Wisdom Tooth (Wisdom Teeth): When to Remove

Wisdom teeth are also known as the third (rearmost) molars. We typically have four – two each in the upper and lower jaws, one on either side. They are associated with wisdom because they usually erupt between the later growing ages of 16 and 21.

Some studies suggest that wisdom teeth could once have been useful, when human jawbones were bigger and could accommodate their fully erupted size. But over the centuries, with a diet of softer, processed food, our jawbones gradually shrank – providing less space for teeth to grow. This has led to most wisdom teeth, especially those in the lower jaw, being impacted.

An impacted wisdom tooth does not grow in the right direction. "It could be partially or fully impacted, either with soft tissue or by parts of the jawbone. An X-ray will show how deeply the tooth is impacted, and the decay associated with it or the tooth besides it," advises the department.

Impacted wisdom teeth can lead to a slew of problems, including:

• Gum infection
• Tooth decay (caries), and occasionally,
• Formation of dental cysts
  When a dental cyst develops and enlarges, it can cause pain in the jawbone and surrounding area, and at times even weaken the jawbone, causing a pathological fracture.

Oral surgeons (dentists with specialty training in Oral & Maxillofacial Surgery, equipped with the skills and experience to remove impacted wisdom teeth) will consider all possible factors before recommending the removal of impacted wisdom teeth.

Since most wisdom teeth are impacted and buried in the gums, a small incision has to be made. Some bone surrounding the wisdom teeth is usually removed for better access to the tooth. The wisdom tooth is then typically divided into a few pieces and removed completely. The gums are then stitched back into the original position.

Impacted wisdom teeth, accompanied by pain and other symptoms, occur mostly in young patients. But elderly patients with problematic wisdom teeth may sometimes need surgery as well.

Older patients, especially those with pre-existing conditions like diabetes or hypertension (high blood pressure), need to take into consideration the managing of their surgical and post-operative care.

Also, they may have a slightly longer downtime to heal, compared to younger people.​

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Dentists are frequently asked whether all four wisdom teeth, even unproblematic ones, should be removed while the patient is young to pre-empt future problems.

On this, the Department of Oral and Maxillofacial Surgery at NDCS says, "This is a grey area which is debatable even among top experts, hence treatment needs to be tailored to the individual."