# Why Do We Have Wisdom Teeth if They Get Removed

Wisdom teeth persist in the modern human mouth because the genetic mechanisms that initiate tooth formation operate entirely independently of the environmental and evolutionary forces that dictate jaw size. While our jaws have dramatically narrowed over millennia due to the processing of food and the adoption of softer diets, our genetic code continues to blindly produce these third molars, leaving them without adequate space to erupt. Consequently, they often become trapped or impacted, leading to widespread surgical removal.

## Bottom line

The human masticatory system is currently experiencing a profound evolutionary mismatch. The development of cooking, agriculture, and modern ultra-processed foods has drastically reduced the mechanical stress placed on the developing jaw, resulting in smaller, narrower dental arches. Because the genetic mechanisms controlling tooth quantity—driven by highly conserved, pleiotropic genes like PAX9, MSX1, and AXIN2—have not kept pace with the rapid reduction in jaw size, the third molars frequently become impacted. This widespread anatomical incongruity has ignited an ongoing global public health debate. While clinical guidelines in the United States overwhelmingly favor the prophylactic removal of wisdom teeth to prevent future pathologies, authorities in the United Kingdom historically advocate for watchful waiting, though emerging evidence regarding severe adjacent tooth decay is prompting a rigorous reevaluation of this conservative approach.

Getting one's wisdom teeth removed—complete with swollen chipmunk cheeks, ice packs, and viral post-anesthesia videos—has become a nearly universal modern rite of passage. Yet, this ubiquitous surgical ritual is a remarkably recent phenomenon in the vast context of human history. For millions of years, the third molars were highly functional, essential tools for survival, serving as the heavy-duty grinders of the ancient hominin mouth. Today, they are the most common source of dental impaction and a leading cause of orthodontic referral, representing a fascinating intersection of evolutionary biology, developmental genetics, and modern surgical dentistry. 

## Why don't our wisdom teeth fit anymore?

To understand why the modern human mouth so frequently rejects its final set of teeth, it is necessary to examine the profound dietary and anatomical shifts that have occurred since the Plio-Pleistocene era. Early hominins, such as *Homo habilis*, *Homo rudolfensis*, and *Paranthropus boisei*, were dietary generalists who frequently relied on "fallback foods" during periods of ecological stress and seasonal scarcity [cite: 1, 2]. These diets consisted of coarse, abrasive, and mechanically demanding materials—raw roots, fibrous plants, hard seeds, and tough, uncooked meats [cite: 3, 4, 5]. A comprehensive 2006 study published in the *Journal of Human Evolution* utilized high-resolution scanning electron microscopy to examine the microscopic wear signatures on the cheek teeth of these early hominins. The specific distributions of pits and scratches indicated a highly abrasive diet that required massive masticatory forces and expansive occlusal (chewing) surface areas to process effectively [cite: 1]. 

In this harsh ancestral environment, a robust, elongated jaw housing 32 large teeth, including four fully functional third molars, was an absolute evolutionary necessity [cite: 1, 5, 6]. Furthermore, because early humans experienced significant tooth wear and frequent tooth loss due to their demanding diets and complete lack of dental hygiene, the late eruption of wisdom teeth (typically between ages 17 and 25) provided a vital set of replacement grinders, ensuring that adults could continue to masticate their food and extract necessary calories later in life [cite: 2, 6, 7].

The evolutionary trajectory of the human jaw changed irrevocably with one of the defining events in human evolution: the dramatic expansion of the hominin brain, known as encephalization. As the neurocranium grew extraordinarily fast in evolutionary terms, the architecture of the skull was forced to reorganize. The face did not simply scale outward uniformly; rather, the facial skeleton retreated beneath the expanding braincase. This resulted in a flatter, more orthognathic facial profile, leaving significantly less anterior-posterior space for the dental arch [cite: 1, 2]. 

Simultaneously, the advent of external food processing—first through the use of stone tools to cut and pound meat, and subsequently through the mastery of fire for cooking—drastically altered the selective pressures acting on the human jaw [cite: 3, 5, 6]. Cooking breaks down the rigid cellular matrices in plants and denatures connective tissue proteins in meat, essentially pre-digesting food before it even enters the mouth. This immense technological leap meant that early humans no longer needed massive, energy-expensive jaw muscles or hyper-robust mandibles to extract calories [cite: 2, 8]. Over hundreds of thousands of years, the human jaw grew progressively shorter and narrower [cite: 3, 4, 9]. 

Interestingly, while the human jaw shrank and its musculature became less robust, it did not necessarily become biologically "weak." Advanced finite element analysis of three-dimensional digital skull models, pioneered by researchers like Dr. Stephen Wroe at the University of New South Wales, demonstrates that the modern human jaw is remarkably efficient [cite: 10, 11]. Historically, the notion of weak human jaws was based on unrefined models that treated the mandible as a simple two-dimensional lever [cite: 11]. However, when analyzed in three dimensions, modern human second molars can exert a formidable bite force of between 1,100 and 1,300 Newtons, outpacing the bite force of orangutans, gibbons, and *Australopithecus africanus*, though lagging behind gorillas and chimpanzees [cite: 10, 11]. 

Because the modern human face is shorter and retracted, the jaw muscles have a significantly higher mechanical advantage. The human masticatory apparatus scales efficiently, capable of producing powerful bites with relatively low muscle force, which exerts up to 40% less stress on the lightly built skull compared to other primates [cite: 10, 11, 12, 13, 14, 15]. Therefore, the reduction in facial robusticity that characterizes modern *Homo sapiens* did not compromise our ability to bite hard; it simply reorganized the mechanics of the skull [cite: 13, 14].

