Additional reasons to remove wisdom teeth.

- Pain, pressure, headaches, cysts, tumors, soft tissue trauma, 2nd molar root resorption.

This page explains the following reasons why your dentist might determine that your wisdom teeth need to be removed.

These issues are a subset of our master list of (valid) indications to remove third molars.

After you've finished reading this page, you may find its companion titled "Is it always necessary to remove impacted wisdom teeth?" of interest.


Reasons to extract third molars -

A) Wisdom teeth that cause pain.

  • The most common reason why people seek an evaluation of their wisdom teeth is because they've recently experienced a painful episode.
  • Having pain is the most common third molar symptom, with 33% of patients reporting problems stating it. (Pogrel)

 

The discomfort may be nebulous in nature.

The type of pain or sense of pressure that the patient reports is often vague or indistinct.

  • The discomfort is sometimes described as a radiating pain stemming from the region of the wisdom tooth (Koerner).
  • In other cases, the tooth is suspected as the cause of headaches or neuralgia (intense intermittent pain associated with the path of a nerve). (Fragiskos)

Section references - Pogrel, Koerner, Fragiskos

Causes of 3rd molar related pain, pressure and headaches.

Especially in the case where the symptoms experienced are vague, indistinct or distant, it will be the dentist's goal to discover a direct relationship between the discomfort and events taking place with the person's wisdom teeth. Possible circumstances include:

1) The tooth's eruption process.

The pain that a person has noticed with their wisdom tooth may be associated with the process of it coming in (its "eruption").

The discomfort may be intermittent or constant. Patients sometimes describe what they feel as a vague sense of pressure.

2) Pressure on adjacent nerves.

In rare cases, an impacted lower wisdom tooth may place pressure on the nearby inferior alveolar nerve (the major nerve of the lower jaw).

This may cause intermittent pain, a general sense of pressure, neuralgia or headaches.

Section references - Haq, Fragiskos

3) Pain of unknown origin.
There can be situations where the pain or pressure felt by the patient certainly seems to be centered on the region where an impacted wisdom tooth lies. But due to the absence of obvious pathology, the dentist can't be certain that the tooth itself lies at fault.
  • If there are no absolute contraindications for removal, these teeth are sometimes extracted. If so, the patient must understand that pain relief may not be achieved and ultimately the procedure they endured was unnecessary.
  • In other cases, the patient and dentist may determine that the best plan of action involves the implementation of palliative treatment (possibly including the use of a prescription pain reliever) and then further monitoring until a diagnosis can finally be made.
Non-odontogenic conditions.

This second approach can be a good one. Indistinct symptoms involving pain, pressure sensation or headaches are sometimes ultimately attributed to non-tooth conditions.

One common one is tempromandibular joint (jaw joint, TMJ) dysfunction or the spasm of its associated muscles. This scenario is especially likely if the person has a habit of clenching or grinding their teeth. It's also possible that a medical condition (migraine, cardiac, vascular or neuropathic pain) is the underlying problem.

Section references - Koerner

4) Common pathologies.

Once investigated, what a person has experienced can often be directly attributed to common wisdom tooth-related issues and pathologies. This could include most any of the conditions or situations discussed further below on this page, or the following items that we discuss elsewhere.

 


B) Poorly positioned wisdom teeth.

Some wisdom teeth manage to erupt but nevertheless have a positioning that causes, or has the potential to cause, problems. For example:

Tissue trauma and associated wisdom tooth.

Trauma to both flap and cheek tissue in the area of a 3rd molar.

a) Crooked teeth.
Teeth whose final positioning is tilted or angled may poke, scrape, crush (bite) or otherwise irritate adjacent cheek or gum tissue. For the most part, the only solution that exists is to extract the offending tooth.
Chronic tissue trauma may cause hyper-keratinization (like the line of dense tissue that makes up the white streak on the inside of the cheek in our picture).
b) High gums or gum flaps.
Gum tissue that creates a tall collar around a third molar, or lies as a flap over its chewing surface, may constantly be traumatized by hard foods or opposing teeth.

This may cause the tissue to become chronically inflamed (reddened, sore and swollen, like the "flap" tissue in our picture).

In some cases, the excess tissue can be successfully trimmed away. In others, it may tend to grow back over time. (It depends on the tooth to jawbone relationship that exists.) If your dentist determines that the latter is the likely outcome for your situation, then the tooth will need to be extracted.

c) Supererupted third molars.

Wisdom teeth that don't have an opposing tooth to bite against often supererupt (poke through the gum tissue further than normal).

These teeth may cause tissue irritation or trauma. Their abnormal positioning may interfere with jaw movements, or create traps between teeth where food and debris tend to accumulate. Teeth having this problem should be extracted.

d) Teeth that are hard to clean.

Some wisdom teeth occupy a position that makes them very difficult to brush and floss. If so, both they and their neighboring tooth are placed at increased risk for complications with tooth decay and gum disease. And for that reason, they should be removed before problems develop.

C) Cysts and tumors.

While not an especially common occurrence, cysts or tumors can arise from the retained developmental tissues associated with an impacted wisdom tooth.

