Wisdom teeth: when they need removing

Wisdom teeth cause more worry and confusion than almost any other dental topic. Do they all need removing? When is it necessary? Is it a big deal? The truth is more measured than the horror stories suggest: many wisdom teeth are fine and need nothing, while some genuinely need removing. This article explains when they need attention and when they can be left alone.

What wisdom teeth are

Wisdom teeth are the last molars, at the very back of the mouth, usually appearing in the late teens or twenties. Some people get all four, some fewer, and some none at all. When there is room and they come through cleanly, they are simply extra molars that need normal care. Problems arise when there is not enough space, which is where the question of removal comes in.

When they can be left alone

A common myth is that all wisdom teeth must come out. In fact, wisdom teeth that have come through properly, are healthy, well-positioned and can be cleaned, do not need removing simply for existing. Removing healthy, functional teeth without reason is not good practice. If your wisdom teeth are fine, the right approach is usually to keep them and look after them like any other tooth, with your dentist keeping an eye on them.

When they need removing

Wisdom teeth genuinely need attention when they cause problems. Common reasons for removal include impaction, where a tooth is stuck against the tooth in front or the bone; repeated infection or inflammation of the gum around a partly emerged tooth; decay that cannot be treated because of poor access; damage to the neighbouring tooth; or cysts. In these cases, removing the wisdom tooth resolves or prevents a real problem, and leaving it can lead to pain and complications.

Impacted wisdom teeth

Impaction is the most common reason for removal. When there is not enough room, a wisdom tooth can become stuck, partly emerged or angled against its neighbour. This can trap food and bacteria, causing repeated infections, decay, and pressure on the tooth in front. An impacted wisdom tooth causing these problems is usually best removed. A dentist assesses this with an examination and often an X-ray to see the position and roots before deciding, as our treatment guide touches on for surgical extractions.

Recovery after wisdom tooth removal

Knowing what recovery involves takes much of the worry out of having a wisdom tooth removed. For the first day or two, expect some swelling and tenderness around the area, which is normal and managed with the painkillers you are given. A cold compress on the cheek helps with swelling in the first day. You will be advised to eat soft, cool foods for a few days, avoid vigorous rinsing at first so the area can heal, and keep the site clean gently as it settles. Most people find the discomfort peaks in the first couple of days and then eases steadily, and are back to normal within a week or so, sooner for a straightforward extraction. A few simple do-nots protect your healing: avoid smoking, which slows healing and raises the risk of a painful complication; avoid drinking through a straw in the early days for the same reason; and do not poke at the area. Your dentist will tell you what is normal and what would warrant a call, such as increasing rather than decreasing pain after a few days. Following the simple aftercare instructions is what makes recovery smooth, and for the great majority of people it is a straightforward few days rather than the ordeal the reputation of wisdom teeth might suggest.

What removal involves

Having a wisdom tooth removed is a routine procedure, done under local anaesthetic so it is not painful at the time, with some swelling and tenderness for a few days afterwards that is managed with painkillers and simple care. A straightforward tooth is quick to remove; an impacted one is a more involved surgical extraction but still routine for an experienced dentist. If you are told a wisdom tooth needs removing, ask why, and a good dentist explains the specific reason. Where they are healthy, the answer may simply be that they can stay.