Despite this mechanical efficiency, the sheer physical real estate available in the dental arch has undeniably decreased. The transition from nomadic foraging to settled agriculture approximately 10,000 to 12,000 years ago accelerated this trend rapidly. Studies of archaeological skeletons from the Levant, Anatolia, and Europe dating back 28,000 to 6,000 years show that the lower jaws of the world's earliest farmers underwent a complex series of shape changes compared to their hunter-gatherer predecessors [cite: 8]. Anthropologist Noreen von Cramon-Taubadel's research further confirms that human jaw sizes and shapes vary directly according to diet, not just genetic lineage. In comparisons of hunter-gatherer populations (such as Alaskan Inuit and Australians) with agriculturalist populations, those subsisting on unprocessed foods that require heavy chewing consistently developed longer, roomier mandibles, whereas agriculturalists eating softer cooked grains and cereals developed "relatively short and broad mandibles" [cite: 16, 17]. While the jaw shrank rapidly in response to these dietary changes, the teeth did not shrink at the same proportionate rate, remaining roughly the same size and leading directly to the modern epidemic of dental crowding [cite: 8].

| Metric | Ancestral Jaw (Hunter-Gatherer) | Modern Jaw (Agricultural/Industrial) |
| :--- | :--- | :--- |
| **Dietary Toughness** | High (raw meats, fibrous roots, tough plants, hard seeds) [cite: 3, 5] | Low (cooked, heavily processed, soft agricultural products) [cite: 6, 8] |
| **Chewing Force** | High muscle input; absolute forces exceeding 1,700+ N in related robust hominids [cite: 11, 14] | Highly efficient leverage; 1,100 to 1,300 N bite force at the second molar [cite: 10, 11] |
| **Jaw Size & Shape** | Large, robust, elongated, heavily prognathic to accommodate 32 teeth [cite: 2, 5] | Smaller, gracile, flatter (orthognathic), narrowed parabolic arch [cite: 2, 4, 5] |
| **Tooth Wear** | Heavy, flat occlusal surfaces; frequent severe attrition and compensatory migration [cite: 6, 18] | Minimal wear; retained natural cusp morphology; high rates of impaction and crowding [cite: 16, 18] |

The Soft Diet Hypothesis and Childhood Chewing Stress

While genetic evolution accounts for the overarching reduction in jaw size across millennia, recent research emphasizes that the development of the human jaw is also highly plastic and profoundly dependent on environmental stimuli during an individual's lifetime. This mechanism is governed by the mechanical loading hypothesis, frequently referred to in recent literature as the "soft diet hypothesis" [cite: 19, 20].

Bones are dynamic tissues that constantly remodel in response to the physical forces placed upon them. In generations past, children regularly chewed tougher, more fibrous foods, providing constant mechanical stimulation to the mandible and maxilla. This strenuous chewing motion sends critical signals to osteoblasts (bone-building cells) to widen and strengthen the dental arches, creating adequate space for the permanent adult teeth to erupt in proper alignment [cite: 16, 17, 20, 21]. Without this forceful chewing, the jaw simply does not reach its full genetic growth potential.

Recent pediatric and dental research conducted between 2020 and 2025 has starkly illuminated the consequences of modern, highly industrialized diets on craniofacial development. A landmark 2025 study from the Faculty of Medicine and Health Sciences at the Catholic University of Valencia rigorously evaluated the diets, dental structures, and skull shapes of children aged three to five years old [cite: 22]. The researchers found a direct correlation between modern convenience foods and craniofacial underdevelopment. Diets heavily reliant on ultra-processed foods (UPFs)—such as soft supermarket breads, pureed fruit pouches, flavored yogurts, chicken nuggets, and ready-made meals—fail to provide the necessary masticatory resistance to stimulate proper jaw growth [cite: 22, 23, 24].

Children subsisting primarily on these hyper-palatable, semi-solid diets were found to have significantly smaller, underdeveloped jaws and a marked lack of natural interdental spacing in their primary teeth, which is a crucial prerequisite for accommodating the larger permanent teeth that will follow [cite: 22, 25]. Dr. Laura Marques Martinez, a pediatric dentistry expert and co-author of the study, noted that chewing solid, fibrous foods like natural proteins and raw vegetables exercises the jaws and prevents deficiencies in the size and shape of the dental arches. Conversely, ultra-processed foods require minimal bite force, depriving the developing maxillofacial muscles and bones of crucial exercise and drastically increasing the risk of malocclusion (misalignment of teeth), protruding "buck" teeth, and even downstream respiratory problems [cite: 23, 24, 25]. 

Nutrition experts and anthropologists now characterize this phenomenon as an "epidemic of jaw shrinkage." Research from Stanford University and the University of Kent corroborates these findings, indicating that the transition to softer diets disrupts the biological signaling systems that determine appropriate orofacial structure [cite: 22, 23]. Because toddlers in western nations frequently derive more than half of their daily calories from ultra-processed, soft foods, they never develop the jaw musculature or skeletal capacity adapted for chewing [cite: 23, 25]. Consequently, when the third molars attempt to erupt deep in the posterior of the mouth during late adolescence, the foundational bone structure is simply too small to house them, leading directly to high rates of impaction [cite: 20, 23, 26].

## Are humans going to stop growing them?

Given the prevalence of wisdom tooth impaction and the ubiquitous nature of surgical extraction, a pervasive misconception has taken root in popular culture and casual scientific discourse: the idea that because humans no longer *use* or *need* their wisdom teeth, our species is actively evolving away from growing them. This assumption fundamentally misunderstands the core mechanisms of genetics and natural selection, relying on a flawed Lamarckian view of evolution where unused body parts simply vanish.

To visualize the biological reality, one can liken the human mouth to fitting furniture into a smaller house. Over millions of years, the "house" (the jawbone) has been dramatically downsized due to changes in diet, reduced childhood chewing stress, and the reorganization of the skull to accommodate a larger brain. However, the genetic instructions that manufacture the "furniture" (the teeth) have remained stubbornly unchanged. The body is still actively attempting to squeeze 32 large pieces of furniture into a floor plan that is now optimized for 28. 

