Q-I have been advised by all the dentists I have consulted, even a 'holistic' one, to remove all my wisdom teeth, although they have not given me problems (only a couple of fillings), but are slightly 'cramped'. The reason given is that, due to insuf

Should molars be routinely removed? This seems to be the stand of the dental profession, and reminds me of doctors who routinely removed tonsils not too long ago because they believed that tonsils served no purpose. CY, Singapore.........

A-American dentists have come to call wisdom teeth 'teeth of misfortune'. This is because the cure is often worse than the 'disease'.

Not long ago, dentists believed that wisdom teeth should be routinely removed as a preventative exercise against possible infection. What they didn't appreciate, until recently, is that removing a tooth can cause serious hidden problems, which can be the source of seemingly unrelated ill health.

Extracting a tooth is not automatically a safe procedure. According to WDDTY panel member Dr Robert Hempleman, when a tooth is extracted, some of the periodontal ligaments that attach the tooth to the bone are often left behind, as are some bacteria. When the socket heals over, a small nest of infection remains (J Endodont, 1990; 16: 54). Unlike most other infections, the body's response is often to encapsulate the infection, sealing it off from bone and even the blood supply. The result is a 'cavitation' a cavity that contains bacteria. And because it has been sealed off, antibiotics can't get to it. This focus of infection (Br Dent J, 1939; 65: 552-3) usually then goes through several stages of ostitis, or inflammation of the bone.

Other troublesome activity in the tooth has to do with the nerve that was damaged during the extraction. In an attempt to heal the ruptured nerve, various elements healing catalysts are sent to the tooth via a two way transport system that flows throughout the body, which means that the bacteria and their toxins are circulated from the tooth socket to anywhere in the body. The eminent Dr Weston Price, who conducted extensive studies on root canals, demonstrated that these bacteria can reach virtually any organ in the body (Price W, Dental Infection: Oral and Systemic, 1923; reprinted by the Price Pottenger Nutrition Foundation, PO Box 2614, La Mesa, CA 91943, USA). Many American dentists believe that cavitations are responsible for a substantial proportion of cases of headaches and ME.

In some instances, the ruptured nerve left behind in an extracted tooth becomes inflamed. This can cause extreme facial pain and is often mistakenly diagnosed as idiopathic trigeminal neuralgia. At his London based dental clinic, Dr Hempleman has successfully treated numerous cases of so called trigeminal neuralgia simply by treating cavitations.

Dr Hempleman tends to take a conservative line regarding tooth extractions; indeed, even the British Dental Association has recommended that wisdom teeth no longer be routinely removed. He doesn't remove wisdom teeth unless they don't erupt properly if they are not causing any trouble. After all, dentists can't say for sure that any given patient will definitely have problems from these 'crowded' teeth and, if they did, the worse that can happen is an infection requiring standard antibiotics or a good alternative antibiotic. However, if this occurs repeatedly, that might be the time to consider getting the teeth pulled.

The only caveat, says Dr Hempleman, is that, if the teeth are causing trouble, it is better to extract a tooth when you are young or middle aged, when your body can more easily bounce back, your bone is more elastic and your immune system more robust.

If it does turn out that a tooth needs to be extracted, Dr Hempleman recommends that the socket be well cleaned out and curettaged (scraped using a special tool called a curette). His clinic removes one millimetre of bone from the socket and irrigates with colloidal silver, if necessary. He also places his patients on high doses of vitamin C or even intravenous vitamin C before and after the procedure.

If you have had an extraction and suspect you may have a cavitation, there are several ways to have it diagnosed.

Two thirds to nearly three quarters of all cavitations will show up on an X-ray. You need to have your dentist take a 'panoral' (panoramic) view of the entire top and bottom jaw. Your dentist should suspect any extraction more than a year old which still shows a socket, or any case were the bony trabeculae are either not present or resemble 'falling rain'.

For more about cavitations, you may want to consult Menace in the Mouth?, by our other panel member Dr Jack Levenson. This contains a special section contributed by Dr Hempleman (The Brompton Dental & Health Clinic, 221 Old Brompton Road, London SW5 0EA; 020 7370 0055) on the subject.