Additional reasons to remove wisdom teeth.

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

• Chronic pain / Pressure / Headache.
• Poor tooth alignment or positioning.
• Cyst or tumor formation.
• Damage caused to neighboring teeth.

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

After you’ve finished reading this page, you may find its companion piece of interest: Is it always necessary to remove impacted wisdom teeth? Monitoring vs Immediate removal.

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 or in the area of the person’s wisdom teeth.

Possible causes of ‘wisdom tooth pain’ include:

• Sensations associated with the tooth’s eruption process.
• Pressure that the erupting wisdom tooth directs to adjacent nerves.
• Active pathology associated with the tooth and/or adjacent structures or tissues, including decay, gum disease, root resorption, and soft tissue irritation, trauma, and/or infection).
• Pain not directly attributable to the wisdom tooth itself, including TMJ (jaw joint) dysfunction or some type of medical condition.

Each of these possibilities is explained in greater detail below.

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).

▲ Section references – Haq, Fragiskos

3) Non-odontogenic discomfort.

There can be situations where the pain or pressure noticed by a patient certainly seems to be centered on the region where a wisdom tooth lies. But due to the absence of obvious pathology, their dentist can’t be certain that the tooth itself lies at fault.

• One common culprit is temporomandibular joint (jaw joint, TMJ) dysfunction, including pain stemming from its associated muscles.

  This scenario is especially likely if the person has a habit of clenching or grinding their teeth, or has recently experienced a period of stress.

• In other cases, the symptoms might be caused by an underlying medical condition (migraine, cardiac, vascular, or neuropathic in nature).

In a rush to find a solution …

In situations where a clear cause for the patient’s discomfort has yet to be identified, a decision might be made to go ahead and remove the tooth in question in an attempt to alleviate the patient’s condition as promptly as possible. If so, the patient must be advised that relief may not be achieved and ultimately the procedure they endured was unnecessary.

▲ Section references – Koerner

4) Common wisdom-tooth related 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.

• Common causes of pain are an infection around the tooth, or trauma to the layer of skin (gum flap) that lies over it.
• Other common issues may involve just the wisdom tooth itself, or possibly the adjacent 2nd molar too. These can include pain as a consequence of tooth decay, gum disease or root resorption.

B) Poorly positioned wisdom teeth.

Some wisdom teeth manage to erupt but nevertheless wind up with a positioning that causes, or has the potential to cause, problems. As examples …

Wisdom tooth positioning issues/problems that can be cause for extraction.

• The tooth has erupted but its alignment is “crooked.”
• The tooth has erupted as much as it will but still doesn’t adequately clear its surrounding gum tissue.
• The tooth’s positioning is such that it’s difficult to thoroughly clean.
• The tooth has supererupted.

We explain each of these deficiencies in greater detail below.

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

a) Crooked teeth.

b) High gums or gum flaps.

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.

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

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.

▲ Section references – Hupp

Misdirected eruption can trigger the resorption of adjacent teeth.

D) Root resorption of neighboring 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).

▲ Section references – Hupp

Comments.

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