A dental cyst associated with an impacted wisdom tooth.

It is the size of the tissues that surround this tooth that suggest cyst formation.

As an example, during cyst formation these tissues can grow in size significantly and as a result displace the wisdom tooth, cause bone destruction, damage nearby structures (including adjacent teeth), and/or cause distortion of the jawbone.
Identification and treatment.

A tooth's associated pathology is most often discovered via x-ray examination. Once identified, the tooth should be removed and its cyst or tumor evaluated histologically (microscopic evaluation) by a pathologist for identification.

Monitoring impacted wisdom teeth.
In cases where a decision has been made not to remove an impacted wisdom tooth, it should be periodically evaluated via x-ray examination. Doing so allows the dentist to compare current and previous pictures, in search of changes that may indicate that a cyst or tumor is forming.

Section references - Hupp

Impacted wisdom teeth can cause root resorption on neighboring teeth.

Misdirected eruption can trigger the resorption of adjacent teeth.

D) Root resorption of neighboring teeth.

It's possible that the attempted eruption of a misdirected impacted wisdom tooth (a third molar) can cause damage to the person's 2nd molar (the next tooth forward).
This process, which is termed "root resorption," is somewhat similar to what happens with baby teeth.

When they fall out, they look as though they don't have a root. That's because as the permanent tooth underneath erupted, its presence caused the baby tooth's root to resorb (dissolve away).

In a similar fashion, when a misdirected wisdom tooth attempts to erupt, its pressure can cause resorption of the rear root of the 2nd molar. The worst-case scenario in this type of situation is one where the offending wisdom tooth and the damaged 2nd molar will both have to be extracted.

Section references - Hupp

 
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 Page references sources: 

Fragiskos FD. Oral Surgery. Chapter: Surgical extraction of impacted teeth.

Haq Z. A survey of reasons for surgical removal of impacted mandibular third molar in armed forces personnel at Afid, Rawalpindi.

Hupp J, et al. Contemporary Oral and Maxillofacial Surgery. Chapter: Principles of Management of Impacted Teeth.

Koerner KR. Manual of Minor Oral Surgery for the General Dentist. Chapter: Surgical Management of Impacted Third Molar Teeth.

Pogrel MA, et al. American Association of Oral and Maxillofacial Surgeons White Paper on Third Molar Data.

All reference sources for topic Wisdom Teeth.

Comments

Sched for extraction tomorw

2 wisdom tooth to pull by tomorow.. is it safe to pull a tooth while im suffering severe pain on all left side jaw,ears and head?

Jam

Possibly. In some cases having the extraction might be the solution. In other circumstances, like when a tooth has an associated infection, the extraction process may need to wait until the secondary issue is brought under control.

You should touch base with your dentist's office and let them know what's going on. They can then quiz you about the pain that you notice and decide what's needed, and what the timing of your extractions should be.

As a courtesy, you should contact them as much ahead of time as possible. They have set aside appointment time for you and now if you don't need it (or just less of it) they should know so they can see other patients that require attention.

extract tooth in lower jaw

i am 42 years old and have in the extra teeth lower jaw. It is always an abstraction for my tongue while speaking. the tongue is cut due to touching of teeth while speaking. I find difficult when i speak because it gives lots difficulty.

* Comment notes.

Amar 1

Like this page discusses, a very legitimate reason to remove a wisdom tooth is because its position in the jaw is such that it disrupts normal function. You should bring this problem to your dentist's attention. Quite likely they will recommend the tooth's extraction.

Wisdom tooth cutting back of my cheek

I am 25. Last year, I got a wisdom tooth on the upper left side. It is partially erupted. Never had a problem cleaning it. But day before yesterday when I woke up in the morning I felt a slight pain at the back side of my left cheek. On closer inspection, I noticed that it was caused by the wisdom tooth slicing across the cheek. It made it difficult (but not so much) for me to completely open my mouth. Yesterday I rinsed my mouth twice with salt water. The pain seems to be fading now. Should I be worried about my tooth? Will it cause trouble in future if I don't get rid of it?

* Comment notes.

PS

You simply need an evaluation by a dentist. They'll advise you as to what should be done with your tooth and if your current infection needs any management by them.

As far as the tooth's outlook, as discussed above, a big question is whether the tooth's partially erupted status is permanent or transitory. If it's expected that the tooth will never fully come into proper position, despite your comment "Never had a problem cleaning it.", as the illustrations on this page show, it's not really possible to thoroughly clean a partially erupted tooth, so there's always the potential that the same problem will occur again at some point.

While we're not entirely clear on this statement: "caused by the wisdom tooth slicing across the cheek." It's not uncommon for an upper wisdom tooth to come in at an (improper) angle where its cusps scrape and irritate the patient's cheek. If a tooth is both partially erupted and has a poor alignment, extracting the tooth is a common solution but it will take your dentist's evaluation to decide if that is indicated.

* Comments marked with an asterisk, along with their associated replies, have either been edited for brevity/clarity, or have been moved to a page that's better aligned with their subject matter, or both. If relocated, the comment and its replies retain their original datestamps, which may affect the chronology of the page's comments section.


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