Extract or Leave

Do I need my Wisdom Teeth Extracted? What are the Signs and Symptoms?

There are a number of reasons why you might need your wisdom teeth removed.

A lot of these reasons are the same as for any other tooth. To get a good overview, have a read of ‘ Why you might need a tooth extraction‘ in the dental extractions series.

The following are specific reasons given by various government bodies such as NICE (National Institute of Clinical Excellence guidelines) or NIH (National Institutes for Health) for removing wisdom teeth:

  • Un-restorable decay
  • Abscess formation
  • Dental Caries in the back of the second molar. Because of food packing, this would be difficult to treat or likely to re-occur unless the wisdom tooth was removed
  • Periodontal disease– if the wisdom tooth is affecting the cleaning of the second molar tooth or is mobile because of significant bone loss
  • Two bouts of associated pericoronitis
  • Resorption of the second molar tooth
  • As part of treatment for removing cysts or other pathology in that region
  • Prior to some jaw surgery
  • As part of orthodontic treatment in order to create space for moving teeth. There is little evidence to suggest wisdom teeth cause crowding of your lower teeth and they should not be removed for this reason alone. Teeth tend to drift forward and overlap slightly anyway as you get older, even if you have no wisdom teeth. Periodontal disease is a more significant factor in causing movement of your teeth.

Should I have One or All my Wisdom Teeth Taken Out?

This totally depends; see- When should I not have my wisdom teeth removed below. If one side is good, there is no reason to take them out unless they are likely to give problems.

If you are having a general anaesthetic however, then you only want to be knocked out once, so it may be best to have all four removed in the one go- unless that is, the chance of complications from removing them is particularly high.

If you have a top tooth or bottom tooth removed, then the opposing wisdom tooth that would normally bite on it, is rendered useless and generally should be removed. The chewing action actually helps to cleanse your teeth, so without it un-opposed teeth often build up considerable plaque and rubbish on their surfaces. Plus they are hard to clean that far back and without the balance of the bite, can continue to erupt sometimes cutting into your cheek. Again if complications from that extraction are anticipated, it could be preferable to leave it alone.

When should I Not have my Wisdom Teeth Removed?

This depends on the benefits versus the risks of having your wisdom tooth or teeth removed and of the other options (if there are any). If the potential complications outweigh the benefits of the extraction then removing the tooth is not advised.

The following are situations where this may be the case:

  • If your wisdom tooth is not causing or not likely to cause any problems now, or in the near future
  • If the tooth is un-erupted and you have heard nothing from it
  • If there appears to be enough space to allow them to come through in-line normally and be a useful tooth
  • If your medical history is such that the benefit from any extractions (wisdom teeth or other) are outweighed by the potential for serious complications, or risk to your general health
  • If the roots of the wisdom tooth are so closely associated with the inferior dental nerve, or lingual nerve, that the chance of nerve damage and its unpleasant consequences are high. Sometimes, your wisdom tooth must be taken out, even where this high risk exists- for example- extensive decay causing pain. In these cases, the procedure is often best handled by an experienced oral surgeon. If however, there is no immediate need to extract the potentially complicated wisdom, it may be better left.

Some more information can be found here- When should extractions be avoided?

Shouldn’t Everybody get their Wisdom Teeth Out?

Gone are the days when everybody has his or her wisdom teeth out as a matter of course. Wisdom teeth can stay in your mouth not causing any problems for many years and in fact they may never do so.

At 60 my dad still has two impacted partially erupted lower wisdom teeth which have never ever given him problems. That’s just an example- your dentist will be able to advise you about your specific case after assessing you wisdom teeth visually and on the X-ray.

Because surgery is often unpleasant and there are risks and potential complications associated with taking your wisdom teeth out, it is important there is a good reason for doing it.

Different dentists have different schools of thought on the ‘removing healthy wisdom teeth’ dilemma. Though there is increasing evidence to support leaving non- problematic wisdom teeth, some dentists still prefer to remove them. At the end of the day, it is down to the individual dentist and the patients’ preferences. It is important you ask any questions you may have, about your particular situation so you can make an informed decision.

If a large periodontal pocket over 5mm exists between the wisdom tooth and the molar in front, then future problems may be more likely and some evidence suggests that in this case, extraction of a non-symptomatic tooth may be advisable.

If your impacted wisdom teeth are not causing trouble, there’s no evidence to suggest that removing them helps or hurts your future health. It seems to be agreed however, that preventing crowding of your incisor teeth is not reason to have them extracted.

A selection of evidence:
The Cochraine Collaboration– A special research body that review all available evidence on certain topics, performed an in depth review on the effect of removing asymptomatic wisdom teeth (those not giving problems). The conclusion was that no evidence existed in favour of, or against their removal and that extraction did not help prevent incisor crowding.

The National Institute for Health and Clinical Excellence, (NICE) in the UK looks at the cost effectiveness of dental services. It says there is no evidence that taking out disease free impacted wisdom teeth is of benefit and advises against removal, considering the risk of complications and discomfort form the procedure.

The American Public Health Association developed a policy called ‘Opposition to Prophylactic Removal of Third Molars (Wisdom Teeth), because of injuries resulting from unnecessary extractions. They state that the removal of teeth should be based on a demonstrable need or pathology, rather than an expectation of future problems.

When is the Best Time to get your Wisdom Teeth Taken Out?

Everything else aside, the best time to have your wisdom teeth taken out is when they first come through the gum generally when you are between 17 and 20, though wisdom teeth can appear much later.

A younger patient will heal much more quickly, with fewer complications and their bone tends to be softer so the wisdom teeth are easier to remove. If the roots of the wisdom teeth are incomplete i.e. they haven’t fully formed yet, they are less likely to be near the nerve and less likely to give rise to nerve problems.