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Be wise about managing wisdom teeth!

Contrary to its name, wisdom teeth has no relation to a person's intelligence.

Instead, they (wisdom teeth) are known as third molars and are the last teeth to develop – usually erupting when a person is between the ages of 18-25 years. 

Wisdom teeth may either erupt upright or at an angle to the second molars (impacted wisdom teeth), or not erupt at all and remain partially or fully buried in bone. 

Wisdom teeth can either be removed preventively, before they cause problems, or symptomatically, when problems arise.

So how do you decide if, and when you should remove your wisdom teeth?

In this instalment of “Ask the Specialist”, Dr Natalie Tan will answer your questions on wisdom teeth and offer insight into the management of wisdom teeth. Be wise and pose your questions now!

Related article:
Wisdom Tooth/Wisdom Teeth: When to Extract

Dr Natalie Tan is a Consultant with the Oral and Maxillofacial Surgery Department at National Dental Centre Singapore.

She graduated from the National University of Singapore with a Bachelor of Dental Surgery in 2013, and went on to obtain a Master of Dental Surgery (Oral and Maxillofacial Surgery) from the same university in 2020. 

Dr Tan is an accredited Specialist in Oral and Maxillofacial Surgery with the Singapore Dental Council.

1. Question by Martyn

Dear Dr Tan, 

I heard that the older one extracts their wisdom teeth the more complicated and expensive their surgery/extraction will be. Would it be recommended for people to extract their wisdom teeth as early as they can, or to wait until it hurts? Thank you!

Answer by Dr Natalie Tan

Dear Martyn, As one ages, your bone becomes more rigid and less flexible. The roots of your wisdom teeth would also be fully formed.

Other than these, other factors such as one’s medical fitness and generally slower healing in older patients could also put you at a higher risk of complications. 

As such, you might wish to consider the removal of wisdom teeth that are exposed in the oral cavity earlier rather than later, as they do carry a higher potential for causing issues compared to those that are fully buried in the jaw.

For teeth that are fully buried, and not exposed in the oral cavity, it could be feasible to take a wait-and-see approach.

These are general guidelines, hence a discussion with an oral and maxillofacial surgeon could help you make the choice between early preventive removal or symptomatic removal based on factors unique to you.

2. Question by Yun Yun

Dear Dr Tan, 

My son is 18 and when we visited the dentist last week, he found that both his lower wisdom tooth are impacted (quite horizontal) while for the two on top, one looks ok and the other is growing at a slight angle. 

The dentist suggests taking at least the lower two out via surgery, but said i should consider even taking out all four. Is this a good time to do so? And is it wise to take all out at one go as recommended? 

Thank you for your advice.

Answer by Dr Natalie Tan

Dear Yun Yun, If your son’s lower wisdom teeth are exposed in the oral cavity, I would recommend consideration of removal.

Since they are impacted, they can potentially cause issues such as decay on either the wisdom teeth themselves or the neighbouring second molar next to it.

He could also develop swelling and inflammation, known as pericoronitis, or gum disease as well.

Your dentist is right that the lower two would require surgery if they are horizontally impacted. As for his upper wisdom teeth, you could monitor them for eventual eruption over the next few years, and if they do erupt, then they may not require surgery and could be extracted.

However, there is a possibility they remain unerupted/impacted, and may still be indicated for removal via surgery if they start causing problems.

There are risks associated with the removal of both upper and lower wisdom teeth, and a discussion with your dentist or an oral maxillofacial surgeon would be best as they will be able to highlight risks based on the clinical and radiographic findings. 

If you are not comfortable with removal all four wisdom teeth at one go, it is possible to split the removal into two sessions, usually removing one side (either right or left), followed by the other side at later visit.

3. Question by Nicole

Dear Dr Natalie, 

If based on XR wisdom tooth appears to be near the sinus, will you still advise for removal if the tooth is not causing any trouble (besides the usual trouble of food being stuck there)? Thanks.

