Wisdom teeth are our third set of molars.  They are the last teeth to come in (16-18 years approximately).  They seem to cause the most problems, as removal of many is necessary.  Not all wisdom teeth need to be removed.  If one has room for them, you will not need to see an oral surgeon.  Expansion of the arches for braces to align existing teeth and decreased jaw size contribute to the lack of space for eruption.  They may remain impacted, under the gums and bone.  If they finish their growth close to the surface, they will eventually become exposed and frequently cause problems.

Unfortunately, more and more wisdom teeth seem to have insufficient room to come into alignment.  This can frequently be predicted as they are developing.  Many of these teeth will be only partially exposed when they complete their growth, i.e. remaining impacted under the gums and bone.  This will present future problems.

The farther back you go in the mouth, the harder it is to clean and maintain.  A wisdom tooth that is partially exposed will be difficult, if not impossible, to maintain healthy for a lifetime.  The gums are not a good defense barrier around a partial exposed tooth.  It is a ready-made periodontal problem.  Debris will collect under the gums and bacteria will take up residence there.  The result of this is destruction of the gums, bone, and teeth; eventually leading to pain and swelling.   The solution to this is removal.

Removal after damage has been done and when the bone is fully mature is more difficult.  The older we are, the slower we heal.  When wisdom teeth complete their development the bone encases and solidifies around them.  The roots are also fully formed.  This may mean more surgery to remove; along with increased risk to vital structures, such as the sinus above and nerve below.

Lower third molars cause much more reaction than the uppers. There is a large nerve belowthem (link), they are encased in dense/non-forgiving bone, gravity collects debris in the area afterwards, and the lower jaw moves.   Most of the stories you have heard about oral surgeryinvolve lower molars that have been removed with big, ugly digs.  This is outdated technology (link) and you will not have to go through that.

The opposite is true of the upper third molars.  They are in softer bone, there is no large nerve in the area, gravity keeps debris away from them, and the area is tucked out of the way.  When there is insufficient room for the lower, the upper frequently comes in pointed toward the check.  They are deflected this way by the palate bone.  An ulcer formed on the cheek here is very painful and will not go away until the tooth is removed. If an upper wisdom tooth is non-functional, it can and should be removed with the lower.

Fully developed third molars, particularly in the elderly that are in proximity to the sinus or nerve can have a coronectomy done (link).  This is the removal of only the top portion of the tooth.  If the roots are healthy, they can be left behind.

If the treatment is better than the problem, surgery is the proper course of action.  Modern technology with minimally invasive techniques (link), grafting (link), and anesthesia (link) make the preventive removal of wisdom teeth beneficial.

The starting point for any discussion on third molars is a consultation (link).  Here you will have appropriate x-rays and possible 3 dimensional CT scan; all the options; the risks and benefits reviewed; along with my recommendations.  My goal is for you to have a healthy mouth that you can maintain for a lifetime.  Sometimes this means removing wisdom teeth.  If so, this is really the least of all evils.

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