Do I Need My Wisdom Teeth Removed?

What are wisdom teeth and why do they cause problems?

Wisdom teeth — the third molars — are the last teeth to develop, typically emerging between the late teens and mid-twenties. Most people have four of them, one in each corner of the mouth. Because modern human jaws are often smaller than those of earlier ancestors, there is frequently not enough room for wisdom teeth to fully emerge in a healthy, functional position.

When a wisdom tooth cannot fully erupt, it is called "impacted." An impacted tooth may be partially visible through the gum, fully buried under bone, or angled sideways pushing against the adjacent second molar. These positions create pockets where food and bacteria accumulate — areas that are difficult to clean and prone to infection.

When do wisdom teeth usually need to come out?

Clear indications for extraction include:

• Recurrent pericoronitis — repeated infection and swelling of the gum flap over a partially erupted tooth
• Decay in the wisdom tooth — when the position makes it impossible to fill or maintain
• Damage to the adjacent second molar — resorption of the adjacent root or cavities on its back surface caused by the wisdom tooth pressing against it
• Significant gum disease (periodontitis) around the wisdom tooth that is not controllable with cleaning
• Cyst formation — fluid-filled sacs that can develop around impacted teeth and damage surrounding bone
• Pain that is clearly attributable to the wisdom tooth and not manageable

For these situations, the case for removal is straightforward.

What about wisdom teeth that are not causing any problems?

This is where there is genuine clinical debate. For many years, routine prophylactic removal of all impacted wisdom teeth was common practice. A Cochrane systematic review found insufficient evidence to conclude that removing asymptomatic, disease-free impacted wisdom teeth prevents future problems 1Ref 1Ghaeminia H, Nienhuijs MEL, Toedtling V, Perry J, Tummers M, Hoppenreijs TJM, Van der Sanden WJM, Mettes TG (2020).Surgical removal versus retention for the management of asymptomatic disease-free impacted wisdom teeth.Cochrane systematic review finding insufficient evidence to recommend prophylactic removal of asymptomatic wisdom teeth. The AAOMS (American Association of Oral and Maxillofacial Surgeons) has maintained that in some situations — particularly in younger patients and in certain impaction patterns — earlier removal may prevent future complications 2Ref 2Banks KA, Beirne OR, Busaidy KF, Eisig SB, Larsen PE, White RP Jr, Dodson TB, Rafetto LK, Phillips C, Offenbacher S (2012).Summary of the Third Molar Clinical Trials: report of the AAOMS Task Force for Third Molar Summary.AAOMS clinical trials data on third molar management, supporting the discussion of prophylactic removal in certain situations.

The current thinking is more nuanced: - Fully erupted, functional, healthy wisdom teeth that can be kept clean do not necessarily need to be removed - Asymptomatic impacted wisdom teeth remain a judgment call — the risk of future complications (pain, infection, adjacent tooth damage) must be weighed against the risk and recovery of surgery - Age matters — surgical recovery is generally easier and bone is more pliable in younger adults (late teens to mid-twenties) than in older adults; waiting until a problem develops means surgery at an older age when recovery may be harder

Many dentists recommend periodic monitoring with X-rays for asymptomatic impacted wisdom teeth, reassessing as circumstances change.

What does wisdom tooth surgery involve?

Wisdom tooth extraction is typically done by a dentist or oral surgeon under local anesthetic, often with sedation (IV sedation or general anesthesia in some cases) for more complex impactions or for patient comfort. Simple erupted extractions are much like any other tooth removal. Impacted extractions may require making an incision in the gum and sometimes removing a small amount of bone.

Recovery for a simple extraction is usually a few days. For surgical removal of deeply impacted teeth, significant swelling and soreness can last up to a week or two. Ibuprofen and acetaminophen (alone or in combination) manage post-operative pain well in most cases 3Ref 3Bailey E, Worthington HV, van Wijk A, Yates JM, Coulthard P, Afzal Z (2013).Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth.Ibuprofen and acetaminophen effectiveness for post-operative pain management after wisdom tooth extraction.

Dry socket — where the blood clot in the extraction socket dislodges — is a painful complication that occurs in a minority of cases, more commonly in smokers and those using straws after surgery. It is treatable by your dentist.

Questions to ask before deciding

• Are my wisdom teeth currently causing any damage to adjacent teeth?
• Do you see any early signs of cysts, bone damage, or decay on the X-rays?
• Am I able to clean around these teeth adequately?
• Based on my anatomy, how likely are these teeth to cause problems in the future?
• If we watch and wait, what would we be watching for?
• What are the risks of surgery for my specific case?
• Does my age affect whether now is a better time than waiting?

Gale and dental specialist care

Wisdom tooth assessment involves a dental evaluation, typically with panoramic X-rays to see the position, angulation, and relationship to adjacent structures. This is done by a dentist or oral surgeon — Gale can help you find the right specialist and prepare for that consultation. After surgery, if you experience recovery concerns, Gale's care team is available to talk through what is normal and what warrants a call to your surgeon.