Wisdom teeth are the third set of molars to emerge at the back of the mouth. Typically, one wisdom tooth will come in on each side in both the upper and lower jaws. However, not all people have four wisdom teeth – and some may have more than four. A patient’s x-ray will reveal any wisdom teeth present before they begin showing above the gum line.

More About Wisdom Teeth

These molars usually erupt (emerge above the gum line) during a person’s mid-teens to early twenties. If the top and bottom wisdom teeth grow through in appropriate alignment with each other, they can function normally for chewing just like the other molars. Patients who have good oral health and enough space to accommodate this third set of molars can usually keep them intact.

However, wisdom teeth are often non-functional. Any wisdom tooth that does not have a matching molar to bite against in the opposing jaw does not serve a useful purpose. A dentist can usually remove this type of tooth without negatively affecting the biting or chewing function of the patient’s mouth.

Patients may experience discomfort when a wisdom tooth grows in at an angle which causes the edge of the tooth to rub against the gum, cheek or tongue. These third molars often don’t have room to emerge fully. This can cause pain and irritation to the gums and occasionally cause shifting in adjacent teeth. An impacted tooth may never emerge. The tooth can stay completely covered by gum or bone tissue throughout a patient’s life causing periodic or chronic aching.

Should a Wisdom Tooth Be Removed if It Isn’t Painful?

A dentist may still recommend wisdom tooth removal even if the patient is currently not experiencing pain or discomfort. A wisdom tooth can shift position over time and cause problems later. The longer a patient waits before seeking treatment, the more complex the procedure. Younger patients have less dense jaw bone tissue and tooth roots that aren’t as well developed. These factors generally make operating easier and less painful. Younger patients often heal more quickly after surgery. Older patients seem to experience a higher risk of having an impacted wisdom tooth develop a cyst.

Patients may also have difficulty cleaning wisdom teeth because these molars are located so far back in the mouth. Food particle accumulation and poor oral hygiene (such as inadequate flossing) can lead to decay in the wisdom tooth and the molar directly next to it. Removing the wisdom tooth may reduce the risk of cavities in the adjacent tooth and make oral care easier. Some patients also have a problem with gum infections around their third molars. These infections may stop recurring after extraction.

Typical Approaches to Treatment

Dentists usually perform wisdom tooth extractions as outpatient procedures using local anesthesia. Patients may receive anti-anxiety medications prior to treatment or conscious sedation to minimize discomfort. A dentist can pull wisdom teeth out using forceps in a simple extraction procedure if the teeth have grown in.

Extraction requires surgery for molars still covered by gum tissue (soft tissue impaction). The roots of wisdom teeth in the upper jaw may extend very close to the sinuses. Patients at risk of sinus perforation should seek treatment from an oral surgery specialist to minimize the chances of complications during or after extraction.

An oral surgeon is also the appropriate specialist for patients who have lower wisdom teeth fully encased in the jaw bone (bony impaction). A skilled dentist can often break up the impacted tooth into smaller pieces before removal. This step minimizes the amount of healthy bone removed to allow extraction of the molar.

Additional Wisdom Tooth Considerations

The patient’s recovery period and post-operative care instructions vary depending on the complexity of the operation. Patients can use recommended over-the-counter or prescription medications to control the moderate pain, swelling and soreness that are typical after the procedure.

Patients should take special care, particularly when eating, to preventing the blood clot that forms in the extraction site from being dislodged. If the blood clot disintegrates too soon or if one does not form, a dry socket may develop. This painful condition requires further dental treatment to promote normal healing. Other rare but more serious side effects include permanent damage to the sinuses, the surrounding teeth or the alveolar nerve in the lower jaw. A dentist will explain these risks fully prior to performing the extraction procedure.

Some dental insurance plans cover a portion of the cost of wisdom tooth extraction. Medical insurance may also apply for cases involving the services of an oral surgeon. Patients without insurance can typically afford extraction by choosing a monthly payment plan offered by their dentist.