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Wisdom Teeth Removal

Wisdom teeth, or third molars, are the last teeth to develop and appear in your mouth. They come in between the ages of 17 and 25, a time of life that has been called the "Age of Wisdom."

What is an Impacted Tooth?

When a tooth is not able to grow completely into the mouth, it is called an “impacted” tooth. Generally, impacted teeth are not able to break-through the gums as there isn’t sufficient space.  It is seen that 9 out of 10 people will have at least 1 impacted wisdom tooth.

How serious is an impacted wisdom tooth?

If it is left in the mouth, these impacted wisdom teeth can end up damaging neighboring teeth/become infected. Since it is difficult to clean the 3rd molar space in the mouth, this area tends to invite bacteria that eventually leads to gum disease. In addition, oral bacteria can also travel through to the bloodstream and can lead to potential systemic infections & illnesses which affect the kidneys, heart &other organs.

Research has also shown that once gum disease has been established in the 3rd molar areas, this problem is always progressive & persistent. The one way to improve the condition is to extract the wisdom teeth. In certain cases, there can be the formation of a fluid-filled tumor or cyst around the base of an untreated wisdom tooth. If this cyst grows, it can lead to even more serious issues as it hollows-out the jaw & damages the surrounding teeth, structures and nerves. 


Complications such as infection (fig. a) , damage to adjacent teeth (fig. b) and the formation of cysts (fig. c) may arise from impacted teeth.
wisdom infection (a) Infection wisdom crowding (b) Damage to neighboring teeth wisdom cyst (c) Cyst

Must the tooth come out if it hasn't caused any problems yet?

Most people believe that if there is no pain in the wisdom teeth, they have nothing to worry about. But just because there is no pain, it does not mean that the area is problem or disease free. As a matter of fact, even the wisdom teeth that come in normally are prone to disease. This was the outcome of the study that the American Association of Oral and Maxillofacial Surgeons & the Oral and Maxillofacial Surgery Foundation conducted.

When to Extract

Therefore, it is important that your dentist monitor the growth & health of all your wisdom teeth when the annual check-ups are being carried out. Most medical and dental professionals agree to the fact that wisdom teeth should always be extracted in these instances:

- Periodontal disease and/or infections
- Cavities which cannot be restored
- Pathologies such as tumors and cysts
- Damage to adjacent teeth

Wisdom teeth that are completely erupted and functional, painless, cavity-free, in a hygienic environment with healthy gum tissue, and are disease-free teeth they may not require extraction. They do, however, require regular, professional cleaning, annual check-ups and periodic radiographs to monitor for any changes.

Wisdom Teeth Growth by AgE

wisdom teeth 12 years

wisdom teeth 14 years

wisdom teeth 17 years

wisdom teeth 25 years

Wisdom teeth are easier to remove when the patient is younger, since their roots are not completely formed, the surrounding bone is softer, and there is less chance of damaging nearby nerves or other structures. Removal of wisdom teeth at a later age becomes more complicated as the roots have fully developed (may involve the nerve), and the jawbone is denser.

When extraction is not required

Wisdom teeth will not have to be removed if they are:

- Completely erupted & functional
- Painless & cavity-free
- In a hygienic environment
- In healthy gum tissue
- Disease-free 

However, even healthy wisdom teeth will have to be cleaned regularly by a professional. It’s also important to get periodic radiographs which can be used to monitor them for any changes.

It is much easier to remove wisdom teeth when the patient is young. This is because the roots of these teeth are not completely formed at this time & the surrounding bone is also much softer. This means there is much less damage to the adjacent nerves and other structures. If wisdom teeth have to be removed at a later age, the complexity of the procedure increases as their roots are fully-developed by this time, the jaw-bone is much denser and it could involve the nerve. 

What occurs during surgery?

If the dentist/healthcare professional recommend that any of your wisdom teeth have to be removed, in most instances, you will be referred to an oral & maxillofacial surgeon for that procedure. Prior to surgery, the oral surgeon will discuss the complete procedure with you & will also tell you want you can expect. This is your opportunity to ask questions and voice your concerns. Ensure that you let the doctor know about any medications you are currently taking or illnesses you have.

There are a number of conditions which affect the manner in which a wisdom tooth will be removed. This includes the position of the tooth as well as the root-development stage. In case the tooth is impacted, the surgery becomes more complex. In most cases, it is possible to remove the 3rd molars with very little/no pain and the extraction can take place at an oral & maxillofacial surgery office. Patients will be given local anesthesia/intravenous sedation/general anesthesia. The surgeon will recommend an option that is best for you.

What happens post surgery?

Post the surgery, you might experience a certain amount of swelling & mild discomfort, - these are a part of the regular healing process. You can use cold compresses to help decrease the swelling, & the medication that  your Oral & Maxillofacial Surgeon has prescribed, will help manage that discomfort. Your doctor may also instruct you to modify your diet post surgery & then transition to normal foods.

What if I decide to keep my wisdom teeth?

If you discuss your dental situation with the dentist/oral & maxillofacial surgeon and then decide not have your wisdom teeth removed, it is important that you take extra care while cleaning & flossing those teeth. Get these molars checked annually and ensure that there is no change in the condition of the gum tissue or the teeth themselves.

The AAOMS-American Association of Oral and Maxillofacial Surgeons is the professional organization that represents more than 9,000 oral & maxillofacial surgeons in the U.S and supports the ability of its members practice their specialty via education, research & advocacy. The members of the AAOMS comply with all the rigorous continuing educational requirements & submit to the periodic office examinations. This assures the public that the office procedures & personnel meet the stringent national standards.

© 2005-2015 American Association of Oral and Maxillofacial Surgeons (AAOMS). All rights reserved.

Reprinted with permission from American Association of Oral and Maxillofacial Surgeons.