Additional reasons why wisdom teeth should be removed.

This page discusses how the presence of a cyst or tumor, poor tooth alignment, chronic pain, or risk to neighboring teeth can each be a justification for the removal of third molars.

At the bottom of this page, we explain why the theory that wisdom teeth can cause tooth crowding doesn't hold water and is not a valid reason to remove wisdom teeth.

After you've completed reading this page, you may find our related page "Is it always necessary to remove impacted wisdom teeth?" of interest.


Reasons to remove wisdom teeth.

A) Cysts and tumors.

While it is not a common occurrence, cysts and tumors can develop in the tissues that surround an impacted wisdom tooth.

(If a decision is made to not remove an impacted wisdom tooth, a dentist will often recommend that an x-ray should be taken of the tooth periodically. This allows the dentist to evaluate the tooth and its surrounding tissues for changes that might suggest that a cyst or tumor is forming.)

Impacted wisdom teeth can cause root resorption on neighboring teeth.

B) Damage to neighboring teeth.

While uncommon, the attempted eruption of a misdirected impacted wisdom tooth can cause damage to a person's 2nd molar (the next tooth forward of the wisdom tooth).

This event is somewhat similar to what happens to baby teeth. Baby teeth, when they fall out, look as though they have no root portion. The tooth did have a root at one time but the action of the permanent tooth erupting underneath has caused its root to resorb, hence the baby tooth looks rootless.

Similarly, when misdirected wisdom teeth attempt to erupt they can cause resorption of the root of the 2nd molar. The worst case scenario in this instance is that both the offending wisdom tooth and the damaged 2nd molar will have to be extracted.

C) Wisdom teeth that cause chronic pain.

The most common reason why people seek an evaluation of their wisdom teeth is because they have experienced pain. There can be a number of different causes or sources for this discomfort, including most of the conditions and situations discussed on this and our previous page.

It is possible that the pain that the person is experiencing is associated with the tooth's eruption process. (Sometimes this pain is described as a sensation of "pressure.") If so, it will be up to the evaluating dentist to try to determine if this discomfort can be expected to be relatively short in duration (and controlled using analgesic medications) while the eruption process comes to completion. Or if an extended eruption process (or unsuccessful eruption process resulting in impaction) is more likely and the offending wisdom tooth should be removed.

D) Malpositioned wisdom teeth.

Some wisdom teeth manage to erupt fully but nevertheless have a poor overall positioning that causes, or has the potential to cause, problems.

For example, some misaligned wisdom teeth may poke at, scrape or crush (bite) a person's cheek tissue. Also, those wisdom teeth that have no matching (opposing) tooth often supra-erupt (position themselves through the bone and gum tissue further than normal). As a result, these teeth can interfere with jaw movements.

Some wisdom teeth are positioned so poorly that they not only provide no functional service to the individual at all but they are also very difficult to clean. In these cases, the wisdom teeth (and neighboring teeth) are placed at risk for experiencing tooth decay and gum disease. These and any number of other complicating factors associated with wisdom tooth misalignment often make tooth extraction the best choice.


III) Reasons given for wisdom tooth removal that seem somewhat debatable.

A) Tooth crowding.

There is a theory that suggests that impacted wisdom teeth, as part of their effort to come fully into place, can put pressure on a person's other teeth and cause them to become misaligned (crowded or shifted).

Changes in the alignment of lower front teeth, especially, are frequently blamed on pressure created by the person's wisdom teeth.

What does research report?

While many studies have evaluated this issue, this theory has never been conclusively proven and it's not universally accepted by the dental profession as a whole.

That's not to say that people don't have teeth that do shift but rather that this type of tooth shifting cannot be conclusively demonstrated to be caused by a person's wisdom teeth coming in. Part of the proof for this stance is that studies have found that people who lack wisdom teeth (have congenitally missing 3rd molars) experience this same crowding phenomenon.

A recent publication that included a review of dental literature on this issue (Cochrane 2012) concluded that they found no evidence to support the routine remove of 3rd molars as prevention for lower front tooth crowding.

Other theories.

Instead of just focusing on wisdom teeth, researchers have identified other factors that may be involved. One of them is simply that some aspects of a person's jawbone may slightly decrease in size over time. But since the teeth held in it don't, tooth crowding results.

If you're interested in more detailed information, our references page contains a link to Karasawa 2013. Its discussion outlines the topic of tooth crowding fairly extensively.

B) Do all impacted wisdom teeth need to be extracted?

This is a question that can only be addressed by your dentist and only after they have had an opportunity to perform a thorough dental examination that includes x-rays.

It is a fact that not all impacted wisdom teeth are destined to become problematic. Certainly many people who have poorly aligned or impacted third molars live their entire life without complication.

Use this link to access our page that discusses issues associated with making a decision to have, or not to have, a wisdom tooth extracted.

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