KANSAS CITY, Mo. — For generations, getting wisdom teeth pulled has been a fairly routine part of growing up.  But a growing number of experts question the wisdom of removing teeth before they’re diseased.

“It’s this ole tooth way back there that’s got that big flap of tissue over top of it, so you just ran out of room, girl,” Dr. Brett Ferguson says to his patient, Hailey Taylor.

Taylor can feel it.

“I just noticed the pain would get worse and worse and worse,” she said.

Her lone wisdom tooth is causing infection and will need to come out.  Ten million wisdom teeth are removed in America each year at a cost of $3 billion.  Not all are diseased.  A study in the American Journal of Public Health found dentists still frequently recommend removal to prevent crowding and other trouble.  But Dr. Ferguson, director of oral surgery at the UMKC School of Dentistry, says only about a quarter of wisdom teeth  will ever cause trouble.

“If it is not causing disease, if it is not causing pain, if it is coming into the normal eruptive pattern of the other teeth, then that tooth certainly can be maintained and it does not need to be removed,” said Dr. Ferguson.

He says it’s better to practice “watchful waiting” or monitoring of the teeth.

“If we know they need to come out, just get in there and get it done,” said Dr. Merle Nunemaker, a dentist for 38 years.  He believes in removing healthy wisdom teeth in some cases.   He pointed to an x-ray of his son’s wisdom teeth at age 16.

“There’s absolutely no way for those teeth to come in.  We had them taken out before the roots were fully developed, so it was actually an easier surgical procedure on him and he healed up very quickly,” said Dr. Nunemaker.

Like all surgical procedures, there is some risk including, in rare cases, death. In June, a Minnesota teen died.

“We see that individuals who die have a tendency usually to be associated with the airway and or some type of underlying medical condition,” said Dr. Ferguson.

He says that’s why your medical history should be carefully reviewed beforehand and also the level of sedation you should have.  If you have one or two diseased wisdom teeth, consider whether others should be removed at the same time.   Some patients want them all removed to avoid another procedure later.

Dr. Ferguson says before you have those discussions, “The consumer needs to first say ‘why does this tooth need to come out?’”

And know that many don’t need to.

The report in the public health journal found that when dentists recommend removal, the biggest predictor of whether someone will have it done is insurance.