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decision pointShould I have a wisdom tooth removed?

Some people have their wisdom teeth , the last teeth to emerge in the mouth, for the rest of their lives. Other people choose to have their wisdom teeth removed, sometimes before they have emerged through the gums. Consider the following when making your decision.

  • You should have your wisdom teeth evaluated if you are 16 to 19 years old.
  • Your dentist may recommend removal of a wisdom tooth if it is crowding your other teeth, causes pain, or has become stuck (impacted) as it tries to emerge. Removal also may be recommended if infection has developed as a wisdom tooth is breaking through the gum.
  • Oral surgeons generally advise that wisdom tooth extraction is easier in younger people, when the roots and bone are softer because they are not completely developed. In general, the younger you are when you have your wisdom teeth removed, the easier the procedure will be and the faster you will heal. Some dentists think it is best to have impacted wisdom teeth extracted before you are 20 years old, to prevent future problems.
  • You may never have any problems with your wisdom teeth. If you are older than 30 and have not had any wisdom tooth problems, you probably will not have these problems in the future. Wisdom teeth that are healthy and properly positioned do not cause problems.

What are wisdom teeth?

Wisdom teeth are the upper and lower third molars, located at the very back of the mouth. They are called wisdom teeth because they usually come in when a person is between 17 and 21 years old-old enough to have gained some "wisdom."

What causes problems with wisdom teeth?

Often a person's jaw is not big enough to accommodate the new molars when they begin to emerge. The tooth may fail to break all the way through the gum and instead become stuck in the jaw (impacted). An impacted wisdom tooth has the potential to crowd other teeth or create painful, inflamed, and often infected, flaps in the gum. Wisdom teeth that have emerged may develop decay and gum disease, because they can be difficult to clean.

Most problems with wisdom teeth develop when people are between 15 and 25 years old.1 Few people older than 30 develop problems that require removal of their wisdom teeth.

Most dentists feel that people between the ages of 16 and 19 should have their wisdom teeth evaluated.

Most dentists recommend that you not wait until you are 30 or older to remove troublesome wisdom teeth, because the bones around the teeth continue to grow and harden. Extraction is more difficult and healing is slower for older adults.

What are the risks of having wisdom teeth removed?

If you have a wisdom tooth removed, you may experience:

  • Pain and swelling in your gums and tooth socket where the tooth was removed.
  • Bleeding that won't stop completely for about 24 hours.
  • Difficulty with or pain from opening your jaw (trismus).
  • Slow-healing gums.
  • Damage to dental work, such as crowns or bridges, or to roots of a nearby tooth.
  • A painful inflammation called dry socket, which happens if the protective blood clot is lost too soon.
  • Numbness in your mouth and lips after the local anesthetic wears off, due to injury or inflammation of nerves in the jaw. Numbness will usually go away, but in rare cases it may be permanent.2
  • An opening into the sinus cavity if a wisdom tooth is removed from the upper jaw.

The decision to have nonimpacted wisdom teeth removed has to be weighed against the pain and swelling most people experience after surgery, as well as the low risk of nerve damage.

General anesthetic often is used during wisdom tooth extraction, and all surgeries that use general anesthetic have a small risk of death or other complications.

What are the risks of not having wisdom teeth removed?

If wisdom teeth are not removed, the following problems may develop.

  • When there is not enough room in the mouth for the wisdom teeth to come in, they may become impacted and never break through the gums.
  • Your wisdom teeth may break partway through your gums, causing a flap of gum tissue to grow over them. Food can become trapped under the flap and cause your gums to become red, swollen, and painful.1 These are signs that germs growing under the flap are causing infection.
  • One or more of your wisdom teeth may come in at an awkward angle, with the top of the tooth facing forward, backward, or to either side.
  • More serious problems can develop from impacted teeth, such as infection and damage to other teeth and bone. A fluid sac may form around an impacted tooth, and the sac may grow into a cyst, which could cause permanent damage to the nearby teeth, jaw, and bones.
  • Your risk of developing cavities and gum disease in the back of your mouth is higher if you keep your wisdom teeth, because it is difficult to brush and floss that part of your mouth properly. But if you visit your dentist once or twice a year, cavities and gum disease can be detected and treated early.
  • If you need orthodontic treatment, allowing your wisdom teeth to remain may affect the treatment.

If you need more information, see the topic Wisdom Tooth Problems.

Your choices are:

  • Have your wisdom tooth or teeth removed.
  • Do not have your wisdom tooth or teeth removed.

The decision about whether to have wisdom teeth removed takes into account your personal feelings and the medical facts.

