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