Wisdom teeth – to keep or not to keep?

Wisdom teeth – to keep or not to keep?

Historically, wisdom teeth removal was deemed a rite for passage of teenagers. Because they emerge after the jaw and other teeth have stopped growing, around ages 17-25, wisdom teeth often end up misaligned and impacted. Is it better to be safe (by removing them early) than sorry?

There are some good reasons for early surgical intervention. The ease of removal is optimal before the wisdom teeth roots have fully formed, before they extend closer to the nerves. In the younger patient, the jawbone is softer, and recovery is quicker. (Most private health funds will cover wisdom teeth extraction surgery fee for patients below 18 and still under their parent’s policy.)

If removal of otherwise trouble-free wisdom teeth is not justified, then these young patients are exposed to the risks of anaesthesia and surgery. Patients, their parents and dentist should discuss whether to keep symptom-free wisdom teeth until (and only if) issues develop.

However, statistics show that 60% of these symptom-free wisdom teeth end up developing gum disease or cavities due to their position in the mouth. Surgery to remove wisdom teeth after disease has taken hold may add complications to recovery. In addition, fully developed wisdom teeth, after the age of 25, have large roots that are notoriously close to the nerves of the jaw.

However, most dentists now agree that wisdom teeth that are completely erupted and functional, painless, cavity-free, in a hygienic environment with healthy gum tissue should be OK to keep – on the condition that it is monitored by regular exams and X-rays.

Still, those healthy teeth pose a dilemma, because there’s no hard evidence on whether it’s better to remove or retain them. Immediate surgery on a young patient has risks. About one in 20 patients develop an infection, one in 100 has hard-to-control bleeding and another one in 100 loses some feeling in the lips or tongue, usually temporarily. There are also risks and concerns with regards to general anaesthesia, if used.

Keeping wisdom teeth until issues arise may mean a more complicated surgery later. It also means spending time and money on regular exams and X-rays. The problem is that no one can predict which teeth will stay healthy.

Given that unpredictability, the best course is leaving healthy teeth alone, especially since some impacted teeth will eventually emerge.

Regular exams will detect swelling, bleeding and other signs to diagnose gum disease around any tooth. When those signs appear around wisdom teeth, it is worth consulting also with a periodontist about whether the best course is extraction or other treatments, such as medication and trimming of tissue around the teeth.

Most dentist recommend extraction when signs of gum disease are present. In our experience, even when wisdom teeth are healthy, less than half our patients choose to keep them.

Every patient is unique, our dentists will educate and discuss all options in the management of wisdom teeth. Removal may not be necessary in some cases as long as a monitoring system is in place.