The process of straightening teeth often coincides with the natural eruption period of the last molars, commonly known as wisdom teeth. These third molars typically emerge in the late teens or early twenties, a time when many individuals are undergoing orthodontic treatment. The presence of these developing teeth introduces a complex variable into the alignment plan. The answer to whether you can have them removed with braces is a qualified yes, but it requires careful coordination and planning to ensure the long-term stability and success of the smile.
Necessity of Wisdom Teeth Removal During Orthodontic Treatment
The decision to remove wisdom teeth during orthodontic treatment is driven by several mechanical and preventative factors related to the overall health of the jaw and teeth. The primary concern is preventing their potential to disrupt the meticulous alignment achieved by the braces. The eruption path of the third molars can be unpredictable, often resulting in them becoming impacted, or trapped beneath the gum line, if there is insufficient space in the jaw.
An impacted wisdom tooth can press against the roots of the adjacent second molar, potentially causing root resorption or damage. A partially erupted tooth can also create a difficult-to-clean area, increasing the risk of pericoronitis—a painful gum infection—or decay that could spread to neighboring teeth. While the idea that wisdom teeth push front teeth out of alignment is largely unsupported, their localized pressure and potential for infection pose a risk to the integrity of the posterior bite correction. Removal is often recommended to eliminate these threats, especially if they interfere with the intended movement of other molars or compromise the final alignment.
Collaboration Between Orthodontist and Oral Surgeon
Effectively managing wisdom teeth requires collaboration between the orthodontist and an oral surgeon. The orthodontist monitors tooth movement and bite structure, making the initial recommendation for extraction based on panoramic X-rays and treatment goals. This recommendation assesses the tooth’s position, available jaw space, and the patient’s stage of development.
Once the need for removal is established, the patient is referred to an oral and maxillofacial surgeon, a specialist trained in complex surgical extractions. The orthodontist provides the surgeon with detailed patient records, including the current treatment stage and concerns regarding the appliances. This exchange ensures the surgical plan minimizes disruption to the ongoing orthodontic work. The oral surgeon then assesses the extraction’s complexity, determines the appropriate anesthesia, and performs the procedure, which is often surgical for impacted molars.
Timing of Wisdom Teeth Extraction Relative to Braces
The timing of wisdom teeth removal is a highly individualized decision, often categorized into three main scenarios relative to the orthodontic timeline. Each phase presents unique advantages and logistical considerations.
Before Braces
Extracting the molars before starting braces is often the most straightforward approach if their development is problematic early on. This strategy ensures the entire dental arch is free of potential interference, simplifying the movement of other teeth. Allowing the extraction sites to fully heal, typically four to six weeks, creates a stable environment before the brackets and wires are placed. This timing also ensures orthodontic treatment begins without the risk of an acute infection or impaction complication interrupting the initial alignment phase.
During Braces
Extraction may become necessary mid-treatment if the wisdom teeth begin to erupt or shift into a problematic position after the braces are placed. It is safe to have the procedure while the appliances are on, though the braces hardware can sometimes complicate the surgeon’s access to the back of the mouth. In some cases, the orthodontist may need to temporarily remove bands or wires on the second molars to allow the surgeon a clearer path. The procedure may also be strategically timed to create space for specific orthodontic movements, such as distalization, where molars need to be pushed backward.
After Braces
If the wisdom teeth are not actively causing issues during alignment, extraction may be postponed until after the braces are removed. This timing is sometimes preferred to prevent damage to the orthodontic appliances during surgery. However, removal after alignment is complete often prevents late-stage relapse or crowding of the newly straightened teeth once the third molars erupt more fully. The use of a retainer after braces is especially important in this scenario to maintain the correction until the wisdom teeth are addressed.
Post-Extraction Care While Wearing Braces
Recovering from wisdom teeth extraction while wearing braces presents specific challenges that require careful attention to oral hygiene and diet. Maintaining the surgical site’s integrity is paramount, which means avoiding activities that could dislodge the blood clot, such as forceful spitting, rinsing, or using a straw for the first 24 hours.
Oral hygiene must be performed gently around the extraction site to prevent infection without disturbing the clot or damaging the braces. Patients should continue to brush their teeth and brackets as directed, but must steer clear of the surgical area for the first few days. Gentle rinsing with a warm salt-water solution, starting 24 hours after surgery, is recommended to keep the area clean and promote healing. Dietary adjustments are also necessary, requiring soft foods that will not get stuck in the extraction site or damage the brackets and wires, such as yogurt, mashed potatoes, and soft soups.