Let's talk about wisdom teeth - to extract or not to extract

Updated: Sep 10, 2020

I’ll preface this by saying I have family members that are in great oral health and have not had their wisdom teeth removed and I was also recommended to remove mine but opted not to.

Without a question, there are medical professionals that take advantage of their degree and recommend treatments for additional compensation. This is wrong, shameful and an insult to the profession.

For this reason, I am going to outline some of the reasons you should or should not get a wisdom tooth removed. Remember that every case is different, so consult a trusted dentist or two for more information.

Pain and Inflammation?


Teeth coming in is kind of uncomfortable. Ask a teething infant. Some level of discomfort is expected when wisdom tooth enters the mouth (this happened to me), but it shouldn’t be constant, long-lasting or impact your sleep or day to day activities.

If the latter is occurring, you probably have pericoronitis and should get them removed. If the pain goes away, you might be able to keep them in place.

In general, we want out body to not be in an inflammatory state. Most major chronic diseases are diseases of inflammation, so keeping out body leveled is a good idea, especially if the tooth is not serving and purpose.

Is there enough space?

If you recently had orthodontic treatment, this is especially relevant to you. Most of us have had ortho completed before our wisdom teeth come in. If there is not enough space for the wisdom teeth, they will likely distort your smile. I have minor, almost undetectable, crowing in my lower teeth, but it doesn’t bother me. I point this out to tell you that its a real risk to consider.

You also want to have room to clean the teeth at their back end (facing the throat surface), because if you don’t, they will get a cavity. Third molars (aka wisdom teeth) are notorious for having weird morphology, so you want to ensure you can clean them.

On the note of space, I also ask another question: can you get your toothbrush back there? If not, get ready for dental decay.

If you have enough space such that your current smile will not be distorted and you can clean the tooth easily, keep them.

Is it biting down on something?

If you third molar is part of your natural bite and all other factors are sound, keep it in place. Opposing teeth help maintain the smile and arch integrity. They will help you chew and prevent shifting of other teeth

Unseen factors


Sometimes, there is an infection underneath the tooth, which is seen on an x-ray. This would require extractions. Even a small cavity may warrant an extraction, because it is not always feasible to restore a wisdom tooth if the dentist cannot reach back into that corner of the mouth. Again, an extraction would be recommended.

Final thoughts


Go to a dentist you trust or get multiple opinions. This means visiting dentists that have different views on how to treat a patient and explain the pros and cons of everything without bias and based on experience and evidence. There is evidence to support and not support third molar extractions. Until the science is clear, having a uni-directional approach to wisdom tooth extraction is not appropriate or scientific (my humble opinion).


Once you’ve found someone you trust, stick with them. As a patient you put your health into someone else hands and it just isn’t feasible time-wise to hop from dentist to dentist. Build a lasting connection.


Sources:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1963310/

  2. https://www.joms.org/article/S0278-2391(14)01628-0/abstract

  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025689/

  4. https://pubmed.ncbi.nlm.nih.gov/10932022/

  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4593524/

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