When is the Right Time to Have your Wisdom Teeth Removed?

When is the Right Time to Have your Wisdom Teeth Removed?

Not every patient referred to an oral surgeon needs to have their 3rd molars (commonly referred to as wisdom teeth) removed.  Every patient, however, should have a thorough examination to determine the right course of treatment.

The only accurate way to determine whether patients should have their wisdom teeth removed, maintained or, in rare instances, partially removed is to have a properly trained oral surgeon conduct a clinical examination and review of a recent x-ray of their teeth.

The wisdom teeth are the last teeth to develop and break through the gum tissue, or erupt, in our mouths. If they have not erupted, they are referred to as impacted. If your wisdom teeth are present – erupted or not – they need to be evaluated.

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The presence of impacted wisdom teeth, even without symptoms, can adversely affect adjacent teeth. The absence of symptoms does not indicate an absence of disease! Periodontal disease progresses in the absence of symptoms and the end result of this disease is loss of supporting bone around teeth. Preventive removal of asymptomatic wisdom teeth is recommended when future problems can be expected but the risks of removal are still minimal.

The only truly reliable way to know if you need to have wisdom teeth removed is through an examination by an oral surgeon. Many patients have the preconceived notion that a consultation means “I have to get my wisdom teeth out.” Most will, but not all.

Dental and medical opinions vary on how to manage wisdom teeth, especially asymptomatic wisdom teeth. However, there is little debate that the age of a patient is a factor. Studies and consensus within the community of oral and maxillofacial surgeons show post-op risks and complications associated with wisdom tooth removal increase with age, especially after the age of 25.

Periodontal defects, as measured by the deepening of the space between the tooth and the gums, deteriorate with increasing age if wisdom teeth are retained. The likelihood of cavities in erupted wisdom teeth also increases with age.

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The American Association of Oral and Maxillofacial Surgeons (AAOMS)

The surgical removal of wisdom teeth should not be taken lightly, and choosing a fully qualified oral surgeon is critical. All surgical procedures can have complications associated with them.  Fortunately, in this kind of surgery, most complications like pain, swelling, bleeding, infection and bruising are predictable and can be managed relatively easily.

There are more severe complications that happen much less frequently, like damage to adjacent teeth, sinus complications and prolonged “numbness” in the lower lip, chin and tongue.  These are monitored and can often be improved, if not resolved, with some additional interventions.

Sometimes the potential complications outweigh the benefits to be gained by removing the wisdom teeth and a recommendation to not remove the teeth may be made. Wisdom teeth that are not removed need to be watched periodically with clinical and radiographic exams to ensure no detrimental changes occur over time.

Finally, in certain rare instances, a recommendation may be made to only partially remove a tooth through a procedure called Coronectomy. Its only real indication is when a lower 3rd molar requires treatment but has roots in a position that put the patient at increased risk for nerve injury. In this rare instance, only the crown, or top portion of the problematic tooth, would be removed. The roots would be purposely left behind to decrease the chance of nerve injury.  Follow-up exams are always recommended and, in many cases, necessary.

Wisdom teeth may be the last teeth to develop in your mouth, but they often times require the most attention.  Having them evaluated while in your teenage years or early 20s can hopefully allow you to have your 3rd molars removed with less risk of complications and save you from having to deal with the problems that can develop into adulthood.

Dr Mark HochbergDr. Mark Hochberg is a Diplomate of the American Board of Oral and Maxillofacial Surgery. He has also earned Fellowship status from the American Association of Oral and Maxillofacial Surgeons, the American Dental Society of Anesthesiology and the International Congress of Oral Implantologists.