A Wisdom tooth is often a problem because there isn’t enough space for it in the dental arch. These teeth are technically called third molars. First molars erupt in the mouth at about the age of six or seven. At around age twelve or thirteen, the second molars erupt. Third molars, if they are going to come in at all, will begin to show up sometime around age nineteen and may take a couple of years or more, if they come in, to fully come in.
We get along just fine with two sets of molars. Why we are given three when we only need two is a great mystery. In cultures where dental care is primitive, the first molars, which are very prone to decay, may rot away and be gone by the time the third molars come in. This will leave the person with only two sets of molars, which is all the modern human jaw ordinarily has space for. That could be part of the reason we are given three sets of molars.
When they don’t erupt in the mouth, often the best policy is to have the wisdom tooth extracted. Click this link to learn when that is advisable and what to expect during and after the surgery.
Some dentists have taken the position that until you get an abscess, they shouldn’t be removed. I disagree with that and recommend that once it’s determined that there isn’t enough space for them to fully erupt into the jaw, they should be removed. There is solid reasoning behind this recommendation, and here it is:
When a wisdom tooth is not yet fully developed, during the late teens up until about age twenty-one or twenty-two, the extraction procedure is generally very straightforward. Not only are the teeth much easier to remove then, but the chances of complications are truly minimal. At age twenty-five, the risk of complications from the removal of wisdom teeth is about double what it was at age twenty. From age twenty-five to thirty, it probably doubles again, and it continues to increase beyond that. As you get older, the roots of the wisdom teeth become fully formed, and the bone becomes harder and more dense. Once a patient reaches the age forty, the risk of complications becomes very great.
For patients over forty, I recommend a conservative approach. At that age, the risk of complications is great. Besides that, if you have not had a wisdom tooth infection until then, the chances that they will cause a problem in the future is lower. So for a fully impacted wisdom tooth in a patient over forty, I would say that if you haven’t had a problem yet, your chances for having a problem later are probably less than the risk of complications from having it extracted. However, if the tooth is partially impacted meaning that part of it is above the surface of the gum and part is below, that tooth will become infected at some point and I would have it out in spite of the risks. In fact, that tooth most certainly already has a low-grade infection.
But for younger patients, it seems to make the most sense to take them out while their extraction is easy. Permanent nerve damage, which can cause a patient to lose all sensation in his or her lip, is the most serious common complication of this surgery, and is the nightmare that no oral surgeon wants to deal with. It is very difficult to damage that nerve if the teeth are extracted before the roots are formed.
I have seen it recommended on some websites to get an opinion on your wisdom teeth from someone who doesn’t make his or her living taking them out. For those inclined to be suspicious of professional people, this advice is appealing. The idea to leave them alone if they’re not bothering you has a seductive ring to it. Having taken out many wisdom teeth myself and being now in a situation where I receive no financial gain from my advice, I still advise people to get them out while they are young. From personal experience, I am certain that the reason oral surgeons are so emphatic about this is that they have removed some of these on patients that were 30, 35, 45, and older, and they know how tough they are to get out at that age and are only too painfully aware, from phone calls received from patients, of the healing complications that escalate with increasing age. I know what some of those phone calls and after-hours emergencies can be like. I personally took out wisdom teeth of every configuration, but I drew the line on patients who were 40 and above. I knew these people would have complications and I didn’t want to be the person they identified as the source of all that misery I knew they were going to experience. So I referred those patients to oral surgeons.
So, don’t suffer needlessly—get your wisdom teeth removed while you are young.
—Dr. David Hall
- A man had a third molar extraction, and a piece of the tooth broke off and was left in his jaw. This is sometimes done when the risk of damage in removing it is greater than the small risk of leaving it in.
- Antibiotics for teeth infections explained and instructions how to use them. Sometimes they are called for, sometimes they won’t help any–they will hurt.
- When one of these teeth is poking out of the gum partway, this a very high risk for gum infection, and I would recommend having it extracted right away.
- Dentists will not usually do a root canal treatment in a decayed wisdom tooth unless some molars are missing in front of it, which would make it a key anchor to save. The reasoning on this has two main parts. First, it is very difficult to do a successful root canal treatment on one of these teeth. They are very hard to get to, they often have many roots, and those roots are often bent. From a patient’s point of view, this means expensive. And besides being very difficult to do successfully, these teeth have limited usefulness. People who don’t have third molars in their mouth function just fine.