Do wisdom teeth have to be removed?
Not necessarily. If you have no pain, enough space, your wisdom teeth are coming in straight or have already came in straight, you practice good oral hygiene, and your wisdom teeth are free of cavities or gum disease, then I don’t see a problem with keeping them. You never know, you might need them when you’re much older. If you ever lose your second molar and you’re not a candidate for a dental implant, you may need to use that wisdom tooth as an anchor for a bridge or a removable appliance.
Some dentists believe it’s better to remove wisdom teeth to prevent potential problems in the future and recommend doing so at a younger age, before the roots are fully formed and when recovery is faster. There is definitely truth to that. Recovery is much faster in younger patients. Also, roots that are not completely formed rarely sit right on top of the Inferior Alveolar nerve making the extraction easier and reducing the risk of nerve damage. However, if the developing wisdom teeth do not show any problems, I tell my patients to keep them and let them come in. Do doctors recommend taking out everyone’s appendix, just because we’re all at risk for appendicitis? No. Just like I do not recommend taking out all wisdom teeth, especially when they’re healthy and do not pose any immediate problems.
However, wisdom teeth removal may be necessary if you have any of the following:
- Pain – pain behind second molars in the upper or lower jaw
- Impacted or partially impacted teeth coming in at an angle – wisdom teeth may start coming in at an angle and push up against your adjacent teeth causing damage. Your dentist will see impacted or partially impacted wisdom teeth (images b,c&d) on a panoramic x-ray and may advise you to have the wisdom teeth removed before damage occurs.
- Pericoronitis – pericoronitis is the inflammation of the gum tissue surrounding the crown of a partially erupted wisdom tooth. It is caused by trauma (biting the gum tissue with the opposing tooth) or the accumulation of bacteria and food debris underneath the tissue flap (image b). Acute pericoronitis is associated with severe pain, swelling, pus and sometimes fever.
- Dentigerous cyst – a fluid filled cyst associated with an impacted wisdom tooth. Impacted wisdom teeth are “stuck” underneath the gums or bone.
- Extensive tooth decay – in some cases the decay is so big, it may not be possible to restore and it’s best to have the teeth removed.
- Gum disease – deep pockets around wisdom teeth collect bacteria, resulting in tissue and bone loss. Once the wisdom teeth are removed, pocketing around the adjacent teeth may improve.
Remember, even if you have enough space and your wisdom teeth come in straight (image a), you can still develop problems over time because these teeth are so far back and difficult to clean. So, if you keep your wisdom teeth, make sure you brush and floss them well and see your dentist every six months!
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