Evolution is not a conscious architect, nor is there a biological "tooth fairy" actively selecting against third molars [cite: 27]. For a biological trait to be aggressively eliminated from a population via natural selection, its presence must incur a significant and direct fitness penalty—meaning the trait must actively prevent an organism from surviving long enough to successfully reproduce and pass on its genes [cite: 1, 27]. Because wisdom teeth typically begin causing clinical problems (if they cause problems at all) in the late teens or early twenties—by which point the vast majority of our early human ancestors had already reached reproductive age and successfully bred—the evolutionary pressure to eliminate them is remarkably weak [cite: 1, 27]. Evolution has no foresight; it cannot optimize against biological consequences or physical pain that occurs after the window of reproduction [cite: 1]. Therefore, the continued presence of wisdom teeth is a clear instance of evolutionary lag. The trait persists not because it is currently useful, but because it rarely imposes a fitness cost severe enough, early enough in life, to warrant its eradication from the human genome [cite: 1].

The Genetic Mechanisms of Tooth Agenesis

While humans as a species are not universally evolving away from wisdom teeth, a significant portion of the global population is naturally born without one, two, three, or all four third molars. This congenital absence, known clinically as tooth agenesis or hypodontia, occurs in roughly 20% to 25% of the worldwide population [cite: 5, 28, 29, 30]. The mechanism behind this absence is not a Lamarckian biological response to shrinking jaws, but rather the result of specific, heritable genetic mutations.

Extensive dental and molecular research has identified several key genes responsible for the complex cascade of tooth development, principally PAX9, MSX1, and AXIN2 [cite: 1, 31, 32, 33, 34]. These genes are deeply pleiotropic, meaning they influence multiple phenotypic traits across the body. They are not merely isolated "wisdom tooth genes"; they are highly conserved regulators of broad craniofacial morphogenesis, jaw patterning, and embryonic tissue development [cite: 1, 33, 34]. 

The PAX9 gene, located on chromosome 14, codes for a paired-domain transcription factor that is absolutely critical during the early stages of odontogenesis (tooth formation) [cite: 33, 34, 35, 36]. PAX9 acts as a master switch, regulating the downstream mesenchymal expression of bone morphogenetic protein 4 (BMP4) and interacting with MSX1 [cite: 34, 35, 36]. Mutations in the PAX9 gene—particularly localized in exons 2, 3, and 4—can severely disrupt the delicate signaling cascades required for the tooth bud to form from the embryonic tissue sheet [cite: 31, 33, 37]. When a person inherits specific mutated variants of PAX9 or MSX1, the tooth germ for the extreme posterior teeth (the third molars) simply never initiates development [cite: 32, 38]. 

These mutations typically exhibit an autosomal dominant inheritance pattern and often function through haploinsufficiency, meaning that a mutation in just one allele of the gene is enough to disrupt the protein concentration required to form the tooth [cite: 31, 35, 36]. Because these pleiotropic genes regulate the patterning of the entire dental arch, a mutation that prevents a wisdom tooth from forming can frequently prevent other teeth from forming as well. Research indicates that individuals missing a third molar are statistically far more likely to experience agenesis of other teeth, most notably the maxillary lateral incisors or the mandibular second premolars, highlighting the deeply interconnected genetic control of the human dentition [cite: 7, 19, 28, 32, 35, 36]. Furthermore, variants in the AXIN2 gene, which regulates the Wnt/beta-catenin signaling pathway, have also been strongly linked to familial oligodontia (the absence of multiple permanent teeth), further proving that missing wisdom teeth are the result of molecular signaling interruptions, not an evolutionary drive toward smaller mouths [cite: 34, 39].

Geographic Diversity in Agenesis and Impaction

The prevalence of third molar agenesis and impaction is not uniform across the globe; it exhibits profound geographic and ethnic variation, underscoring the complex, population-level interplay of genetics, ancient mutations, and modern environment. 

A comprehensive meta-analysis of over 63,000 subjects established that the worldwide baseline rate of third molar agenesis is approximately 22.6% [cite: 28, 29, 30]. However, this data reveals a distinct geographic distribution driven by regional gene pools. Asian populations exhibit the highest rates of third molar agenesis globally, often averaging nearly 30%, with specific cohorts (such as Korean populations) demonstrating agenesis rates as remarkably high as 41% [cite: 28, 30, 40, 41]. Conversely, populations of African and Indian descent tend to display the lowest rates of third molar agenesis, with studies showing prevalence as low as 5.7% to 11% [cite: 30, 40]. European and Caucasian populations generally fall into the middle of this genetic spectrum [cite: 28, 42]. 



Similarly, rates of wisdom tooth impaction—where the tooth successfully develops its bud and crown but becomes physically trapped in the jawbone or soft gum tissue due to a lack of space—also vary heavily by region. A rigorous 2024 systematic review and meta-analysis involving 183,828 subjects across 98 studies found a pooled global impaction rate of 36.9% per subject, and 46.4% when measured per tooth [cite: 41, 42]. Consistent with the agenesis data, Asian populations showed the highest rates of impaction at 43.1%, followed by Middle Eastern populations at 36.5%, and European populations at 24.5% [cite: 41, 42].

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 Furthermore, studies show a slight predilection for agenesis and impaction in females compared to males, and a higher likelihood of the anomaly occurring in the maxilla (upper jaw) versus the mandible (lower jaw) [cite: 29, 41, 43, 44].

## Do you actually need to get them removed?

When wisdom teeth fail to erupt properly, they can grow horizontally, become trapped entirely within the dense jawbone, or only partially emerge through the gums. A partially erupted third molar creates a permanent, hard-to-clean flap of soft gum tissue called an operculum. Because it is nearly impossible to reach with a toothbrush, this warm, moist pocket becomes a breeding ground for bacterial accumulation, leading to recurrent, painful infections (a condition known as pericoronitis), severe swelling, and the development of cysts or tumors that can hollow out the surrounding jawbone [cite: 4, 5, 6, 45]. In these acute, symptomatic scenarios, surgical extraction is universally indicated and medically necessary.