Deciding about wisdom teeth removal
Reasons to have your wisdom teeth removed Reasons not to have your wisdom teeth removed
  • Your wisdom teeth may become impacted if there is not room for them.
  • Your risk of developing gum disease or jaw infection is higher if you keep your wisdom teeth.
  • If you have a medical condition that may get worse over time, you may want to have your wisdom teeth removed while you are healthy. Wisdom tooth extraction can be a difficult surgery and poses risks for both minor and major complications.
  • If a fluid sac (cyst) forms around an impacted wisdom tooth, it may permanently damage nearby teeth and the jaw.
  • Corrective and restorative dental work (such as braces and crowns) may be damaged or more difficult for your dentist to do if your wisdom teeth are coming in or have come in.

Are there other reasons you might want to have your wisdom tooth removed?

  • You may never have problems with your wisdom teeth.
  • There are risks involved with any surgery, although the risks of wisdom tooth extraction are slight.
  • If you are older than 30, you have only a small risk of developing problems with wisdom teeth.
  • Existing teeth and dental work near the wisdom tooth may be damaged during the extraction process.

Are there other reasons you might not want to have your wisdom tooth removed?

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about having your wisdom tooth removed. Discuss the worksheet with your dentist.

Circle the answer that best applies to you.

1. My teeth are fairly crowded now, and my wisdom teeth may not have room to come in. Yes No Unsure
2. I am older than 30 and don't think I'll have problems with wisdom teeth in the future. Yes No NA*
3. I already have trouble keeping the teeth in the back of my mouth clean. Yes No Unsure
4. I don't want to have dental surgery unless I have to. Yes No Unsure
5. I have a medical condition that may get worse in a few years, and I don't want to be concerned about problems with impacted wisdom teeth. Yes No NA
6. I have health insurance and I can afford optional surgery. Yes No NA
7. I am going to need orthodontic treatment and don't want wisdom teeth emerging later on and pushing my teeth out of alignment. Yes No NA
8. I am concerned that I may develop dry socket or other problems after tooth extraction. Yes No Unsure
9. I would rather wait until I know I'm going to have a problem with wisdom teeth before I decide to have them removed. Yes No Unsure

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

 

 

 

 

 

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have your wisdom tooth removed.

Check the box below that represents your overall impression about your decision.

Leaning toward having my wisdom teeth removed

 

Leaning toward NOT having my wisdom teeth removed

         

Citations

  1. Macleod DK (2007). Common problems of the teeth and oral cavity. In NH Fiebach et al., eds., Principles of Ambulatory Medicine, 7th ed., pp. 1864–1878. Philadelphia: Lippincott Williams and Wilkins.

  2. Esposito M (2006). Impacted wisdom teeth, search date August 2005. Online version of Clinical Evidence (15).

Author Ellie Rodgers
Editor Susan Van Houten, RN, BSN, MBA
Associate Editor Lila Havens
Specialist Medical Reviewer Arden Christen, DDS, MSD, MA, FACD - Dentistry
Last Updated October 2, 2009

WebMD Medical Reference from Healthwise

Last Updated: October 02, 2009
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

How Do I Measure Up? Get the Facts Fast!

Number of Days Per Week I Floss

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or
Answer:
Never
(0)
Good
(1-3)
Better
(4-6)
Best
(7)

You are currently

Only 18.5% of Americans never floss. You are missing out on a simple way to make a big difference in the health of your mouth. Regardless of how well you brush, plaque still forms between your teeth and along your gums. Floss removes food trapped between the teeth and removes the film of bacteria that forms there before it turns to plaque, which can cause inflamed gums (gingivitis), cavities, and tooth loss. Try flossing just one tooth to get started.

You are one of 31% of Americans who don't floss daily. You are missing out on a simple way to make a big difference in the health of your mouth. Regardless of how well you brush, plaque still forms between your teeth and along your gums. Toothbrush bristles alone cannot clean effectively between these tight spaces. Flossing removes up to 80% of the film that hardens to plaque, which can cause inflamed gums (gingivitis), cavities, and tooth loss. Aim for 3 more days!

You are one of 31% of Americans who don't floss daily, but you're well on your way to making a positive impact on your teeth and gums. Regardless of how well you brush, plaque still forms between your teeth and along your gums. Toothbrush bristles alone cannot clean effectively between these tight spaces. Flossing removes up to 80% of the film that hardens to plaque, which can cause inflamed gums (gingivitis), cavities, and tooth loss. Aim for all 7 days!

Only 50.5% of Americans floss daily, and good for you that you are one of them! Regardless of how well you brush, plaque still forms between your teeth and along your gums. Toothbrush bristles alone cannot clean effectively between these tight spaces. Flossing removes up to 80% of the film that hardens to plaque, which can cause inflamed gums (gingivitis), cavities, and tooth loss. Congratulations on your good oral health habit!

SOURCES:

American Dental Association, Healthy People 2010

This tool is intended only for adults 18 and older.

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