Dentist—Do you Have to Remove your Wisdom Teeth?

If you’re in your late teens to mid 20’s, it is important to visit the dentist to check the potential growth of wisdom teeth. If not removed, they can damage the rest of your smile or cause infection.

Children fortunate enough to be born with teeth that require little professional intervention from their dentist, such as orthodontics or extraction, may be unpleasantly surprised when they reach their late teens. Between the ages of 17 and 25 (on average), 90% of the population will develop what are colloquially known as wisdom teeth. Sometimes referred to as “third” molars, these teeth may have to be removed if they become impacted or their maturation will cause unwanted shifting and damage to other teeth.

There are four main types of impaction that will require removal by a dentist: vertical, horizontal, mesioangular, and distoangular. The two most common are mesioangular and vertical, which will occur in a combined estimate of about 82% of patients. Mesioangular is where the tooth grows at an angle towards the front of the mouth. In most cases it will not fully erupt due to blockage by bone or molar. While generally not an immediate problem, over time bacteria can grow below the surface and cause infection. Vertical impaction, the second most common, is where the tooth grows straight but is unable to completely emerge through the bone. A dentist may recommend waiting if there is no clear obstruction to full eruption. However, if it is clear that the tooth is remaining submerged, extraction will be recommended.

The other two types of impaction occur in less than 10% of patients, but pose no greater threat than other forms (however, they almost always require extraction). Horizontal is when the wisdom tooth grows sideways, in a direction heading towards the roots of the second molar. Distoangular is where the tooth grows angled backwards towards the throat rather than another tooth. Partial eruption may be less common due to growth obstructions. As with any other problem wisdom tooth, if there is no clear path, infection may develop or the other teeth may be pushed out of place or damaged.

Extraction of impacted wisdom teeth is important for oral health as well as smile aesthetics. Erupted third molars can cause overcrowding, which may result in the need for orthodontics later in life if left untreated. In order to remove them, surgery is required, but most procedures barring a few exceptions are routine. Local anesthetic and twilight sedation are often used to numb pain and make the procedure more comfortable. The dentist will make a small incision on the gum line where the tooth lies, and then it is generally removed in small pieces.

The patient can go home the same day and may be prescribed some pain medication for the first few days following surgery. Individual recovery varies from mild to moderate discomfort and soreness. A few patients may have noticeable swelling for several days afterwards or the area may become inflamed, requiring a break from some regular activities. There may be some bleeding and oozing from the area for the first three days, and gauze is recommended to help staunch the flow rather than rinsing. Temporary or permanent nerve damage is a rare but possible complication.

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