As an oral surgeon, I’ve heard many fallacies and misconceptions over the years about wisdom teeth. Here are a few myths and misconceptions and the realities:
“My lower wisdom teeth are causing pain and need to be removed. But why do I need to remove the upper ones? They don’t bother me.”
Upper wisdom teeth are highly prone to decay and gum disease and shift downward after removing the lower teeth. They eventually have to be extracted, so better to have the upper and lower teeth removed at the same time.
“My wisdom teeth are visible and they are not causing any problems. Do I need to get them out?”
Effective oral hygiene is very difficult around wisdom teeth, resulting in frequent decay and gum disease. Plaque builds up easily, and there is usually poor access for effective cleaning. Extraction is recommended to achieve long-term health of bone and gum tissue behind the second molars.
“I get occasional pain around my wisdom teeth, but it always goes away. Can I just leave them?”
You are experiencing pericoronitis, inflammation of gum tissue around the crown of wisdom teeth. This type of inflammation recurs frequently, but it can progress to significant infection, pain, and swelling. Chronic inflammation often causes gradual bone loss (gum disease) or decay to adjacent teeth which can be irreversible. Early extraction is the best approach even when symptoms are sporadic.
“I just had a panorex x-ray done and my dentist said my wisdom teeth are too close to my nerve and I could loose sensation with surgery!”
Panoramic X-ray is a 2-dimensional image and it does not provide adequate information on proximity of wisdom teeth to vital structures such as nerves or sinus cavities. In many cases, while the wisdom teeth appears close to these structures on a panorex, in reality they are separate with safe zone of safety in between. The only way to diagnose the anatomical relationship of wisdom teeth to nerves or sinus cavities is a 3-dimensional Cone Beam CT Scan (CBCT)
“My wisdom teeth are crowded and not coming in. If I wait long enough, will they become straight and come in normally?”
The answer is no. There is usually inadequate space between the second molars and jaw bone to allow proper eruption of the wisdom teeth. This spacing does not significantly change with growth or time. Furthermore, once the roots are fully formed, usually between the ages of 18 and 21, teeth do not erupt any more.
“I am 52 years old and still have my wisdom teeth. They are not impacted and they don’t cause me pain or problems. I just have some bone loss around them but it does not bother me. Do I need to worry?”
Long-standing wisdom teeth are highly susceptible to bone loss and gum disease. This is a progressive disease and will continue to destruct healthy bone. Extraction is the best long-term treatment. If there is no pocketing in the gums and the area can be easily cleaned, then the teeth may be monitored for disease process. Healthy and asymptomatic erupted or impacted= wisdom teeth in individuals older than 65 may be monitored closely with X-rays every six months.
“My wisdom tooth has been deeply broken for some time but does not hurt. Do I need to remove it?”
Yes. broken teeth, even if asymptomatic, harbor bacteria and can progress to further decay, gum disease, bone loss, and infection. Root canal procedures and fillings are significantly more difficult to perform on wisdom teeth and therefore not recommended.
“Can removal of my wisdom teeth cause a change of my jaw position and how I bite?”
No. Extraction of wisdom teeth does not affect jaw position, movement, or function in anyway, unless the wisdom teeth themselves are already interfering with normal bite and function. In this case, removal will improve jaw function and bite. Following extraction of a wisdom tooth, the teeth in front do not shift backward. However, the opposing wisdom tooth can super-erupt, or shift downward if not removed at the same time.
“My teeth are getting crowded. Will they straighten after I remove my wisdom teeth?”
No. There is some belief that wisdom teeth may contribute to teeth crowding but they are unlikely to be the sole cause. Removal of wisdom teeth does not correct teeth that have shifted or crowded. Orthodontic treatment is recommended to correct teeth crowding.
“My wisdom teeth have decay. Is it possible to do fillings?”
While placing restorations on wisdom teeth is possible, it is extremely difficult to do well. Lack of space and access creates challenges for a dentist to place proper restorations. Plus, wisdom teeth are always prone to additional decay due to difficult access for hygiene. Any wisdom tooth with decay should be extracted.
“I have TMJ problems. Can wisdom teeth surgery make it worse?”
Routinely, the jaw and its joint (TMJ) are protected during surgery by use of a special rubber block that allows the patient to rest their teeth. Excessive pressure on the joints is prevented by gentle surgical techniques and the use of proper instruments. Increased TMJ problems are unlikely with wisdom teeth removal if these precautions are taken.
“I’ve been told it is very difficult to numb me.”
There are several local anesthesia techniques that are effective in patients who are resistant to numbing. Providing an adequate amount of local anesthetic and giving it more time to take effect can be helpful. However, IV sedation is the best option for patients who, for various reasons, are difficult to numb.
“How soon can I wear my retainers after the surgery?”
Most retainers are made for upper teeth and extend to the second molars. Patients can safely wear retainers in 24 hours post-surgery without interfering with the healing process. Although, if uncomfortable, patients may wait up to a week before using their retainers again without any concerns.
“I was told to remove my wisdom teeth one side at a time so I have less pain!”
Since perception of pain is not additive, it will remain the same whether you have one, two, three, or all four wisdom teeth removed. It makes no difference in the level of post-operative pain. Also, analgesics reduce pain quite effectively regardless of the number of teeth removed. Since pain is not a factor, the best approach is removal of all four wisdom teeth at the same time to avoid another surgery.
“I have a cold and I am scheduled to have my wisdom teeth removed. Should I postpone the surgery?”
If the cold is mild, with no coughing or impeded nasal breathing, surgery is usually OK. If the cold is severe, with productive coughing, chest congestion, or stuffy nose, it’s best to wait. This is especially important with IV sedation. If it is an emergency extraction, it can also be done safely under local anesthesia with nitrous oxide.