Answer by Dr Natalie Tan

Dear Nicole, 

If you are having food trap issues with your upper wisdom teeth, then I would recommend consideration of removal, if you are medically fit and healthy.

There is potential that food trap can cause problems of pain from either decay or gum disease, if not adequately and expediently cleared. 

There is a risk of sinus floor perforation with the removal of upper wisdom teeth that are close to the sinus floor.  However, sinus floor perforations can usually be repaired, and once repaired and healing is complete, carries low risk of causing persistent sinus issues.

4. Question by Edwin

Dear doctor, 

I am 69 years old and have a wisdom tooth at the far end of my lower jaw. Thus far it has not given me any problems or pain. My dentist is encouraging me to get it removed as a precaution though I remain unconvinced. Is there any medical based reason on why and when I should get it removed? Thank you.

Answer by Dr Natalie Tan

Dear Edwin, 

Good job on keeping your wisdom tooth well all these years! In general, removal of wisdom teeth in older patients can be associated with slower healing and higher risk of complications compared to younger patients in their late teens and early 20s. 

As such, I would offer the option of monitoring, and removal of the wisdom tooth if the need arises, as an alternative treatment option to preventive removal. 

Situations where removal of wisdom teeth may be recommended include development of signs and symptoms of pain and swelling, development of disease associated with the wisdom tooth (e.g. cysts, benign tumours), or even as part of clearance for medical treatment such as starting medication for osteoporosis, chemotherapy, radiation therapy to the head and neck and cardiovascular surgeries.

5. Question by SK

Hi Dr Tan, 

I’m 77 years old. A portion of my top left wisdom tooth broke off last year. My dentist did to fill it up twice but failed to fix it. It has no pain for now. What is best for me? Please advise. Thank you.

Answer by Dr Natalie Tan

Dear SK, 

It is difficult to offer my opinion on what is best for you, without having a full picture of your medical history and the status of your wisdom tooth, other than the issue of the tooth being fractured and not being able to retain a filling. 

Generally, if your tooth is well, without any root canal issues, active decay, no associated disease (e.g. cysts, benign tumours)  or risk of causing deterioration of your adjacent teeth, then leaving it alone and monitoring it could be feasible, since it is asymptomatic.

However, if the tooth is non-functional (without any opposing teeth biting against it), then my suggestion would be to have it removed, if you have a favourable medical history.

6. Question by WY

Dear Dr, 

I’m 65 years old. My dentist has told me that I’ve got an impacted wisdom tooth on the lower left side. Should I wait for when it gives me trouble before removing or should I remove it while I’m still “young”? Thank you.

Answer bt Dr Natalie Tan

Dear WY, 

In general, removal of wisdom teeth in older patients can be associated with slower healing and higher risk of complications compared to younger patients in their late teens and early 20s. 

As such, I would offer the option of monitoring, and removal of the wisdom tooth if the need arises, as an alternative treatment option to preventive removal. 

Suituations where the removal of wisdom teeth is recommended may include development of signs and symptoms of pain and swelling, development of disease associated with the wisdom tooth (e.g. cysts, benign tumours), or even as part of clearance for medical treatment such as starting medication for osteoporosis, chemotherapy, radiation therapy to the head and neck and cardiovascular surgeries.

7. Question by Toh

Dear Dr, 

My son is serving his NS now. He is thinking of removing his wisdom teeth though not causing any pain or problem now, as he won’t have to pay for the surgery. What is your advice? Thank you.

Answer by Dr Natalie Tan

Dear Toh, 

Most of the time, wisdom teeth removal is an elective procedure, and there may be situations where leaving the wisdom teeth alone could be recommended if the risks of surgery outweigh the benefits of removal.

As with any surgical procedure, there are risks of complications with removal of wisdom teeth, for example, injury to the inferior alveolar nerve, which could result in potentially permanent numbness to the lower lip and chin. 

As such, it is generally not advisable for anyone to undergo surgery of any kind because the procedure is “free”. I would recommend getting a consultation with a dentist or an oral and maxillofacial surgeon to discuss his options, risks and benefits, before deciding to proceed with the removal of his wisdom teeth.