However, a fierce and long-standing debate exists within the global dental and maxillofacial community regarding the management of *asymptomatic*, disease-free wisdom teeth. If a wisdom tooth is impacted but completely painless and currently free of infection, is it better to proactively remove it to prevent future problems, or to leave it alone and monitor it with X-rays? The answer varies drastically depending on geographic location and national health policy, creating a stark divide in clinical consensus.

The United States: Preventative Extraction and Risk Mitigation

In the United States, the clinical consensus strongly favors prophylactic (preventative) removal of impacted wisdom teeth. The American Association of Oral and Maxillofacial Surgeons (AAOMS) explicitly recommends that third molars associated with disease, or those deemed to be at a *high risk* of developing disease in the future, should be surgically managed [cite: 46, 47, 48]. 

The rationale driving US policy is aggressive risk mitigation. The AAOMS argues that an absence of symptoms in a young adult does not equate to an absence of disease, nor does it guarantee a lifetime of health. Longitudinal studies cited by US practitioners indicate that the risk of future pathology requiring the eventual removal of retained, asymptomatic wisdom teeth exceeds 70% over an 18-year follow-up period [cite: 48]. 

Furthermore, surgical morbidity, recovery time, and the risk of severe permanent complications increase significantly as a patient ages [cite: 47, 48]. In the late teens, the roots of the wisdom teeth are only partially formed, making them easier to extract, and the surrounding jawbone is softer and more vascular, which aids in rapid healing. As a patient ages into their thirties and forties, the roots of the third molar grow longer, frequently hooking around or becoming deeply entangled with the inferior alveolar nerve (the major sensory nerve of the lower jaw). The surrounding bone also becomes denser and more calcified [cite: 5, 48, 49]. Extracting teeth at this later stage vastly increases the risk of paresthesia (permanent numbness of the lip, tongue, and chin) and prolonged recovery [cite: 48, 50]. Consequently, oral surgeons and orthodontists in the US heavily advocate for extraction during the late teens or early twenties while the patient's healing capacity is optimal, a philosophy that results in the surgical extraction of approximately 10 million impacted teeth annually in the United States [cite: 5, 45, 46].

The United Kingdom: Watchful Waiting and Public Health Economics

Conversely, the United Kingdom has historically adopted a highly conservative, non-interventionist approach to wisdom teeth. In March 2000, the UK's National Institute for Health and Care Excellence (NICE) published Technology Appraisal 1 (TA1), a landmark document that revolutionized British dental practice by explicitly stating that the routine practice of prophylactic removal of pathology-free impacted third molars should be strictly discontinued in the National Health Service (NHS) [cite: 51, 52, 53, 54]. 

The NICE guidelines were established primarily on the principle of *primum non nocere* (first, do no harm). The institute sought to prevent young patients from undergoing unnecessary surgical procedures that carry inherent and serious risks, including temporary or permanent nerve damage, alveolar osteitis (dry socket), hemorrhage, and severe postoperative pain [cite: 52, 55]. Secondarily, the guidelines were driven by public health economics; by halting the preventative surgeries that accounted for up to half of all wisdom tooth extractions in the 1990s, the NHS estimated it could save between £5 million and £12 million annually, freeing up resources and reducing surgical waiting lists [cite: 53, 55]. Under the NICE TA1 directive, surgical removal is strictly limited to patients with clear, irrefutable evidence of existing pathology, such as unrestorable caries, cysts, osteomyelitis, or at least two severe episodes of pericoronitis [cite: 53, 54, 55].

The Distal Surface Caries (DSC) Controversy

The divergent approaches of the US and the UK have provided dental researchers with a massive, population-level natural experiment over the last two decades. The clinical results of the UK's conservative policy have forced a profound reevaluation of what actually constitutes a "harmless" retained wisdom tooth. 

Mounting clinical evidence over the past several years reveals a severe, delayed consequence of the UK's non-intervention strategy: an alarming increase in Distal Surface Caries (DSC) on the adjacent second molars [cite: 50, 52, 56, 57]. The issue occurs specifically when a mandibular wisdom tooth is partially erupted and tilts forward at a mesioangular inclination (between 30 and 90 degrees) [cite: 50, 56, 57]. In this position, the crown of the wisdom tooth impinges directly on the distal (back) cervical surface of the adjacent second molar, below the gumline [cite: 50, 56]. This creates a tight, inaccessible biological crevice that permanently traps food debris and cariogenic plaque. Because it is physically impossible for the patient to clean this impingement zone with a toothbrush or floss, aggressive tooth decay quietly destroys the root and back wall of the otherwise perfectly healthy second molar [cite: 52, 56]. 

By the time this subgingival decay progresses far enough to become symptomatic and painful, it is frequently too late to save the second molar. Consequently, the UK has witnessed a highly concerning demographic shift in dental surgery: the routine retention of impacted third molars has led to a delayed spike in complex surgeries among middle-aged and older adults, who are now frequently losing *both* their wisdom tooth and their vital second molar to decay [cite: 48, 50, 52, 56]. Studies have shown that following the implementation of the NICE guidelines, the mean age of patients admitted for third molar surgery in the UK increased dramatically from 25 to 32 years, accompanied by a corresponding increase in severe surgical complications due to the patients' advanced age and denser bone structure [cite: 48, 56]. 

In response to this undeniable clinical evidence, major professional organizations, including the Faculty of Dental Surgery (FDS) at the Royal College of Surgeons of England and the British Association of Oral Surgeons, have fiercely criticized the 2000 NICE guidelines for placing a generation of patients at unnecessary risk of losing healthy teeth [cite: 49, 50, 52]. They argue that a partially erupted, mesioangular third molar is inherently high-risk and should warrant prophylactic intervention to save the adjacent second molar, even if the wisdom tooth itself is not yet actively decaying [cite: 56, 57]. A 2016 Cochrane systematic review attempted to settle the debate but concluded that there was insufficient high-quality evidence to definitively support or refute the routine prophylactic removal of asymptomatic impacted wisdom teeth, leaving clinicians caught between conflicting national guidelines and observed clinical realities [cite: 52, 56]. 

