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Terrified to get her wisdom teeth out

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Hello Dr. Hall,

I am terrified to get my lower left wisdom tooth out. I am a 34-year-old female. The tooth is partially exposed with a cavity, and partially under gum and bone. I’ve been to a surgeon who said there is a risk of nerve damage but he did not do a 3D scan to see how close it is to the nerve. I’ve sent you a copy of my recent x-ray:

A panographic x-ray showing all of Keri's teeth, with a circle drawn around the lower left wisdom tooth and two neighboring teeth.

A dentist said I am high risk because of the terrible angle of my tooth and because the tooth is next to a molar with a root canal. I don’t know if high risk means its a dangerous procedure, or high risk of nerve damage. Also terrified of this procedure changing my face. Thank you.

– Keri

(See Dr. Hall’s answer below.)


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Keri,
So you’re 34 years old. Oh, this would have been so easy 15 years ago. I am really bothered by a minority of dentists and some others who tell people to not do anything about their wisdom teeth until they bother them. You’re a great illustration of why that thinking is so wrong-headed. Before the roots fully form and before they start to thicken and before the bone gets denser, these wisdom teeth are fairly easy to take out. Now, for you, they are clearly going to be a lot more difficult. But your lower left wisdom tooth absolutely needs to come out—it will only get riskier and harder for you the longer you wait. And it’s only a matter of time before it develops an infection. But I think I can set your mind at ease somewhat.

This lower left wisdom tooth does not look like it impinges on your nerve at all. Yes, any responsible oral surgeon is going to need to tell you that there is some risk, because there is some risk. But with the help of a 3-D scan, he or she should be able to navigate around the nerve. Please remember that the tendency of many oral surgeons is to exaggerate the risk when they explain this. They do this to protect themselves against possible lawsuits.

I am less certain about your wisdom tooth on the other side, and I’m hoping that one never gets to the point where it bothers you. The way the roots are more radiolucent right where the nerve canal goes by them makes me think that the roots are very close indeed to the nerve, maybe even wrapping around it.

The angle of the tooth is not a risk. It’s a complication making the extraction more difficult. And being close to the tooth with the root canal means that the surgeon needs to be more careful, but a skilled surgeon shouldn’t have that much problem with that. I don’t see how this procedure could change your face. Yes, your face will be swollen after the extraction, but that will go down after a few days and you’ll be back to normal.

I would be sure you have an excellent oral surgeon taking this out for you, and I would have the surgeon take out both your upper wisdom teeth while he or she is at it. They are also impacted and need to come out, and will be much easier than the lower. I would also have the surgeon evaluate, with the 3-D scan, the position of the nerve in relation to the lower right wisdom tooth and consider taking that one out also, unless it actually does impinge on the nerve.

– Dr. Hall

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About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

Sedation for Wisdom Teeth Extractions

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Dear Dr. Hall,
My daughter is 23. She has two impacted wisdom teeth that need extraction one of which is under the bone. The question is what type of anaesthesia is required to remove them considering some bone needs to be removed. Will it have to be general anesthesia or will sedation be enough? I am very concerned about the general anesthesia. Thank you.
Best regards
Thanuja from Pennsylvania

(See Dr. Hall’s answer below.)


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Thanuja,
I don’t know the complete circumstances about your daughter’s case, but it is hard for me to imagine that there could be serious complications enough to warrant general anesthesia. I extracted many hundreds of impacted wisdom teeth, and never used anything more than conscious sedation, and can’t remember a patient who was uncomfortable.

Especially for a 23-year-old. At that age, the bone is relatively pliable, and there hasn’t been time for cementum accumulation on the roots of the teeth, so the extractions should be relatively uneventful. It’s a rare case of a 23-year-old that has truly difficult wisdom teeth. Yes, there are added risks with general anesthesia, and I think it’s a good rule to not use any more anesthesia/sedation than is necessary. If you have a dentist who is telling you that she needs general anesthesia, I would seek a second opinion.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

My wisdom tooth is touching the nerve. Will it cause nerve damage to take it out?