8. Question by David

Hi Dr Natalie Tan, 

May I know when should I remove my wisdom teeth ? They are currently not giving me any pain or problem. I am 68 years old. Thank you.

Answer by Dr Natalie Tan

Dear David, 

In general, removal of wisdom teeth in older patients can be associated with slower healing and higher risk of complications compared to younger patients in their late teens and early 20s. 

As such, I would offer the option of monitoring, and removal of the wisdom tooth if the need arises, as an alternative treatment option to preventive removal. 

Situations where removal of wisdom teeth is recommended may include development of signs and symptoms of pain and swelling, development of disease associated with the wisdom tooth (e.g. cysts, benign tumours), or even as part of clearance for medical treatment such as starting medication for osteoporosis, chemotherapy, radiation therapy to the head and neck and cardiovascular surgeries.

9. Question by RZ

Hi Dr, 

I am 75 year old and still have all my teeth fully working. My wisdom tooth was erupted in the lower jaw on both sides but in the upper jaw it never erupted. 

Now food traps between lower wisdom tooth and molar tooth. So the wisdom tooth is not used as there is no corresponding wisdom tooth in upper jaw. 

Please advise if both wisdom teeth could be extracted to avoid food trapping. Thank you.

Answer by Dr Natalie Tan

Dear RZ, 

Firstly, let me congratulate you on taking fantastic care of your teeth and maintaining them all these years! 

If you are having food trap issues with your lower wisdom teeth, then I would offer the option of removal, if you are medically fit and healthy. There is potential that food trap can cause problems of pain from either decay or gum disease, if not adequately and expediently cleared. 

Do bear in mind, however, that removal of wisdom teeth in older patients can be associated with slower healing and higher risk of complications compared to younger patients in their late teens and early 20s. 

Do discuss with your dentist or an oral and maxillofacial surgeon on the risks and benefits of removing your wisdom teeth. There is always the option of monitoring and maintaining good oral hygiene around your wisdom teeth should the risks of surgery outweigh the benefits of removal.

10. Question by Javen

Dear Dr. Natalie, 

Hope you can answer some questions I have regarding my wisdom teeth. 

For the longest time, I have been contemplating if I should remove my wisdom teeth even though after every dentist visit, I have been encouraged to remove them. 

I have a low pain threshold and the pain and discomfort I experience such as sensitive teeth and the prolong opening of the mouth discourages me from the idea of removing my wisdom teeth. I have 4 wisdom teeth as seen in my OPG taken in January 2023 and it has since been there. 

I have no disturbances from the 4 wisdom teeth thus far except for some food that are hard to remove sometimes and of course I do fear the possibility of future issues with my teeth as I get older. 

What is your advice and do you think I need to go through surgical route or even general anaesthesia to have them removed or you feel it isn't necessary? 

What are the costs like? I had the opportunity to remove them when I was in national service but I missed it. 

Appreciate your advice please. Thank you.

Answer by Dr Natalie Tan

Dear Javen, 

If you are having food trap issues with your wisdom teeth, then I would offer the option of removal, if you are medically fit and healthy. There is potential that food trap can cause problems of pain from either decay or gum disease, if not adequately and expediently cleared. 

If any of your wisdom teeth are unerupted or impacted, then they may require surgery. 

General anaesthesia is an available option that can be explored if you are more apprehensive of undergoing the procedure awake, under local anaesthesia. 

Costs of removal depends on where you eventually have your wisdom teeth removed. Removal under general anaesthesia would usually cost more than removal under local anaesthesia as you would need to factor in the anaesthetic and facility fees as well. 

There is always certainly the option of leaving alone and monitoring your wisdom teeth, if you are able to maintain good oral hygiene around them. 

Do consult your dentist or an oral and maxillofacial surgeon to discuss the pros and cons of the options that are available for you.