Recognizing this growing body of real-world evidence and intense pressure from the maxillofacial community, NICE has initiated a full, comprehensive update of its wisdom tooth extraction guidance (under project ID898), with evaluations being conducted by the Liverpool Reviews and Implementation Group (LRIG) [cite: 52, 58, 59, 60]. This ongoing review signals a potential shift away from strict watchful waiting toward a more nuanced compromise that acknowledges the insidious threat of distal surface caries.

Ultimately, whether a wisdom tooth must be extracted cannot be reduced to a binary rule; it is a highly individualized clinical decision. It requires a comprehensive radiographic assessment of jaw space, the precise angulation of eruption, the health of adjacent periodontal tissue, and the patient's age and healing capacity [cite: 5, 47]. While the modern human jaw is, from an evolutionary standpoint, ill-equipped to house 32 teeth, a blanket policy of extracting every third molar in teenagers is giving way to a more sophisticated, evidence-based approach that weighs the anatomical realities of the shrinking human face against the long-term biological risks of surgical intervention.

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12. [researchgate.net](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQEs5P4nwR1DZCDABuVghMllv8rQ-02FXwDKGGM9GPkYo4600yfTgi3hT9amNxpVMy0ot_0kUbWkiXvHhONYWf5mnuqH_dYKx_Hds1l1GkXZJ_-wd7tM2zl-QEhf0bzEi8lWojwZIAQFhtooRbKWM7ff1y3SUDdCler2OosNbX2EyUDWyUqQguDkzuVbY-SZr76KlOezET23FYmLGwNc0IzSczSgAreAedLbB6vuxMf-LZTgcD0hDj7t)
13. [nyu.edu](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQEEewtXfxhbelIoTDzelsk2NB2O9QXxLrN20HJ6tXp7RYmcqYSb6Bs_FN8tocRcPSYFyQB_YT2mnIDJ_8LXGuM5Ka06pyUzSXUOOiyiz1wm4bDyah8Y2bqYl2a5BUfoBEHRkmmCMtwrZpIosz7Yua286KtVrAuBZKwYKdfJ54wpAc4-eIBMi_M0ujfvYxJu_54ENemxf5rTJfPnlIFwSgR4C7a_kS9R-dw4Ek4Zrgytz3mo3GI6nvi343tXifxCEKE-2LnhZcYOQ98VUmT5QdnHsRCJhEHf40hIjAWjuq0ewq75OEKOMS_RmA==)
14. [nih.gov](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQEKQKbwW7s_itlp9F2MOU3-cLxpYyZ17YL3t15jiSOcGp2OWuDFUJ5kGyU0stgO15CR-xYlZ8Lpyl9fesFNw9V5_IlrKQfQou9K1Qp0dCC78D-zMgHpLzmP1xXh5WDdWdkZ5uHjRni1)
15. [sciencedaily.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQHTM8e3bjwnxAX9QW0nfsE-hDDoh0j2_OAMg1UQ_pJWhhqHGC85Bn9fDPy_LSQKDzYtaN76_giSVEgBIYJ58iAqaMwsEaQl1gBilgZHQW3O_lBOSD3IO9ccHWbdfzT_QiFbo5M9-H4J3lEBrtshRfg37YoOjA==)
16. [icr.org](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQGw5c-j6sUL4Ok0rQ4HHBSGpEdX_bbdlS_6WLa46itXfMQwZAxRAWNHOGtBRHI1uMenxGkflTB5Fq3cWzwjrL3f8lGfX32zF-U2nEbBxBU3ltumJ64B47rDe-qxTKgUsmyhBw6mQxNnJpTxye1Sm-R_Uq_rdNcCLxgzmQVTNppvuAjnPA==)
17. [icr.org](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQGHKXb8V-_qJ-mfI6kTfGW3RoGCjTGFmb04J35WQn4jzROH_nFUY-lcvKODK6ojfwTg90i3gLuXBfIZBayKkS_E9YMQ2UYlRMCG8JAMXA4thfwr-J5UZuk=)
18. [pgocclusion.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQFcgKn3QafLlYbULGdLCA5WKywWD6QUfTBOMvj5AFeq9DYm1zCZMUeymuKanHNiC7RiRPsa1nHXeWP9mO7yDDE2wpSf03U1--jw-FFOxeEOPfPIjP_z4t_aQZ9oI1mOkdsXJzNG9JDoE2WXf63Rqgo4j8CU7zICzrALCIKlqHvkCRwnnAE=)
19. [johnhawks.net](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQF_FrxSUicryRA05VrqzC-wIN5l7pTqiShy54KDzUwZx3ikbictdQFkflYoP5GXoBk5pzSuakCT-34GuGJkhHZV2BL98xD02t5kyWGFuwYJ8chhkQqFuYqsWb-Dg8GfJHjY9vm2SlfAdqjGlJYm_mxKlR0zoLFpqrKNPnXJuTqkuED9-OI=)
