tissue to try to prevent an infection from spreading to other parts of the body.”

    You may also be interested in similar phenomena such as granulomas and nodulation. (in insect immune response)

    1. “a capsule formed by normal tissue to try to prevent an infection from spreading to other parts of the body.”

      This suggests a rather touching concern by normal tissue for what happens to other parts of the body, and a singular wisdom about what to do. Could it perhaps rather be that animals that did not form such capsules died from infection at a greater rate than those that did, until eventually the survivors all formed capsules, with none of them ever knowing why, or even that, they did?

      That’s an interesting concept. Perhaps it has wider applications. I wonder what I’ll call it?

  19. Never had a wisdom tooth. Must be a mutant. My father had 2. My two son’s each had 4 like their father. My sister had a couple, I think – she’s such a angry christian I don’t care to ask. Could be her karma.

  20. You’re all making me paranoid because I still have all my wisdom teeth! They seem to be pushing my bottom teeth forward just a bit, but no real trouble. They have little growth spurts on occasion, then stop again.

    1. I had the same problem with mine before they were removed I could feel my front teeth being pushed together and crowded. My dentist swore that it was very unlikely, but I told him no..I can feel it happening

      1. Yep, that and a gum bleeding (false alarm, naturally – first year of heavy studies, problem with my immune response) got me x-rayed and then put on the op table twice.

        Made me go “I know my body” for years.

  21. Relatedly, what good are our sinuses? I pursued this question once, briefly, but came up empty.

    1. I don’t know if it has been hashed out. But I seem to remember nice model images on how they can distribute stresses on the bones, which can have all sorts of functions.

      In any case, maybe they are vestigial structures? The early bone structures formed in other environments.

  22. Strangely I find this blog interesting. My sister is devoid of wisdom teeth and was told by a dentist that she’s more evolved, or so she tells me.

    I’ve had flare-ups of pain above my upper-right molars and an x-ray revealed the pain was actually my sinuses which extend to the area above my teeth. Now I’m wondering if the problem was working the other way around as did with Jerry. Altho, I’m not really curious enough to visit the dentist to find out..

  23. Just two weeks ago I had a big and very painful internal abscess at the root of one of my upper teeth, and it finally burst into my sinus cavity, filling it with pus. When I turned my head in a certain way, large quantities of clear warm yellow pus would suddenly drain from my nose like I had turned on a faucet.

  24. I’m really not getting this… You’re saying all our wisdom tooth problems are evidence of evolutionary improvement? Surely the happy Aborigine with his pearly whites has a major advantage over the bed-ridden analgesic consumer? Evolution sounds even more mad than religion!!

  25. 1. People in traditional societies that do not consume processed food have few difficulties with tooth alignment. Their wisdom teeth come in just fine. This is partially due to a diet low in minerals that causes the bone structure to gradually shrink, but it is also due to a lack of delayed breastfeeding (nature’s palate expander) which is very common in less modern cultures.
    2. Have you had a root canal done near where your abscess was found? Google cavitation.

    1. I think you have fallen for some nonsense peddled by “natural living” woo-meisters.

      Human jaw reduction and the wisdom-tooth consequences have been evolving for many, many, thousands of years and reflect changes in dietary habits over long periods of time. This evolution has been driven by the invention of cooking foods and the shift from hunting to agriculture.

      Breastfeeding is a wonderful thing for many reasons, but prevention of wisdom tooth problems is not one of them.

      – A breast-fed, wisdom-tooth-extracted witness.

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