Indications for the removal of wisdom teeth.

Reasons to extract third molars.

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

Select from these lists –

1) Common (valid) justifications given for the extraction of wisdom teeth.

• Pericoronitis / Infection. – The positioning of some wisdom teeth predisposes them to experiencing recurrent infections.
• Complications associated with tooth decay and periodontal disease. – Wisdom teeth are often difficult to clean, and if so, cavity and/or gum disease formation is likely.

• Associated pathology (cysts, tumors). – The tissues that form teeth may also spawn cyst or tumor formation. If so, these lesions must be removed and evaluated.
• Risk of damage to adjacent teeth / Root resorption. – The natural process of eruption of a third molar may result in damage to the root of the adjacent 2nd molar.
• Chronic pain, headache, pressure. – While difficult to know in advance, the removal of an impacted wisdom tooth may provide a solution for these symptoms.
• Problems associated with poor tooth alignment. – Although erupted, the final positioning of some 3rd molars will only be marginally acceptable. If so, the patient may be better off without it.

2) Questionable (debated) reasons given for removal.

• Wisdom teeth cause front teeth crowding. – This issue that was once considered a hard fact is no longer. Our page explains why.
• The “all third molars must go” train of thought. – Wisdom teeth that erupt into place may prove to be valuable members of a person’s dentition. And even those that don’t may not pose much of a risk.

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).

▲ Section references – Koerner

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

What’s the reasoning that lies behind indications for wisdom tooth removal?

The remainder of this page explains (or links out to our pages) that explain the principles and guidelines associated with those extraction justifications that the dental community as a whole generally seem to consider valid.

For the most part, the reasoning associated with each can be explained by the application of one or more of the following standards.

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.

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

• 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 animation)
• People with lax brushing habits.

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.

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:

• Cyst or tumor formation.
• Damage to a neighboring tooth caused by the presence of a 3rd molar (such as root resorption).
• Extra wisdom teeth (4th molars) that have an associated condition.

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

Identifying problems.

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 that a diagnosis can be made, 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).

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 school of thought that all impacted 3rds must be removed is no longer universally accepted. (This attitude is especially apparent in European countries, see discussion in the box below.)

▲ Section references – Friedman, Boughner

Comments.

This section contains comments submitted in previous years. Many have been edited so to limit their scope to subjects discussed on this page.