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Hi Dr. Hall,

I am most grateful I came across this website. I have read the posts and I can’t say how much appreciation I have to see your honest and direct feedback and opinions.
I would be very very grateful if you could shed some light with your experience in my situation:
1. I have an impacted lower left wisdom tooth, I did an x-ray and the doctor (surgeon specialist) said it is close to the nerve and he recommended me to take a CT scan, which I did.
2. CT scan came back and he told me the tooth is touching the nerve (how much I don’t know), but I asked him what is the probability of damaging the nerve? He said 10% chance to damage the nerve, but after reading your blog about the risk of nerve damage, it seems like with a tooth touching the nerve – chances of damaging the nerve should me much higher? please would very very much appreciate your thoughts on this.
I am turning 30 years old this year.
One more piece of information – the impacted wisdom tooth is lying horizontal and food gets stuck there most of the time when I eat.
– Dennis

Dennis,
You referenced my earlier blog post on what are the real chances of nerve damage from wisdom tooth removal. The main point there is that the surgeon is more likely to exaggerate the chances of nerve damage rather than minimize it. I would take the 10% chance of nerve damage that he has quoted you as a fair estimate. And I would add to that that the damage would most likely be temporary. The most likely type of damage would be compression or bruising of the nerve, and not severing the nerve. I’m not saying that permanent damage isn’t possible but that it isn’t likely.

The use of CT scans is decreasing the chances of damage to the nerve because the surgeon can now tell, in advance, exactly where the nerve is in three dimensions. When I was doing this, if the nerve appeared superimposed over the tooth, I didn’t know whether it was in front, behind, touching, 1 millimeter away, or anything like that. So I had to be very cautious and allow for multiple possibilities.

Your surgeon just has to avoid any pressure in the direction of the nerve and, in sectioning your tooth prior to removal, has to stay away from the nerve. Then, post-operatively, you need to be aware that there will be swelling that could press against the nerve. If you notice any prolonged tingling or numbness after the novocain has worn off, advise the surgeon, and he will likely prescribe a steroid to hold down the swelling and minimize that pressure against the nerve.

– Dr. Hall

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Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

Preventing Dry Socket

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Dry socket is a potential complication of tooth extraction, and studies have shown that it occurs after anywhere from 15% to 30% of the time after the extraction of an impacted mandibular third molar (wisdom tooth). However, in my practice, I went the final ten years of my practice doing hundreds of extractions of mandibular third molars, including many full bony impactions, without a single incidence of dry socket. Let me tell you how I did it.

As I began my practice, I had a special interest in oral surgery. In dental school I had won the award as the outstanding oral surgery student of my graduating class. I considered specializing in oral surgery, but decided I really wanted to be a general dentist. I did decide, however, to try to tackle difficult extractions, gradually increasing in difficulty until I didn’t refer any of them to oral surgeons unless the patient was over 40. With these extractions, I had a normal incidence of dry socket in my patients.

One day, when I had two patients return to me with dry socket, I realized that in the case of both of these patients I had used a great deal of force in extracting the teeth. This gave me the idea that forceful compression of the mandibular bone was a precipitating factor for dry socket. From then on, if I couldn’t get a lower wisdom tooth out with moderate elevator force, I would section the tooth and/or remove bone until I could. I was very pleased that this dramatically decreased my incidence of dry socket. Over the next seven years I had only two dry sockets in my patients. This was up until around 1991 or ’92.

Then I read a study in a journal where the researchers had tried placing a square of Gelfoam soaked in a suspension of clindamycin antibiotic into the socket after the extraction and suturing the tissue over it. They did this on one side of each patient, and left the other side untreated. For every patient that developed dry socket after the extractions, it never occurred on the side that was treated with clindamycin. I am unable to find what journal that was in, but I was able to find an online reference to that study on the website of a Dr. Ted Rothstein.

I found the study very persuasive, so I applied this practice routinely for every impacted lower third molar that I extracted, and for the next ten years, extracting all sorts of impacted lower wisdom teeth, didn’t have a single incidence of dry socket. And I did not shy away from any difficult extractions. I did partial and full bony impactions including horizontal impactions, disto-angular impactions, whatever.

