An overview of indications for the removal of wisdom teeth.

- A listing of the most common justifications dentists give when recommending 3rd molar extraction (both impacted and non-impacted teeth). | What guidelines they're generally based on. | Why some reasons for extraction are no longer universally accepted.

(Valid) Reasons to extract third molars.

This page serves as our hub for information about reasons why wisdom teeth, either impacted or erupted, should be removed. (Each link in the list below will direct you to that section of our website that discusses that indication in detail.)

The remainder of this page then gives you a general idea of the principles, guidelines and thinking associated with those reasons that pass the test as valid justifications (per what's generally considered the collective judgment of the dental community as a whole). Surprisingly, not all do.

Common justifications given for the extraction of wisdom teeth.

A mesially impacted lower 3rd molar.

Pericoronitis, tooth decay, gum disease or even root resorption issues might become a factor with this impacted 3rd molar.

Questionable (debated) reasons given for removal.

We've labeled these last two issues as "questionable" because their validity no longer seems universally accepted by the dental profession as a whole (despite having been used previously as a justification, even for decades).

Of course, there will always be differing opinions about the need for any type of medical treatment, and oral surgery is no different. And in fact, even some the reasons we've categorized above as being "valid" are sometimes debated. But these issues seem especially suspect.

Section references - Koerner

A partially erupted 3rd molar.

Dental plaque can accumulate underneath a partially erupted tooth's gum line. But it is impossible to remove.

What's the reasoning that lies behind the indications for wisdom tooth removal.

For the most part, the rationales associated with each of the above reasons (to extract or not) can be explained by the following principles, events or current schools of thought.

1) Some 3rd molars are hard to properly maintain.

Wisdom teeth frequently have a positioning in the jaw or bone tissue that makes them difficult, if not impossible, to adequately clean and maintain.

This is especially true for:

 

The problem.

If an environment exists where dental plaque tends to accumulate (for any reason, ranging from patient neglect to situations that are simply impossible to clean), both the tooth and the tissues that surround it will be at increased risk for problems.

This can include tooth decay, periodontal (gum) disease and recurring infections (pericoronitis). Additionally, areas that harbor bacteria and debris can also be a source of breath odors.

So for any of these reasons, whether a current problem or a likely one to come, your dentist may make a recommendation that your unmaintainable wisdom teeth should be removed.

Takeaways from this section.

A dentist's concern isn't just for the wisdom tooth itself but also the neighboring 2nd molar.

  • Any gum disease issues that develop will affect it too.
  • If the mass of dental plaque that has caused decay on the 3rd molar extends onto the surface of the 2nd, it will be at increased risk for cavity formation too.

That means waiting to remove a wisdom tooth that a patient has persistently shown an inability to clean until a point when an obvious problem has developed may also be a point when the neighboring tooth has already been damaged, possibly significantly so. In extreme cases, both teeth may need to be extracted.

2) The presence of major pathology or abnormalities.

Some very valid reasons to remove wisdom teeth involve situations where they are associated with some type of abnormality or pathology. They can include:

For the most part, the occurrence of these types of conditions are relatively rare.

A panoramic dental x-ray.
Identifying problems.

Pathology and abnormalities associated with wisdom teeth are frequently only identified when a full-mouth x-ray examination is performed.

Historically, this typically took the form of a survey of 18 to 20 small individual films of your teeth (four of which are intended to show the area of your 3rd molars), or better yet (in terms of diagnosing conditions with wisdom teeth) a single panoramic radiograph (see picture).

While in most cases one of the above general surveys will provide enough information for diagnosis, the use of 3D (cone beam) x-ray imaging is now fairly commonplace and may be required for more detailed information (either for diagnosis or surgical purposes).

 
Takeaways from this section.

The ability to identify problems that otherwise could not be detected is one reason why dentists frequently recommend that a full-mouth x-ray examination should be performed every 3 to 5 years.

Even when no pathology is noted (which of course is the hope), this type of evaluation can provide informative details such as the current stage of development, eruption and alignment of the wisdom teeth, or identify cases where one or more of them are absent.

3) Some justifications for extraction are simply no longer universally accepted.

As mentioned above, some of the justifications for wisdom tooth extraction given in previous decades are no longer widely accepted by the dental community as a whole, to the point that some of them are now heatedly debated.

For example, it was previously thought that the process associated with 3rd molars coming in could cause other teeth in the mouth to shift. The fact of the matter is, however, that this "tooth crowding" theory has never been definitively confirmed by research.

Additionally, the basic train of thought that all impacted 3rds must be removed is no longer universally accepted. (This attitude is especially apparent in European countries.)

Takeaways from this section.

While a decision for each tooth should be made on a case-by-case basis, there seems to be growing consensus among many in the dental community that leaving impacted wisdom teeth alone and monitoring them over time may pose less of a risk than those potential complications associated with removing them needlessly. (Friedman)

A standard recommendation for the removal of asymptomatic impacted third molars (a stance still frequently taken by general dentists and oral surgeons in the USA) runs contrary to the conclusions of a Canadian health technology report, American Public Health Association policy, and health technology reports from Sweden, Belgium and the UK. (Boughner)

For more information: Overview of reasons not to remove third molars.

Section references - Friedman, Boughner

 
 
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