Do I really need my wisdom teeth out?
Short answer: Not necessarily. A wisdom tooth that has come through cleanly, bites properly and can be kept clean is generally best left alone. Removal is genuinely indicated for repeated infection, decay that cannot be restored, damage to the tooth in front, or cysts. Removing symptom-free, fully erupted wisdom teeth "just in case" is not routinely recommended.
When removal is genuinely indicated
- Repeated infection around the gum flap (pericoronitis). One episode may be manageable; recurring episodes are a strong indication.
- Decay that cannot be restored. Wisdom teeth are hard to reach and harder to fill well.
- Damage to the tooth in front. An angled wisdom tooth pressing into the second molar can cause decay or bone loss on a tooth well worth keeping — this is one of the strongest reasons.
- A cyst or other pathology associated with the tooth.
- It cannot be cleaned and the gum around it is persistently inflamed.
When watching is reasonable
If a wisdom tooth is fully through, in a sensible position, biting against its opposite number and cleanable, the case for removing it is weak. It is a functioning tooth.
Fully buried wisdom teeth with no symptoms and no sign of pathology are also frequently left, monitored with occasional x-rays. Surgery has real risks — including, for lower wisdom teeth, temporary or rarely permanent numbness of the lip and tongue from nerve proximity — and those risks have to be weighed against a problem that may never arrive.
The old idea that wisdom teeth should be removed to prevent front teeth crowding is not supported by the evidence.
Questions worth asking
- Which specific problem is this solving — infection, decay, damage to the tooth in front, or prevention?
- Can I see the x-ray, and can you show me the problem on it?
- How close is the nerve, and what is the risk of numbness?
- What happens if I wait and monitor it?
- Does it need all four, or only the one causing trouble?
"All four at once" is sometimes right, particularly if you are having sedation. It is also sometimes convenience rather than necessity. Asking is reasonable.
If the answers do not satisfy you, bring the plan and the x-rays to us — free, on any dentist's plan, and we are happy to say when we think a tooth can stay. See also what to bring.
Common questions
Do wisdom teeth have to be removed?
No. A wisdom tooth that has erupted cleanly, bites properly and can be kept clean is generally best kept. Removal is indicated for recurring infection, unrestorable decay, damage to the tooth in front, or cysts.
Should I remove wisdom teeth to stop my teeth crowding?
That reasoning is not supported by the evidence. Crowding of the front teeth has other causes, and removing wisdom teeth is not a reliable way to prevent it.
What are the risks of wisdom tooth removal?
Swelling and discomfort for several days, and for lower wisdom teeth a risk of temporary — rarely permanent — numbness of the lip or tongue, because the nerve can run close to the roots. Your dentist should tell you how close it is in your case.
Can I keep just the ones that are not causing trouble?
Often yes. Removing all four is sometimes sensible, particularly under sedation, but it is reasonable to ask whether each one individually needs to go.