11. Question by Fitim

Dear Dr, 

My mother is 87 years old. Last year had removed one wisdom tooth. Also, she lacks some teeth. Before 15 years ago had placed crowns but has fallen. Therefore, I was planning to put new Crown in upper side of jaw but I was wondering if crowns in old age practical and reasonable in medical point of view? Thanks in advance.

Answer by Dr Natalie Tan

Dear Fitim, 

A thorough examination and diagnosis would be required before a treatment plan(s) can be proposed for your mother. It would be best to consult a dentist or a prosthodontist (crowns, bridge and denture specialist) on the options available for the replacement of her missing teeth.

12. Question by Josephine

Dear Dr Tan, 

I have an impacted wisdom tooth (lower) which has recently chipped off one of its corner while I was eating. 

There is a gap between this wisdom tooth and my 1st molar as my 2nd molar has been extracted many years ago. My questions are:

a) Should I remove the wisdom tooth though there isn't any pain at the moment? 

b) Should I do a tooth implant to replace my 2nd molar? 

c) Is it advisable to do wisdom tooth extraction and tooth implant procedure at the same time? 

Hope you would answer my questions. Thank you.

Answer by Dr Natalie Tan

Dear Josephine, 

Depending on how bad the chip is and if there was any decay associated with your lower wisdom tooth, there might be cause to have it removed. I would recommend having it checked with your dentist or an oral and maxillofacial surgeon.

hether an implant is suitable to replace your 2nd molar that has been extracted depends on a few factors, such as the amount of space between your upper teeth and the missing gap, the quality, volume and height of bone present, your medical history, and overall gum health, to name a few factors. If an implant replacement is suitable for you, then the impacted wisdom tooth at the back will usually be indicated for removal. Your dentist or oral and maxillofacial surgeon can further advise you on this too. 

It may be possible to have the wisdom tooth and implant done at the same time, but this again would require a consult and thorough planning with your dentist or oral and maxillofacial surgeon.

13. Question by Geraldine

Dear Dr Natalie, I hope you are well! 

I have 2 questions on the topic: 

I visited the dentist last year and she advised to remove a fine upper wisdom tooth even though it wasn't causing any issues. I didn't think much then but on second thoughts, should I have kept it and not extracted it? 

I have 2 bottom wisdom teeth, one on each side that have not erupted (I hope they stay like this). After checking my x-ray, the dentist advised that if there is a need to remove them, there is a high chance of facial paralysis as they are situated dangerously close to my nerves. The gums in those areas are hard. 

What are the chances of wisdom teeth not erupting? If the day comes that I have to remove them, is there any way of reducing facial paralysis? Thank you!

Answer by Dr Natalie Tan

Dear Geraldine, 

It is quite common for upper wisdom teeth to be indicated for removal, even if they are sound and not causing problems, especially if they are non-functional – meaning they do not have an opposing tooth on the lower jaw. Non-functional teeth do not help with function, and may eventually cause problems still with tooth decay or gum issues. However, it is also fine for them to be left alone and only removed when symptoms arise. 

Removal of lower wisdom teeth are associated with nerve injury. The nerve that may be affected is known as the Inferior Alveolar Nerve, or Inferior Dental Nerve. This nerve is a sensory nerve and provides sensation to the lower teeth and gums, as well as the lower lip and chin. This nerve has no motor function, and hence would not cause facial paralysis if injured. It is difficult to advise on the nerve injury risk without radiographic information. 

Wisdom teeth usually erupt between the ages of 18-25 years. If they are impacted against the tooth in front and buried in bone past 25 years, it is likely that they would not erupt. They could become exposed (not erupted) if they are only covered by gums (but still not exposed in the oral cavity) if the gums do recede over time. 

If you are at high risk of nerve injury with removal of your wisdom tooth, it is usually recommended to seek a specialist for removal.  An Oral and maxillofacial surgeon at NDCS will employ some techniques and options that can potentially help to lower the risk, but there are many factors to consider to determine if these options are suitable for you. These can be discussed with the surgeon during your consult.

Ref: G25