Wisdom teeth: do they always have to be removed?

In short: no, wisdom teeth do not always have to be removed. If they come through well positioned, you can clean them and they cause no trouble, they can often be left. They are taken out when they cause pain, recurring infections, decay or push against the other teeth. The decision is made by looking at your mouth and an X-ray.

What are wisdom teeth for?

Wisdom teeth, or third molars, are the last to come through, normally between the ages of 17 and 25. Hence the name, because they appear in the full bloom of youth. In their day they had a chewing function, but today our jaws tend to be smaller and there is often not enough room for them to come through well positioned.

When there is no space, they can become trapped within the bone or gum (what is called an included or impacted tooth), come through crooked or only partly emerge. And that is where they start to cause problems. But be careful: having wisdom teeth does not automatically mean they need to be removed.

So, do they always have to be removed?

No. This is the most important idea in the whole guide. A wisdom tooth that has come through well, that is straight, that bites against its partner above or below and that you can clean with a brush like any other, does not need to be touched. Removing something that works and causes no trouble makes no sense.

The key is not age or the fact that “everyone has them out”, but how yours is in particular. That is why the decision is always made with an examination and an X-ray (sometimes a panoramic one), which is the only way to see what is beneath the gum and how the root is positioned. What is right for your neighbour may not be right for you.

When is it best to remove them?

There are some fairly clear situations in which removing the wisdom tooth is the sensible thing to do. The most common are:

• Pain or recurring infections. When the tooth only partly comes through, a flap of gum is left where food and bacteria build up and it becomes infected again and again (pericoronitis).
• Decay that cannot be treated properly. Being so far back, it is sometimes impossible to clean it or fill it as it should be done, and it decays itself or causes decay in the tooth next to it.
• It pushes against the other teeth. If it presses forward it can affect the neighbouring teeth.
• Cysts or lesions associated with an included tooth seen on the X-ray.
• Difficult to clean, so that it keeps the gum in that area chronically inflamed.

In these cases, leaving it usually costs more in the long run (in discomfort and in neighbouring teeth) than removing it in good time.

What is the extraction and recovery like?

A wisdom tooth extraction is done under local anaesthetic, so during the procedure you feel no pain, only some pressure. Depending on how it is positioned (whether it has come through fully or is included in the bone), it will be a simple extraction or a minor oral surgery procedure. At the surgery we explain beforehand what type of case yours is.

Afterwards it is normal to have some swelling and discomfort for the first two or three days. To make it go as well as possible:

• Apply cold on the outside of the cheek for the first few hours.
• Rest on the first day and no exertion.
• Soft, lukewarm diet; avoid anything very hot, alcohol and tobacco.
• Look after your hygiene gently, without rinsing hard on the first day.
• Take the medication as per the guidance we give you.

If the idea of the procedure makes you wary, remember that conscious sedation can be considered so that you get through it more calmly. And at check-ups it is a good moment to take advantage of a dental cleaning and get your mouth in shape.

This guide is for information only and does not replace a consultation or a professional diagnosis: only by looking at your case and your X-ray can it be decided whether or not it is best to remove a wisdom tooth. If you have doubts or discomfort in that area, write to us or pop in to see us; here is the contact and how to find us for the clinic in Bilbao.