Not So Everyday Medicine: The Wisdom Of Teeth


Dr. Bonnie Padwa is the Oral Surgeon-in-Chief at Boston Children’s Hospital. We spoke recently about being smart about wisdom teeth removal, teeth as a source for stem cell harvesting and how an early experience as a hospital candy striper almost derailed Dr. Padwa’s dream of becoming a doctor.

Can you tell me about your work at Boston Children's Hospital?

I really do love my job as an oral maxillofacial surgeon. When people think of oral maxillofacial surgeons, they think of dentists and yes, while we have a dental degree, the practice is about more than teeth. It's jaws, function, joints, aesthetics. In this speciality, I perform surgery and technical procedures and I see a range of problems, from routine to very complex. My patients are of all ages, which means very different types of emotional and physical development. A toddler is a very different patient than a preteen, who is very different from a teenager, who's very different from an adult. 

What is your area of speciality within your practice?

My area of expertise is caring for children with facial differences, primarily children who are born with cleft lip and palate. This is immensely gratifying, especially because some of the procedures that I perform in late adolescence and early adulthood have a major impact on these patients’ self-esteem. 

What would people be surprised to learn about the life and practice of an oral maxillofacial surgeon?

I think people would be surprised about what a physical sport being a surgeon is. And it's not just oral and maxillofacial surgery, it’s any surgical or procedural specialty. It’s hours of concentration, which can be intellectually and emotionally exhausting, and also physically exhausting as surgeons stand for several hours at a time.  So surgery of any kind is really a physical sport.

Just out of curiosity, what is the longest surgery you have been in?

Probably [close to] 16 hours. We would start at 7:30 a.m. and finish up close to midnight. I don't do those regularly, but it does happen.

What specialities do you work with the most?  

I work very closely with plastic surgeons and with dentists and orthodontists. Since I do a lot of surgery that's related to cleft lip and palate, some of the procedures these patients have are performed by plastic surgeons, and then a lot of what I do for the jaws and the mouth require orthodontic collaboration.

I wanted to ask you about wisdom teeth since so many teenagers I know were told they need to get them removed. Why do we have wisdom teeth, and why do most of us need them removed? 

The name “wisdom teeth” comes from the fact that these teeth are the last ones to come in; it is said that you have more wisdom when you get them. As for the origins of these teeth, long ago our diet was very coarse and to accommodate the foods we ate, and we had very large jaws. The large jaws of our distant ancestors had room for these wisdom teeth, while the current jaw size is much smaller than it was and therefore does not have room for the wisdom teeth to develop. There was also no dental care back then so it was very common to lose teeth, and wisdom teeth were seen as a form of replacement teeth. Since these are the last teeth to form and the last teeth to come into the mouth, there's not always enough room for them. These teeth then get stuck in the jaw and the bone - this is called impacted wisdom teeth, which is why we recommend they get removed

All right. In terms of prep and downtime, what should kids and their parents plan for, in terms of wisdom teeth removal? Time out of school, or time off from activities and sports?

The prep is minimal, if you’re having IV sedation, then that means nothing to eat or drink after midnight before the procedure which usually takes place in an office. The procedure doesn't take long, usually about 1-1.5 hours, and then you head home feeling pretty drowsy. We ask you to take it easy that day, use lots of ice to keep the swelling down in the first 24 to 48 hours. There might be 3-5 days of swelling and possibly some bruising. I recommend that my patients don't plan any big event for at least a week after the procedure if they want to look and feel their best. For school, people go back as soon as they feel up to it, usually after 2-3 days. If you had your wisdom teeth out on a Thursday, you should be fine by the following Monday or Tuesday. Recovery is about rest, keeping ice on hand to reduce swelling, some ibuprofen or tylenol for pain, eating softer foods (nothing too hot!) for a few days until you feel like yourself again.

I read about harvesting stem cells from the dental pulp of wisdom teeth, is that possible?

Once wisdom teeth are fully developed, they don't really have the stem cells that developing teeth do. If you remove the wisdom teeth when they're very immature and before they've developed their roots, yes, there is a good amount of stem cells available. As the tooth develops, the first thing that develops is the crown of the tooth, and right underneath the crown of the tooth are the stem cells. Over time, the roots start to spread and then the stem cells are just inside the roots. If the tooth is in what we call the bud stage, where you just have the crown, you take the crown out, there is a little pocket of tissue where all the stem cells are. Since the average age for removing a person’s wisdom teeth is somewhere between 16 and 20 years old, it would mean removing them earlier - before age 16 - to get the best stem cells from the developing teeth.

I want to transition to talk about your journey into medicine. Did you always wanted to be a surgeon?

When I was about 12 or 13 years old, I thought I might want to be a doctor. I was volunteering as a candy striper at a hospital and every week, there was a patient that I would see when I brought him his breakfast, and we would chat. And one day I overheard the nurses saying that he had died, and that rattled me and I decided I didn't want to be a doctor. At that same time, I was seeing an orthodontist for my braces, so I decided I wanted to be an orthodontist instead. I started dental school at Harvard and since the first two years of dental school are the same as medical school, I found that I really enjoyed the medical school [track]. In my first year, it was very clear that I was going to be a surgeon because I really enjoyed the anatomic dissection. In that same year, we had a class on embryology, which is a class that describes how the body forms. One of the speakers that came to talk talked about what happens when the face doesn't form properly and the facial differences that develop. He discussed some of the surgical procedures that are performed to fix those facial differences. And that’s when I knew: oral maxillofacial surgery was for me.

Charlotte Lawrence is a junior at Manchester Essex Regional High School.  As the school district’s student health ambassador, she seeks to raise awareness about issues that impact the health of our students and community.

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