Patients often require both orthodontic treatment and the removal of their wisdom teeth, also known as third molars. These procedures are frequently coordinated by dental specialists. The presence of developing wisdom teeth requires careful consideration in an orthodontic treatment plan, but their removal is fully compatible with having braces. The ultimate goal is ensuring the long-term stability of the newly aligned smile while addressing potential complications caused by the third molars.
Why Wisdom Teeth Affect Orthodontic Treatment
Wisdom teeth typically begin to emerge in the late teens or early twenties, a period that often overlaps with or immediately follows orthodontic treatment. The main concern arises because the human jaw often does not have sufficient space to accommodate these final four molars. When space is restricted, the wisdom teeth can grow at an angle or fail to fully emerge through the gums, a condition known as impaction.
This restricted eruption can create pressure on the adjacent second molars, which may contribute to shifting or crowding of the teeth that the braces are actively correcting. An impacted or partially erupted wisdom tooth creates an area difficult to clean, increasing the risk of infection, decay, and gum disease. Removing these problematic teeth eliminates a source of inflammation and potential damage to the second molar, helping to preserve the integrity of the overall dental alignment.
Timing the Extraction Relative to Braces
The decision of when to remove wisdom teeth in relation to orthodontic treatment is highly individualized and is based on the patient’s age, the position of the molars, and the overall treatment progress. This timing is determined through joint consultation between the orthodontist, who monitors the alignment, and the oral surgeon, who assesses the surgical needs.
One common approach is extraction before braces, especially if X-rays clearly indicate a lack of space or a high likelihood of impaction. Removing the teeth before treatment allows the extraction sites to heal completely, which typically takes four to six weeks, before the braces are placed. This ensures that the orthodontic process starts with a clear path for tooth movement and removes any potential source of interference.
It is also possible and frequently necessary for the extraction to occur during braces treatment. If a patient’s wisdom teeth develop faster than anticipated or begin to cause pain, impaction, or infection mid-treatment, the orthodontist will refer them for immediate removal. In this scenario, the orthodontic adjustments may be paused briefly to allow for the initial healing period following the surgery.
The third possibility is extraction after braces are removed, which may be recommended if the wisdom teeth are not causing any immediate issues. This is often done to prevent late-stage problems, as removing the molars after treatment can help maintain the stability of the final alignment. In all cases, the primary consideration is the potential for the wisdom teeth to compromise oral health or the success of the orthodontic result.
Practical Considerations During the Procedure
Removing wisdom teeth while the patient is wearing braces introduces specific logistical and post-operative challenges that require careful planning. The presence of brackets and wires can make it more difficult for the oral surgeon to access the wisdom teeth, particularly those that are fully impacted or deep within the jawbone. The surgical team must work diligently to avoid damaging the orthodontic hardware during the procedure, a task that is routinely managed in oral surgery practices.
Post-operative care is also more involved, as the patient must manage healing surgical sites alongside the fixed appliances. Maintaining strict oral hygiene is paramount to prevent infection in the extraction sockets, but patients must brush gently around the brackets and wires to avoid disturbing blood clots. Specialized cleaning tools, such as interdental brushes or water flossers, are often recommended to remove food debris from the braces without irritating the surgical area. Diet modification is also tailored to account for the braces, requiring a sustained diet of soft, non-chewy foods to prevent damage to the wires and brackets and promote comfortable healing.