How Do I Know If My Wisdom Teeth Must Go?

The painful appearance of wisdom teeth is a rite of passage for many teenagers and young adults. These third molar teeth often present during the transitional period between childhood and adulthood, thus earning their name, “wisdom teeth.” Their presence can cause many issues, such as pain, swelling, crowding in the mouth, and even cysts and tumors. Many people who develop these problems need to have the teeth extracted, although there are some fortunate individuals who do not develop them or even need to have them removed.

To increase your wisdom about these molars, Michael D. Turner, DDS, MD, Chief of Oral and Maxillofacial Surgery at The Mount Sinai Hospital, answers patients’ most frequently asked questions.

Do we need wisdom teeth?

In our mouths, we typically develop three sets of molars, which are the wide teeth in the back of the upper and lower jaws.  Your “wisdom teeth” are the third set of molars, which are the most posterior teeth. Typically, they fully develop at age 18, although this happens slightly earlier or later for some.

Wisdom teeth were most useful for early humans who, thousands of years ago, had a diet of tough meat, roots, and leaves. Now, most people eat food that has been softened by cooking so the jaws have decreased in size and have become too small to accommodate three sets of molars. Because of this, the third molars, for the most part, do not erupt fully.  We call this an “impaction.”

What are some signs and symptoms that wisdom teeth are coming in?

Symptomatic third molars can present in multiple fashions, including:

• Jaw pain
• Swelling overlying the third molar sites
• Pus and foul odor from the site
• Halitosis, also known as bad breath

If your wisdom teeth are impacted—not emerging—and causing pain, they should be removed during an individuals’ late teens to their mid-twenties to decrease the amount of complications from the surgery that can occur.

However, if impacted teeth are not causing any symptoms, your dentist may not recommend removal, since extraction of impacted third molars should be based on the clinical and radiographic findings. So, if they are not causing pain, you might be one of the lucky few who will not need to have the teeth removed.

What should I expect during a wisdom tooth extraction?

Wisdom tooth extraction is typically performed as an outpatient procedure. Patients can have the procedure with just local anesthesia or with sedation, depending on their preference. Often the procedure is complete in one hour, although, this depends on both the complexity of the extraction and the number of teeth being removed.

After the removal of the teeth, most people are swollen. This swelling takes three to four days to resolve. Full recuperation generally takes five to seven days, so if parents do not want kids to miss school, the summer or winter breaks are the best times to schedule. Most patient’s pain can be controlled by ibuprofen, although sometimes a small amount of a stronger pain medication is prescribed.

What complications should I look out for following surgery?

Dry socket is a problem that occurs about two to three days after surgery. It happens when the blood clot, which forms at the base of a tooth extraction, is dislodged—or dissolves—before the area can sufficiently heal. Without the blood clot’s presence, the underlying bone is exposed, causing pain and a bad taste and smell. Most patients report that healing is proceeding as normal and then, suddenly, they experience a pulsing sharp pain in the area of the extraction. Fortunately, dry socket can easily be managed by your surgeon by cleaning the area and applying a medicated dressing.

Post-surgical infections are rare and if they occur, are not apparent until three or four weeks following the surgery. Typically, infection is an effect of the bone healing, although food that gets caught in the extraction socket while healing can be the culprit.  Post-operative antibiotics have not been shown to prevent infections from occurring. Patients are only prescribed antibiotics if there is an active infection.

The most significant complication that can occur due to the removal of the lower third molars is a change in nerve sensation to the lower lip, teeth, chin, and gums. Although this side effect occurs at about the same rate regardless of age, the rate of permanent sensation change increases with age.  If you wait until you are older, then you are at a much higher risk.

My wisdom teeth are not causing me any pain. What happens if I never have them pulled out?

If the teeth are completely impacted and surrounded by bone, most likely nothing will occur. Although, occasionally the developmental cyst that is present around the third molar can transform into an aggressive and destructive cyst, or rarely, into a benign tumor.

However, if your wisdom teeth have partially emerged, they can become decayed, cause decay on adjacent teeth, or become infected.

If you, or your child, are experiencing signs that your wisdom teeth are emerging, it’s best to make an appointment with your dentist.