Do Your Wisdom Teeth Really Have to Come Out?

Once you’ve moved into your late teen years, you may think the teeth you see are the only teeth you’ll ever get. But there’s a strong possibility that isn’t true.

Your wisdom teeth can still break through, or erupt, even in early adulthood.

Knowing more about your wisdom teeth and how they behave can make it easier to deal with problems that arise and the need for extraction, says oral surgeon Michael Horan, MD, DDS, PhD. Here, he answers common questions his patients ask about wisdom teeth:

Q: Does everyone have wisdom teeth?

A: No, not everyone is born with a full complement of teeth. In fact, the wisdom teeth are the most common congenitally missing teeth, Dr. Horan says.

Q: How do you know when there’s a problem with your wisdom teeth?

A: Pain in the upper or lower jaw can often be the first sign that your wisdom teeth are causing problems. You may feel a sensation of pressure in the back of your mouth. Also, the gum tissue around the erupting wisdom tooth often becomes sensitive, swollen and inflamed.

However, you may also feel no pain at all.  But absence of pain doesn’t necessarily mean there isn’t a problem. “A lot of folks don’t have any symptoms,” says Dr. Horan. “That’s why you should have your wisdom teeth examined by a dentist to determine if extraction is appropriate.”

Q: Is removal always necessary?

A: If your wisdom teeth are impacted, thereby preventing adequate oral hygiene, it’s often best to have them removed.

Teeth that erupt in an upright and functional position often don’t need to be removed, Dr. Horan says, as long as they cause no pain and aren’t associated with decay or gum disease.

However, even wisdom teeth that come in correctly can develop problems over time because they are so far back in the mouth and difficult to clean. So if you keep your wisdom teeth, be sure to brush and floss them well, and see your dentist regularly.

Q: What happens when a wisdom tooth is impacted?

A: It’s common for people to have impacted wisdom teeth. These teeth are buried, either partially or completely, in the soft tissue or jaw bone, and are more susceptible to disease and other problems.

The problem is you can’t clean impacted wisdom teeth properly, so they can start to decay, and you can develop gum disease. Although less common, cysts or tumors can also develop around impacted teeth, says Dr. Horan.

Dentists generally evaluate impacted teeth on a case-by-case basis to determine whether to remove them, he adds. If a tooth is fully impacted in bone and X-rays show that eruption is unlikely, your dentist will often recommend removal to prevent future problems.

Q: What problems can occur after removal?

A: Mild to moderate pain is normal and expected after an extraction, but a few other complications are also possible. Here’s a rundown of what you can expect and how your doctor would likely treat each possibility:

• Pain. Some pain and swelling is likely to occur with all extractions, says Dr. Horan. In most cases, non-steroidal anti-inflammatories paired with a limited dose of narcotic medications can help control most pain. Ice is recommended for the first 24 hours to minimize swelling.
• Dry socket. Though rare, this is one of the most common true complication following surgery. It typically occurs four to seven days after a tooth is extracted when the blood clot needed for healing dissolves too soon. Your dentist likely will treat it with an oral antiseptic solution or a specialized dressing depending on the severity of pain.
• Subperiosteal abscess. This is a pus pocket that develops when bone and tissue debris are trapped between the healing extraction socket and the tissue covering the bone. Your dentist can drain the abscess and provide you with antibiotics to help clear up any infection.
• Bacterial infections. Postoperative bacterial infections are rare, occurring in fewer than 6 percent of all cases, says Dr. Horan. Your dentist may give you a dose of antibiotics before surgery to sidestep problems with infection. After surgery, antiseptic mouth rinses or additional antibiotic regimens are sometimes needed.

Q: Is there any way to avoid problems with your wisdom teeth?

A: Ultimately, you have little control over your wisdom teeth. “Other than keeping up with oral hygiene and going to the dentist on a regular basis, there’s not much patients can or need to do,” says Dr. Horan.