Almost two-thirds of people with four normal wisdom teeth show signs of periodontal disease in their 20s, and in many the periodontal disease is progressive, according to a study discussed at a press briefing sponsored by the American Association of Oral and Maxillofacial Surgeons.
“Most people would think that you don't get periodontal disease until you are 35 years old,” said Raymond P. White Jr., D.D.S., one of the authors of the study.
“The finding that surprised all of us is that the prevalence of periodontal disease in people in their 20s is much higher than anyone would have anticipated,” said Dr. White of the University of North Carolina at Chapel Hill.
He expected that only about 10% of people in this age group would have signs of periodontal disease.
Many other studies have confirmed linkages between periodontal disease and a number of systemic illnesses including coronary artery disease, stroke, renal vascular disease, diabetes, and obstetric complications.
As a result, Dr. White recommended that adults be evaluated for periodontal disease well before the age of 25, and if disease is present they should give serious thought to having their wisdom teeth removed, even if they're asymptomatic.
The study involved 254 individuals, mean age 27.5, who had four asymptomatic wisdom teeth (more formally known as “third molars”), and who were followed for at least 2 years; 93% of the subjects were at least high-school graduates.
At baseline, 59% of the subjects had a periodontal probing depth (PD) of 4 mm or more on at least one wisdom tooth, and 26% had a PD of 5 mm or more.
Gingival pockets of at least 3–4 mm in depth indicate the presence of periodontal disease.
Among the subjects who had PDs of 4 mm or more, 38% experienced an increase in PD of at least 2 mm in the subsequent 2 years.
More than half of those subjects had other indicators of periodontal disease, including high levels of bacteria and inflammatory markers. Subjects with both a baseline third molar PD of at least 4 mm and high bacteria levels had 19.7 times the chance of having progressive periodontal disease, compared with subjects with neither risk factor.
Removing the wisdom teeth is not the only option for patients with periodontal disease. Scaling and root planing every 3 or 4 months is another approach, but dentists have a difficult time working that far back in the mouth.
Studies have shown that dentists are unlikely to remove more than 50% of the bacteria in patients with deep gingival pockets, Dr. White noted.
The message to patients is, “If you ignore [this] and you don't do something about it, you're running the risk of chronic oral inflammation and then not only problems in your mouth but also systemic problems,” Dr. White said.
“Just because you have no symptoms doesn't mean that you have no problem. What we're recommending is that everybody with wisdom teeth should have them evaluated. Twenty percent or maybe 25% of people can keep their wisdom teeth with no problems, but you can't ignore them. They need to be evaluated seriously,” he added.