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Wisdom Teeth Extractions: Considerations for TMD Patients

Dr. Gio Iuculano, DDS

In this interview, Gio Iuculano, DDS discusses the extraction of wisdom teeth, and the importance of doing so carefully for patients with TMD.

Why is it important to extract all the wisdom teeth at once?

Wisdom teeth can be removed separately or all at once. But it’s important to remember that the teeth are always moving within the jaws. Opposing teeth keep each other in line as they meet when the mouth is closed, so if a wisdom tooth is extracted from the upper jaw, then the opposing tooth on the lower jaw will likely drift up over time and create bite issues.

What would happen if the wisdom teeth on only one side were extracted?

Extracting teeth on only one side could lead to TMJ dysfunction, headaches, and muscle issues. This is part of why we recommend that patients have all four wisdom teeth removed at the same time. T-Scan digital technology is useful in these cases to help us align the bite.

So T-scan technology helps determine where the bite needs adjustment?

Yes. Many dentists (myself included) use “blue paper” (carbon paper) to look at basic bite patterns. We’ll have a patient bite gently on the paper and then analyze what we see. A T-Scan shows in detail how long teeth are in contact with each other (duration), the intensity being placed on those teeth (stress), and which teeth touch first or if they touch evenly (timing). This helps us to know where in the mouth we need to go to smooth down the teeth, or build them up with white fillings (fillings made of composite material to create contact points that should be there).

As a dentist experienced in TMD treatment, what questions would you ask an oral surgeon who might be extracting wisdom teeth for a patient with TMD?

For a TMD patient, I would stress the importance of removing the teeth with as little force as possible, and would ask the surgeon about minimizing the time spent during the surgery holding the patient’s mouth open with bite blocks. It is possible to do this by sectioning the wisdom teeth and removing them one section at a time. This sectioning process is certainly something I would ask about. The concern about applying force during oral surgery is that it stresses the jaw and forces the jaw joint to go sideways, which could undo the position of the condyle (disc) between the upper and lower jaws.

Have you encountered many TMD patients needing wisdom teeth extracted?

No, but because we do shorter visits with TMD patients in our own office and take as many precautions as we can, it’s logical that an oral surgeon treating a TMD patient should do the same.

Updated May 7, 2019