The “inside-the-box” thinking on the causes of dry socket is pretty rudimentary. The blood clot is missing, therefore the patient must have sucked it out! So therefore, don’t suck through a straw and that will reduce the incidence of dry socket. Similarly, if you smoke after the extraction you will suck it out. There are no clinical studies that give any credence to these simplistic theories. I don’t believe them and didn’t pass them on to my patients.

– Dr. Hall

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About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

All impacted wisdom teeth do not need to be extracted

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Hello Dr. Hall,
I am at age 41 and have fully impacted horizontal bony wisdom teeth. My dentist said to remove them to avoid issues in future. Is it worth removing this late in age? I have a pano x-ray which I can send. I appreciate any honest feedback you can give.
– Ajay from Arizona

And here is the x-ray that he sent. I have cropped out the parts we don’t need for this post.
impacted wisdom teeth


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Ajay,
This is an interesting subject area, the prophylactic (preventive) removal of wisdom teeth that aren’t causing any problems currently.

Prophylactic Removal of Wisdom Teeth

I addressed the general question back in January in a post titled, Is Wisdom Tooth Removal a Racket? There are some articles in the popular media asserting that there is no need to remove any wisdom teeth unless and until they cause a problem. They assert that this is a scam perpetrated by oral surgeons who want to make money taking out wisdom teeth. I did a little investigating on the source of this erroneous thinking and found that a lot of this thinking is pushed by a Dr. Jay W. Friedman, who, it turns out, is actually an insurance company consultant. So the truth is that the idea that your shouldn’t preventatively remove wisdom teeth is a scam perpetrated by the insurance industry because they are trying to save money at the expense of the patients. You check with any dentist who removes many wisdom teeth, and I am pretty confident that their children have had their own wisdom teeth removed. That speaks to their sincerity.

But Not Every Impacted Wisdom Tooth Should Be Removed

However, I do believe the rule needs to be tempered. There is a judgment call to be made here. Let me explain how I would make that judgment, because, from the x-ray you have sent me, without the benefit of other clinical information, it doesn’t appear that you need to have these wisdom teeth out.

This is a risk-vs-benefit proposition. There are benefits to having wisdom teeth gone because there are problems that they can cause. I have seen some of those problems, and they can be nasty, even life-threatening in some cases. But there are significant risks associated with removal of wisdom teeth including pain, swelling, possible post-operative infection, nerve damage, dry socket infection, trismus, and other problems. So we weigh the risks of leaving them alone against the risks of removal and come up with a decision.

In your late teens and early twenties, the risks associated with wisdom tooth surgery are the lowest. These operations are fairly straightforward. The bone in the jaw, at this age, is fairly pliable. In addition, the roots of the wisdom teeth may not be fully formed, thus greatly simplifying extraction. But as you age, the roots not only get fully formed but they tend to add cementum, making the teeth in some cases fatter at the end of the root than near the crown of the tooth. Removal of teeth like this can be difficult. In addition, the bone becomes less flexible. All of this magnifies the risks of complications.

On the other hand, the longer you go with your wisdom teeth, not having had any problems, the lower the risk that you will have problems in the future.

The Partially Impacted Wisdom Tooth

a partially impacted wisdom tooth

A partially impacted wisdom tooth

The wisdom tooth that is partially erupted and partially under the surface has by far the greatest risk of causing problems. Here is a photograph of such a wisdom tooth.
A partially impacted tooth like this is practically certain to cause a serious infection at some point, possibly when the patient is the most vulnerable. They tend to flare up during pregnancy or when the patient is weakened from some other illness. You can see in the photograph that the tissue that is over the tooth has a bluish tinge and looks puffy. Peeking under the tissue on the buccal side (opposite the tongue) you can see redness there. There will be a persistent low-grade infection around these teeth. Food gets under the tissue flap, and bacteria multiply freely because the pocket is impossible to clean. The pocket is also a source of unpleasant mouth odor. If an aggressive strain of bacteria gets into this pocket, or if the patient becomes weakened from some other illness, the infection will flare up and start to swell and hurt. I would tell my patients with partially impacted wisdom teeth that they were much better off choosing the time to have these teeth removed rather than having the time choose them.

