Wisdom teeth are the last to come through and the ones that cause the most trouble. Even so, it is not true that they all have to be removed.
What is a wisdom tooth?
The third molars, or wisdom teeth, usually come through at the very back of the jaw between the ages of 17 and 25. There are four in total; in some people some or all are missing from birth. When there is not enough room in the jaw they stay impacted in the bone or gum, lie sideways or only partly appear.
What problems can they cause?
- Pericoronitis: Food and bacteria collect under the gum covering a partly erupted tooth and the gum becomes inflamed. It causes pain, swelling, difficulty opening the mouth and a bad taste.
- Decay: Being right at the back they are hard to clean; both they and the neighbouring tooth can decay.
- Damage to the neighbouring tooth: A tooth lying sideways can press on the root of the molar in front, causing root resorption or bone loss.
- Cysts: Rarely, a cyst can develop around an impacted tooth and damage the jawbone.
When should it be removed?
Removal is recommended when:
- There is repeated gum infection (pericoronitis)
- The tooth or its neighbour has decay that cannot be treated
- There is damage to the root of the neighbouring tooth or the bone around it
- A cyst is found around the tooth
- An orthodontic or prosthetic treatment plan requires it
When does it not need removing?
Wisdom teeth that have fully erupted, bite properly against the opposing tooth, can be cleaned with a brush and cause no complaints can stay. Teeth completely buried in the bone that cause no symptoms are also usually just monitored with regular X-rays.
The decision is made separately for each tooth. For this, a panoramic X-ray is used to assess the tooth's position, the shape of its roots and how close it is to the nerve.
Do wisdom teeth cause crowding of the front teeth?
Although this is widely believed, research shows that wisdom teeth are not the main cause of crowding in the front teeth. The lower front teeth tend to crowd with age even in people who have no wisdom teeth at all. So removing a trouble-free tooth purely to prevent crowding is generally not recommended.
How is it removed?
Erupted teeth are extracted like any other tooth. For impacted teeth the gum is opened under local anaesthesia, some of the bone covering the tooth is removed if necessary, and the tooth is divided and taken out in pieces; the area is closed with stitches. The procedure usually takes between half an hour and an hour and you feel no pain during it. Details are on our oral surgery page.
Healing after removal
Swelling, mild pain and limited mouth opening are to be expected after surgical extractions. Swelling peaks on the second and third day and then goes down. Stitches are removed after about a week. For what to do in the first few days, see our article on care after a tooth extraction.
Frequently asked questions
What is the best age to have a wisdom tooth removed?
If removal is needed, it is easier and healing is faster at a young age, when the roots are not fully formed and the bone is more flexible. Removal can also be done later in life.
Can all four wisdom teeth be removed at once?
It is possible, but in a clinic under local anaesthesia the upper and lower tooth on the same side are usually removed in one session. That way the patient can chew comfortably on the other side while healing.
My wisdom tooth hurts and then stops. Should I wait?
Pain that comes and goes is usually a sign of recurring gum infection, and each episode can be worse than the last. Having an examination and making a plan while the pain is gone is more comfortable than an emergency extraction with swelling and infection.
This article is for general information and is not a substitute for diagnosis or treatment. If you have a complaint, please see your dentist.