20. [lonestarkidsdds.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQFf03B_JWOl8txB0_41qd7DrOsoFxK_ferm7N_v280GaxeC91jctoFRbhpfcYeAkQn58KXn5MhYbffEwBw2MfZrttVpL1CXIjFw2Z2f0I0jENBW4VzDXGQL9t71sFDgf0mkVJTO-8vJGhCBmrd39MTfnfmzv88gS1_5GBMUl_ATBo3j1Q==)
21. [larsonortho.net](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQEBtHrD99JqgSZ0h9eUc6XN-XdkrcpaWqimm4qi-jVPPP8IA4EQk2Fj_BM6PHRL0MmzJauUA0PLpysrU4gUshe98Nbu_eV4wa8f6VC8uG2KaPXUpsf-ZCxLGptbnXIXenXHNwAI0vyrzoQrpBV5bB1To7yWEBoHVg3FxCrM9pM=)
22. [jpost.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQESpfnaMEGcF_-DZmzpztd30gk74qx8Kdie6NdyyqjC62NraQmUNYmijKLiGOsNRs7H6hXinIwUxRJBIX49MIrGqxV3rTBNYPLUY074o5isygaW68mQKmX99N708iXDCc2mT4zIn4a5oWAiXyPO84gR1KEXThR26i1X5EI1vxsTmhT3Rd45MHATm35ay2yrh_eHu5g=)
23. [dentistry.co.uk](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQGXPVH3qQ52yp0d16_jiYVeeE3BAT-5flz0U7ioFSS59QLmAdJ-dl1hKtLB8BBsu_UGmFq-0cq1kUk4kenbxwPX4AMfdCUF75HynjuYpdrZfUr334BiXTEDYdI0ZTefSaXP9u4gmB_PAYC1o2WwwRmv-qpk5O5R9xYsz9lUw87HXfYdYLtYMOd1YMuB)
24. [medicalnews.pk](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQFZbs0ihfbdZl-lzNSGK94ebXLrshGcCBHRNIqM6C5l9WzQs6vg2UTY4zUIlM5qZ_UQgEOqlZdlfwsyVzBl75nlr6DWdHFdiW1Dmt6Z6zCDk4FVfisJrWc9_OXZpDBubQ7vv95bcYhWa-j-pURRyknr5fPslYqvCktvbzi126HfXCe-oWE=)
25. [healthnika.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQE0M0ha_VfEjgwKLz9VnQKULvglsQNXvfRWuryhLwIeSwEQzj9gM240k7eRok-kOx9pAm9vTSuj60yfSv1tCpQmirWwPkzIBDsTv7-52Hhhn81jXKD8DyygRhvV2r8vP3gzdEtK_Cwlr2lNP1upgYq5XndMX6sTg_IKFHNwjsBuul7ct2ocKbuUQqU9a-4_JA4gTnRqv2I3G-Xo8DALOgN2n9OoiQV8)
26. [theguardian.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQFFhCCbqaoYJQaE7s2Vq5NJM3JBh92IsVt5EY2l0TTfNlYJzhsa1asEjiJfBSzDXyfioy3wa1nrnbjk4c6p53vDbqIAKmpTozTXTSVI3upkUocXJjB0jByPDQX1KcJ2aujGLdYkYl7BG4nkFkU_OacxNC9s90Nqjet-o0x2YxeyqdmaosqhuorNAoYlJnKVvIhpuNDhBYa-8xq4rOSm7Q==)
27. [quora.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQHzGwUQOt-sF7bSbfUqlTIzlAIm5HrhILC2HDivlShenQZfC2PuJ9jiIFNxIRiGYyBn0Eim_TOHNbpnO37OyGehhwbYeq-Fi-uPhmLY6q71k8JXO3diHqE8sRHK2JvouPIzKmDiWQrk8TGmxcpCT9zxAoczzc28VkfvJcsO0O8h4R71F6xID2Mb-LfTGHiNzop00lDZwZaF99MCGC88VQ4zg9TgsqNsW38p9q7Zcny3Bxkfy41lABmUxOGJxYUY)
28. [nih.gov](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQHgx5_4eHtjbTRzhAMF-WIrNcKxKaAec9g6NA8yDbfeBfkArdtW-AKYfnO9pO8ICAG4DtBva51exLJrE-vsKx-C3ugu1OmQNb_Qx26_GkxthTFoDMJEsKKg_zMe1yXmFEXYfMhx7kDc)
29. [harvard.edu](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQG2OTLr89aDQl9Bg8qXOkWQ9KPlBozQ4dcwINQOy74mQ_YRzGrd6_qAO0XBNlxoDnc7iIJtM-Lxneq2DzDu3-7Hms9c0txuVKX3neac2MkeW8hriAXmyvAlgujldG-TOiJfQpXn--_TU8FjmoAH2AWEbmFIuJrl8Ufv4Wwo8k6omi3LD-448xoR)
30. [mdpi.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQGWZbibR5kwdMDjOgH1_ozv2W2YppfBAJo5cKAbCgFSzPPxvDg86IC5nw-HLWYjbaTBgpXTDesxR1lP1xm0I3vNgvjofRUZ3pNmZmIze1UXDtxwsoz4DPfZx_caAtfm)
31. [nih.gov](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQG_o6G7x8Kh2zBWRgaIGsR2c4aI_nX_5vo6gm9PMXXdHasl4LWKEgvea5_exbQJDNE3ms4RhVpntom4K8qatVGSkSf0OT5VCNA6DINBlsHRMT3uEcpHiI2xd191SOIf1bkjE__IsA1v)
32. [klarity.health](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQF1xMCrMty-Ip9tUqJQb8D5Q_qjaCgEGd1zU8nJnoP0Rfkbf4QUbpmKQRC9KI9DwtY_LruXqdE3ez_n-D8q5JXZm1WgYMlQslsJlU67o_lJmhoaYs9yWUqD4lSguAc-hwgALXNZAm3yt8UhyyzuQlbzC5MeoCptqMYUMUQtEchHLRqFGpOjIfR_j1vSLqtfJOQ=)