The Completely Impacted Wisdom Tooth

The fully impacted wisdom tooth is a different story. With no opening to the oral cavity, there is no real risk of infection. There is a risk of cyst formation. I was taught about these cysts in dental school, but in over 20 years of dental practice I never saw a patient who had one, so I figured that this risk is fairly small. In younger patients, with the roots of the teeth not fully formed, there is a risk that the tooth could surface partially and thus become infected later. There is also a risk that a wisdom tooth could damage the roots of the second molar in front of it.

So that brings us to your case, Ajay. You can see from the x-ray you sent me that each of these teeth is fully under the bone—i.e. is a complete bony impaction. So the risk of them causing you problems is on the small side. Additionally, you have made it from age 20 to age 41, over twenty years so far, without them causing you any problems. And then if you look at the roots of these teeth, you’ll see that they have fattened up quite a bit from about twenty years of cementum deposition, so removing them will be a nasty experience. In addition, look at the nerve canal that goes through the middle of your jawbone back in the area of these teeth. Notice that on the left side the roots of that wisdom tooth impinge on this nerve canal. This greatly increases the risk of damage to the inferior alveolar nerve that goes through this canal. Damage to this nerve can cause you to lose all feeling in your lower lip on that side and all feeling to your teeth—a nasty complication.

I’m not going to prescribe treatment for you, since I don’t have any direct observation information or anything other than this x-ray. For that I refer you to your own dentist. But I will tell you this much. In my practice, I drew the line at age 40 for completely impacted wisdom teeth. If a patient got to age 40 without the tooth causing them any problem, I almost always recommended that they leave the tooth alone.

I will add that in your case, I would want a better look at your left side. That wisdom tooth appears, from the angle of this x-ray, to be pushing directly against the root of your second molar. I would want an individual periapical x-ray of that area at a different angle to see if that is the case and to inspect the root of the second molar for any damage. There could be something going on there that would argue for extraction.

I hope this is helpful.

– Dr. Hall

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About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

Is wisdom teeth removal a racket?

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.

Digg is an online magazine, a news aggregator, and yesterday they published a particularly ignorant article under the banner, “Wisdom Tooth Removal Is a Racket and Other Facts.” It definitely needs a response.

The author, Rob Wile, relates his own bloody wisdom tooth removal experience, which ended in his catching pneumonia. His description of the experience leaves me wondering if he is exaggerating, it seems so far out of the normal, but let’s accept it as true.

He says that he had his wisdom teeth removed when he was in his early teens. If that is true, that could explain some of his problem. At that age, if the wisdom teeth are even present as tooth buds. they are round and slippery and often deeply embedded in the bone. Because of their shape and slipperiness, sectioning them is difficult, so you have to cut a hole in the bone as big as the tooth to get them out. And even then, it’s difficult to grab them. In my practice, I took out hundreds of wisdom teeth. It’s easiest to take them out when the roots are mostly, but not completely, formed, and the teeth are close to the surface, which usually happens in the later teens.

He then cherry-picks some published articles by various scientific journals to give credibility to his argument. None of the articles, however, would lead to the extreme conclusion that he draws that wisdom tooth removal is a scam. But let’s examine a quote from one of them, a Dr. Jay Friedman. Wile’s article says this, quoting Dr. Friedman:

“It is specious to contend that less than 3 days of temporary discomfort or disability is a small price to pay to avoid the future risks of root [destruction], serious infections, and cysts,” he wrote in his paper. “Also ignored is the risk of incidental injury such as broken jaws, fractured teeth, damage to the [mouth] joints, temporary and, especially, permanent paresthesia or dysesthesia (numbness and dysfunction of the lower lip and the tongue).”

I looked up this Dr. Friedman. He’s a dentist, it turns out. He had an article published in the American Journal of Public Health titled “The Prophylactic Extraction of Third Molars: A Public Health Hazard.” In there he lists what he calls myths about wisdom teeth removal. One is given thus: “Myth Number 2–early removal of wisdom teeth is less traumatic.” That is simply not true, and no one who has taken out many wisdom teeth would say that. Actually, I don’t think any dentist who has taken out many teeth of any type would say that. As patients get later into their 20s, 30s, and older, the bone gets increasingly unyielding. The roots of the teeth also get fully formed and then begin to accumulate more cementum, often making them fatter toward the end of the root than they are closer to the surface, a factor which greatly complicates their removal. That’s a well-known fact among all dentists who do many extractions on patients of varying ages.

