Wisdom teeth: when to remove and when to leave alone

The common misconception

There is a widespread belief that wisdom teeth must always be removed as soon as they appear. This is not true. A tooth that has erupted fully and healthily, has an opposing tooth to bite against, and can be cleaned easily, has no justification for removal.

The decision rests on a medical indication, not on the tooth's existence.

Signs that call for removal

Recurrent inflammation of the surrounding gum. When a tooth erupts only partially, a flap of gum remains over it trapping food and bacteria, so inflammation, pain and swelling recur with no lasting resolution.

Decay in the tooth itself or in its neighbour. Difficulty reaching the area to clean makes decay common, and it often affects the back surface of the tooth in front, which is the more serious problem.

Pressure on adjacent teeth, or a cyst around the crown of an impacted tooth visible on X-ray.

A need for space within an orthodontic plan determined by the specialist.

When to leave it

When it is fully erupted, healthy, cleanable and causing no symptoms.

When it is completely buried in bone with no symptoms and no change on X-ray. In that case your dentist may recommend periodic monitoring rather than intervention.

Why X-rays come before the decision

X-rays show the relationship between the lower tooth's roots and the inferior alveolar nerve, and between an upper tooth and the maxillary sinus. That information changes the extraction technique and defines the risks that must be explained to you beforehand.

Where the tooth lies close to the nerve, 3D imaging may be requested. It is a step worth the time, because it protects against a complication that can be long lasting.

This article relates to extraction & oral surgery at My Clinic. For an assessment, book an appointment or message us on WhatsApp.