33. [nih.gov](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQHdzgnxJi_7JtoXjcG-8kRSmGCHTAkYTjRqy-wDuVKmrC8KKnF_5CkSOOf_D0dD9dpsYX-lEd5s_RUEEFirGZ0ut8sFmW8SMtmzJ8OqBzERmwUAVuMZ16WFTJO9C36rrLt0jsFupGzDWg==)
34. [scielo.sa.cr](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQFdXJIEOzR4FcSCitU_UCxOklrwD0cbSHr1UsMQR97-48-y7V-sraYmb5-Q9jgkKBwZrixtDb3tIWAiud-bHiWPf3EeAenIrnL8c8GHuBaauIzc-XebUnNrlQgAz1JJHz56C0ls3W5gjuO63TyTUlYejOMTV0AgCSqdoryELKPUdutNfjYc6r2n)
35. [mdpi.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQFuWvp4R9dOkELkWy7ZikCSzNSLXRlzqxHtgpwFa0Nnl0fmWojs4w7ufxlW2Jl90KlU4NLbLgjGfy5WH5khhn04X8HKqc8zDEjlR8e5Y65FwUHxS6J2MD5LuCMWSUq9ZA==)
36. [nih.gov](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQEzRy5bCuUjmCMP0_AbXsiDDd-8evllREffscsov3orZ7kt-gRBHRM-R8waSxg12LFOGfHFxbFeYer7NocTJIVom0hKXm0t1L2rEa90d2USXXclQNVh8anLjXfhBtgGEBG3NJoQeUKe)
37. [kyleyoshida.net](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQFfJVtf43ucs0zzdwxA1VhjcHKFs87WGvALS9VV80mdt_RIKBCuJuYGqf8924fFYOP6w0lbkBWicriwmTxFGo5VeKXpxilzWXwO4bZmHHuY0cf0fxGPKWF9nWRjw2pCXWIkQf4QYsfpVDO5QWm34ixH-SXASH7q4UCcJfcBbE6ef0GKvSfW9ylpnikEQ8AcaY9rm31kauY=)
38. [oralfacialsurgery.miami](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQGOYv1fkzw0dZBdbGKqkYgKAaxSemfnGQJMzkE13azpxorhzAZiOR_x6cWBBuAgY8v4Da4rOL4Rs82vgbr_xs-99fDQq8XQIfAgsiLruqraHPi6npOdm0U4JSPP-BsVzkGGSNPgSviY8yMOsnAJCsIAn7y0H5YbHoIXvloow7TFBK5u93Yd)
39. [nih.gov](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQH5i8k16w5Xef_Cy3LBUp3DGq2_PySiTbbH35OPvO5TeGznvlq-g9hEco3vrHnmcs_gQEQURbY4QJV0Lgf1Wv4x8FkVOLhX5IiMJ8UZu1wRzTO9sF9Kn1thlLlhA5baXOncXXPg2CSt)
40. [nih.gov](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQGgTNIMh2-PbkAdM9m67mUUHZYL0Ual8U4KN0UGyMofc_c2tDhPcwKKrv1lpwS9QHx1MakGcEuAH_jDfGj5XW89ecc4k1K6MDCJOrvL-NHK76QHPG_4e6ePVZ-x1zPCRQAF-l6T6dbg)
41. [nih.gov](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQFB5Fupg6hpxHiwwnKo2Xj2nPEGr4P8bFVFDOoxgVhrKLJb9gWo1bBHeu4KEzdCT0_0jRbL13QQQB1cV3PwpSgF4iGN_QI2WmzBeDfx9zroDMrUDaZ7nqVTi0fweo1POQ==)
42. [nih.gov](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQG0BXkAHPv3CsSbjFCvg9QGWI20rX7FIJ8PyIiuTFRB3f3ZSR7AMi-LJdU4RQhaF_7tH3PDJVaMkDyQuiHTj3-3cXfC4W3UHOfx1OTDWJYYTfyN9C0nbXJxiEh428Ho1qTfF4OrFNmeDw==)
43. [nih.gov](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQFrOj_eIhevHwF09kgXZn7rNpDC4IUhFxrm-eJkRiR6jdpEz0Hsst8xI0wW6pPPSoydxtvbtbTOvFiZRm8XyMLLGvoWNZI44HfY0hXTpxwlwSzqV17cyKq4h9plCKdSnUnXQi-kx-aV)
44. [journalagent.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQGYXOvg4ys_WzhZ0uvmm0rce_7AhQ4m-ksZTjD7Q35WEMZUIU4fpE-lBUpMjL28reGdRXX_jyl_fssBL0Ttn2Do409sszUS_U2v8Xx0vKMeunR_z1_SbOR_b0S7aso0odNeVqJfeJIZ_nla7d3CmvPn)
45. [nih.gov](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQHj84RKsokFnBXOZDHst22ZXFIxy6RB8AkCAj_eMmmeu6woOO3LBug9Ki8Un6SHQKY-5qLdueKmksxWhVUGLA5MrlRuxHsuNQRXwR0rJeaGiWMQ--rg0heu034M79TCoKV57NGd-cY1CA==)
46. [nhakhoathuyanh.com](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQEScig14_p_GvGOk87v4qleb3cejT6EuMQZtIllA52iCOSzPEa6VkX_LB1Sh7agMe0htLu2uviHdhEk9pHlEANYfHA-yu4UbSpo5xRbtqW2vUyRXkTZ3kOCUNnFc5E7Irgj_OFpGX0kSdPsGguQTGWkjcE83iq28OXqfXM6ebT__RAga_oO6Pxoyk_KS10=)
47. [aaoms.org](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQFgHf8JmOOhWamdSXKMQ38jlzNx8cisATMjiY0qQyeYzjWC2Vusc1zNKW-s_R6gLIK1x8C4wtNLGbNoK9Av20-UWGEghkVRigHi1ZwEDRAEyuhqu4Mu7Jy9GkfZw5Lcnr63PL70dZzxkDgr80nXbG0p25lxPbKngN4Q1u4X5QpywmmdR9E5zdO6-w==)
