do all wisdom teeth need to be removed

For years, many people were told that wisdom teeth (the third molars, the last teeth at the very back of each jaw) should all come out "just in case". Mainstream dental advice today is more careful. A healthy, useful wisdom tooth is a tooth worth keeping, and every surgery carries some risk. The real question is not "do they all go?" but "is this particular tooth healthy, or is it heading for trouble?"

When a wisdom tooth can stay

Your dentist will usually be comfortable leaving a wisdom tooth alone if most of these are true:

• It has erupted fully and stands upright, not tilted into the tooth in front.
• It has a partner to bite against, so it is doing useful work when you chew.
• You can actually clean it. If your brush reaches it and the gum around it is firm and pink, it can be maintained like any other molar.
• There is no decay on it or on the back surface of the second molar in front.
• The gum and bone around it are healthy, with no deep pocket where food collects.

A tooth that is fully buried deep in bone, causing no symptoms and showing no disease on X-ray, is also often left alone and simply watched over time.

When removal is usually advised

• Repeated gum infection around a half-erupted tooth, called pericoronitis. One mild episode may settle; repeated episodes usually mean the tooth should go.
• Decay that cannot be reached or repaired properly, especially on a tooth with no biting partner.
• Damage to the second molar: a tilted wisdom tooth can trap food against the molar in front and cause a cavity or bone loss there. That second molar is far more valuable than the wisdom tooth.
• A cyst or other change seen around the tooth on an X-ray.
• Before certain treatments, such as some orthodontic or jaw procedures, when the specialist plans for it.

The "remove it while you are young" argument

There is some truth in it. Roots are shorter and bone is softer in the late teens and twenties, so healing tends to be quicker than at fifty. But age alone is not a reason to operate on a tooth that is causing no harm. A fair middle path is this: if a tooth is clearly unable to come through properly and is already causing small problems, dealing with it sooner is sensible. If it is healthy, it can stay.

What happens if you decide to keep it

Keeping a wisdom tooth is a decision, not a free pass. Brush right to the back with a small-headed brush, keep regular check-ups so the area is examined and X-rayed when needed, and come in early if the gum there becomes sore, swollen or tastes bad. Many patients first notice trouble after a few days of late nights, stress or a cold, when the gum flares up.

How we decide with you

Your dentist examines the tooth and the gum around it, and takes a digital X-ray (RVG) to see the root and its relationship to the tooth in front. If a lower tooth sits close to the nerve canal, a CBCT or OPG scan may be advised, and we will tell you where it is done and what it costs. Difficult or deeply buried teeth are planned with our oral and maxillofacial surgery department. You can read more on our wisdom tooth extraction page, or book a consultation to have your own wisdom teeth assessed before deciding anything.