Valid reasons why wisdom teeth should be removed.

- An overview of the most common justifications dentists give when recommending 3rd molar extraction (both impacted and non-impacted teeth).

A mesially impacted lower 3rd molar.

Some reasons are more valid than others.

As you read through this list, take note of the fact that we have labeled a few of them as being "questionable."

By this we mean that their validity is not universally accepted by the dental profession as a whole (despite having been used as a justification 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. In fact, even some the reasons we've categorized as being "valid" are sometimes debated.

For more information about this topic visit our page: Is it always necessary to remove wisdom teeth?

A) Valid reasons to extract.

B) Questionable (debated) reasons given for removal.

The above reasons can be grouped into the following general categories.

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

A partially erupted 3rd molar.

Wisdom teeth frequently have a positioning in the jawbone that makes it difficult, if not impossible, to adequately clean and maintain them.

This is especially true for:

  • Teeth that have erupted but are misaligned or malpositioned.
  • Partially erupted teeth, meaning those that don't fully stick out above the gum line as they should. (see diagram)

If dental plaque is allowed to accumulate, both the tooth and the tissues that surround it will be at increased risk for problems such as tooth decay, periodontal (gum) disease and recurring infections (pericoronitis). Additionally, areas that harbor bacteria and debris can also be a source of breath odors.

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.

B) Major pathology / Abnormalities.

Some of the events that necessitate the removal of a person's third molars may be related to types of pathology or abnormalities that are relatively less common.

These can include:

A panoramic dental x-ray.

In most cases, these types of problems are only identified when a full-mouth (panoramic) x-ray examination is performed.

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.

C) Some justifications for extraction are 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.

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 2007) [References page.]

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 2013)

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

 

 
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