48. [aaoms.org](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQH8UeHrbS21__o7lb6eIoTEg8EFYH8EnDpgMfCg6UFfs3LpXzcCdx615i62CxZqGWotBe1LEQLwXc8fxbZXe3d_ZVLOqqgKVT0H4UC3gBJ5KMbB-ngx7NdX21Qse6H2mjH6aa3JQBUQ6NmB28plgkHyQKIt6ZPYH3nz-C1t_jhavUIW0CJ4V2_G3Vqtujk=)
49. [rcseng.ac.uk](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQGbJdTKTXkvUIZEI_T8xdH-Rnelt2E9oJinvXQfJ5gK3VH3emPCWMpHjMrV8hnjkDiz5mVxbttzKMWrb389JI8AhpRah4Hx3e8ideRnMXsU1_-b8tqbIQRDi1H1S3W_WK4qXSp2q7jl77IDbrX-jE9hbQhcBmZ2DlSc019G5-kCIF5Cnyaxudmq1B85UMec7lYELM4o-ONZ5AIv0ZMnnDLOJ_nijOzAzzvibKY3V5zs4k2mm4Hy8fPpWSXYRAPU_0PAHFw=)
50. [researchgate.net](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQGkBdHsEDaDUbT7JQ3fO7mDZrN1H7wct9geddJ6PEdbRi8g8qtp1QyE_nC77EfGSytmDem-1UUC262mBIIVOFxYygabw1OOGZWueM16pBkYDS_qi2HiK_xy3Fm3AVZ2rijPJACszVNkgyuB_rmAEGM5i6BIHLy4lGVEeipER8uHbtxT_hHdV5q9KnDLAx6O)
51. [nice.org.uk](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQEYKEImRHE7VtBsZER6KiF6Gd0cQ7zykBquMR0-Gle3ho8uJtNNNV9lPk8GMlz-UMGEBqyVyUS1WLyrEucdGf72RQWan6WF6qRicfeydSVfKcFRo3jvdiC9K2M=)
52. [exodontia.info](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQEhtNZtOtKO7rHPAzOsuJLdFbAjwv53-qam6iy2hCvqHdfnw8fO6SM3gGJ71pG4PBtkf1RPBQp1KFPdenw0knHqxTHLrgb_wdS3f03nCxkSoI_zc_d_TX7pkj8WbnSZe8JShCBn6q2G8j6ZeAGDPUM3KZO2zUXvARybc4JRuoe_OLALICx2ZSbKnzZ0kcvwdySzD9Jy1_8zKddNtE1Dj0HpyKroouLfu4YvVNBBew8XGhExNyEgSmoFgyEWE6zcUvmqyg==)
53. [nih.gov](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQGdq73T3_hQJ8PDlsOVgmHRYdvS3RDtuDZywBTsCdgp3XVoTjDLKcogLqXZ05lxy5DIaA68wGGwwUYiey2LdoqvBgm2I5EgTsLxv8g9DHkWzALiByGXcof4NqnrA7Ir_ua-e1OXCgdo)
54. [nice.org.uk](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQGTCPCtRA9SWO5oOFYuqAVubYPExK5FZrFtA0OVQbgkrXF9OIj2dpENRqGFsblpnVqAObkcyKA5SqGi1VYzKbi3S0Dgue2n-i5EkpDWJErJTw_l8w_iVRvMJKtxMR-bBur-qTbB4Z36zvY_GFsXnDLKvtmwrFaFLCtaIzKvIO-3GKhwNRe6y3QDy9CnNCFj7VOLvrdHNA==)
55. [exodontia.info](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQE0bI1yTtY1-csZilLvRFjpJ3hJPfQrGxW_SHWFEqhyOcwzrBNAP2bv41V7UtbXEoHtinz1q1WR64U4SbpVySFx0RI8arJO8HqDJLDfDwH8hq82VbCRGSk675hWqdqFX_9GT9lbb8AtLl_iUCIrVQPAC3Ymm03ykqazsd26nQkUPmrzD7VHiobkt0i4lYq7HzmwssaJQVmPrg==)
56. [umw.edu.pl](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQG_qzV8Ab9jmIwwb2HFnR72otJPLL9eTGE-xCfBoQifK7CiZta4_V97EGfzMJGTJjK-DqfDRSWYAGZdoL5QqZDzgXaAWDsLjyvE5mGhoDlWNiOwA3-laZXg-zSvZDt3AHvF1irClWY=)
57. [rcseng.ac.uk](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQHbe9BMFoyAgEITBzGQ5VPwkIrhTjg3e8uVCefZWM4H3Vej47uJDDFTAT1EJ2NKK46yC6v_xLoWPkXAfl5IiXFDt3dX373LCB1F-ZT_axgNfrJn1tnNBV-UEqEVKlXqlJ8vaXHq8p10BAcbENhZVaJHlmKMf3a5vIZDreaG8DsvAY4YAWuG0sGljQ-qgCH7RUxKN2QT7x9N)
58. [nice.org.uk](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQHkvSXRAajFa8gLR24wZQvc707GhrGJPKgo-V9S7YuHu9JtKOHwQJq7xt39pixv3UFygSJAKx_4_4MzUTuOVb8_-kYwDDBBWrFrlfC7Dh30_izCg42Fr0X2a8YqFqbhMyYnfUbOKdZy8zpGNlkx7No=)
59. [nice.org.uk](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQEn76JTCiRwdpEW_tC0R1CRPVyP0OQS2Gr5Ui8ZJc58ZGfc0AjH3z3aXZYUNU1vm37FWL-nTTz4DRHUYlJVE4Fvg3P1jSZrb7cgjAWGpSsFpaib-167L0pzw61RM7JRWc_9h--g3mh30px3792Afx9s1_wwp8-WJgWm5w==)
60. [nihr.ac.uk](https://vertexaisearch.cloud.google.com/grounding-api-redirect/AUZIYQHCTYfss4J3e_N8vb6Iii9OlXotBKeR8NAO0gLR7UnLa6DOzx08DtmdbgO7ESqO_ij1Sdu_30HDHoYArzMG8DnkBp2sFMM09nALGLHP89Q_ZMTcke06Mxt_fN-b_cfxsxvnaDyQBA==)