So I decided to check out this Dr. Friedman. Turns out he is not a practicing dentist. He’s a dental insurance consultant. I should have known. He has a DDS degree and then a Masters in Public Health, and has been working as an insurance consultant since 1962. Clearly it is in the interests of his insurance company to discourage the removal of wisdom teeth. In his Linked-In profile he describes himself as a “consumer advocate” and a “gadfly.” You don’t say!

In the cited American Journal of Public Health article he states: “Furthermore, dry socket, secondary infection, and paresthesia are less likely to occur in persons aged 35 to 83 years than in those aged 12 to 24 years, who experience more third-molar extractions.” As one who took out hundreds of wisdom teeth in my career, I will tell you that is completely foreign to my experience. I witnessed all of those complications in my practice, but never in a teenager. If you can take out the wisdom teeth when the roots are not quite completely formed and the tooth is close to the surface, the surgery is predictably straightforward and quick.

But what annoys me the most about Rob Wile’s article is the impugning of the integrity of the dental profession. Now I am one who has been highly critical on this blog of many dentists. Nevertheless, from my observation, as a whole, the dental profession has more integrity than any other profession with which I have been closely associated. And from dealing with the dental insurance industry, of which Dr. Friedman is a member, it has been clear to me that they have a lower average level of integrity than dentists. By far.

Here’s a challenge for anyone who feels that wisdom tooth removal is a scam. Ask the families of oral surgeons who extract a lot of wisdom teeth. Do they have the wisdom teeth extracted on their own children? I’ll wager that they do, but you can go ahead and do a survey. I extracted the wisdom teeth on my children, all when they were in their late teens, because I’m confident it was in their best interest. And I’m confident that other dentists feel the same way.

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About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

Should I wait until my wisdom teeth bother me before having them out?

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I am 26 years old and am having trouble with my wisdom teeth. I only have 3 wisdom teeth (2 on top, 1 on the bottom). All three are impacted. I have an appointment to have the top two removed and am trying to decide if I should have the bottom tooth removed. The roots of the bottom tooth are past the nerve. The surgeon told me that the risk of nerve damage was low (but my risk was slightly higher because the roots are past the nerve) and that I had a few options.
Option 1 – leave it until it starts bothering me.
Option 2 – pull it.
Option 3 – remove the tooth part and leave the roots and hope it doesn’t get infected (if it gets infected they’ll have to go back for the roots).

I was leaning towards just waiting but I’m feeling some pressure in that area of my mouth (although I don’t know if it’s from the bottom tooth or just the general pain I’ve been feeling from the top tooth). Also, I’m not fond of the idea of going through surgery a second time. I would like to know what your opinion was on my options and how likely an infection would be if I just go ahead and have the tooth part removed but leave the roots. Thanks!
– Mary from New York

Mary
The problem is that with your impacted wisdom teeth, they get much more difficult to remove the older you get. Every dentist I know of who has taken out many wisdom teeth always advises people to have impacted wisdom teeth removed when you are young (as you are), and the reason is that they know from experience how much more difficult these tooth extractions get the older you get.

The difficulty of extracting them and the risks of complications go up exponentially the older you get. You’re 26 now. When you are 30, your risks may double, at age 35 they may be double that, and so on. And if they are impacted, it is only a matter of time before they give you trouble. What happens is your bone gets harder and stiffer as you get older and the roots can tend to thicken. Why wait until they are infected and the situation becomes an emergency? My advice is to take care of this problem now when you can do it on your own timeline rather than waiting until the time picks you.

As far as leaving the root, that is a reasonable option, though I wouldn’t leave the entire root – only the root tip. If the piece of root is small, the body rarely has a problem with it. Though if I were the surgeon, I would suggest letting me make that determination during the surgery. Often the surgery goes more easily or is more difficult than anticipated, and that decision can be made with more clarity, in my opinion, once I’m in the middle of it.
– Dr. Hall

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About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

Should I have wisdom teeth out at age 59?

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Dr. Hall,

I am going on 59 years of age and the dentist advised me to pull two of my wisdom teeth. The teeth are not giving me any problem and because of my age, complications appear to be a factor with the surgery. My question, since I did not have my teeth removed when I was younger, should I removed my wisdom teeth if they are not giving me any problems? I would like a second opinion or some advice that would help me to make an intelligent decision. I don’t mind having them removed if my health is at risk. On the other hand, I don’t believe pulling teeth for the sake of pulling teeth is a wise choice. Please give me your honest opinion on this matter considering my age. Also, would you give me some questions that I can ask my dentist to put the wisdom teeth surgery in some perspective. I am having serious second thoughts, because I am not thoroughly convinced. Thanks.
– Leon in Texas

Leon,
It’s hard for me to advise you on your specific situation without seeing your wisdom teeth for myself or seeing x-rays. I can say this much. If your wisdom teeth are fully erupted and not causing you any problems, I would advise against having them out. If they are fully impacted, not bothering you, and you are 59 years old, I would also advise against having them out.

If they are partially erupted, it would depend on all the circumstances.

If wisdom teeth are fully impacted – they are completely under the surface, I generally recommend having them out if you are under 40. As you get older, the chances of complications increase if they are extracted, and the chances of trouble with them decrease if you leave them alone.

But if they are partially erupted – partially above the surface and partially below – then there are much greater chances that they will cause problems, and the worry is that they will cause problems when you can least afford to have trouble – when there is some other health urgency that really complicates having them out.

I hope this is helpful.
Dr. Hall

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About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

Should I have my wisdom teeth out at age 42?

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Wisdom tooth removal.

I am 42 yrs old and have been told I need all 4 removed. My dentist said 1, the oral surgeon wants to remove all 4. Only one has come through the gum and has given me trouble. The other 3 don’t bother me at all. In your opinion, is it necessary to remove all 4? I am worried about complications and really only want the one removed in hopes to reduce risks of complication and recovery time.
– Mary from Texas

Mary,
I don’t know what your x-rays show as far as the potential for these wisdom teeth bothering you, but I can give you some general guidelines that hopefully will help.

If your wisdom teeth aren’t erupted at age 42, they should have been taken out when you were around 20. The chances for causing complications increase with increasing age. When you’re 20, they are fairly easy to remove. They are considerably harder now. They will be harder yet in 20 more years. I don’t know how long you’ve been going to your current dentist, but if this tooth has been poking through the gum, he should have recommended having it out as soon as he saw it.

Another principle is that it is usually best to take them all out at the same time. If there is any significant potential for them causing you trouble and they aren’t in a particularly risky position, I would advise having them all out. The amount of discomfort is only a little more and the healing time is the same. I can tell you from going through this experience with a number of patients that it is an awful pain to deal with four surgeries, one after the time that each tooth starts to bother you, instead of just one. And it’s much better to choose the time when you have them out rather than have the time thrust upon you. What if they start to bother you when you are having some medical crisis? It could be a really nasty time for you.

Another useful piece of information is that complications surrounding the extraction of upper wisdom teeth are minor and transitory. They are much easier to take out.

Hopefully you have a feeling of trust in your surgeon that you will get straight, honest answers. I would ask this question about the lower wisdom tooth that isn’t the current problem tooth. Is it totally impacted in the bone – totally underneath the surface of the bone – or is it poking through the bone and could be exposed by merely raising a soft tissue flap? If it is totally impacted in the bone, the chances for it causing you trouble later on are much less. If it is poking through the bone, there is a greater chance of infection getting in around the tooth. Often it’s just a matter of time before they become infected. In my practice, I always advised that patients have all their impacted wisdom teeth removed, except if they had reached the age of 40 without them causing any trouble and they were totally impacted in the bone. I reasoned that if they had gotten this far without them bothering the patient, and there was no easy path for infection to get to the teeth, that the risks of surgery began to outweigh the risks of leaving the teeth alone.

I hope this helps.

Dr. Hall

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About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

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