Managing the eventual development or removal of third molars, commonly known as wisdom teeth, often overlaps with the process of straightening teeth. This dual consideration requires careful planning between the orthodontist and the oral surgeon. The good news for patients is that having braces does not automatically prevent a necessary wisdom tooth extraction. The decision to remove wisdom teeth is a highly individualized one, based on diagnostic imaging and the specific goals of the orthodontic treatment.
Extraction While Wearing Braces
Yes, it is possible and often necessary to have wisdom teeth extracted while orthodontic hardware is in place. The presence of brackets and wires on the teeth does not physically block the oral surgeon’s access to the third molars. The surgical procedure for the removal of impacted or erupting wisdom teeth remains largely the same, whether or not the patient is undergoing alignment treatment.
The two specialists must coordinate closely when the extraction occurs mid-treatment. The orthodontist may temporarily remove a small segment of the archwire or a bracket on a second molar to improve the surgeon’s line of sight or access. The primary concern shifts to post-operative care, where the patient must be diligent about keeping the extraction site and the surrounding hardware clean. Special care must be taken to avoid actions that could lead to a dry socket, such as using straws or forcefully spitting.
Timing Considerations Relative to Orthodontic Treatment
The optimal time to remove wisdom teeth is determined diagnostically, often through X-rays that reveal the tooth’s development, angle, and position within the jawbone. The decision falls into three main phases relative to orthodontic treatment.
The first phase is before starting braces, which is often recommended if initial X-rays show severe impaction, an unfavorable eruption path, or if the orthodontist needs the space created by the removal to relieve existing crowding or correct a bite. Removing the teeth upfront clears the path and prevents potential complications during the alignment process. The second phase is mid-treatment, which becomes necessary if a previously monitored wisdom tooth suddenly accelerates its eruption, causes pain, or begins to interfere with the movement of other teeth.
The third phase is after the completion of orthodontic treatment, if the wisdom teeth are not currently problematic and the orthodontist wants to monitor their development. In this scenario, the removal serves as a final, preventative measure to protect the long-term stability of the newly aligned teeth. Ultimately, the timeline is a joint decision made by the orthodontist and the oral surgeon, prioritizing the patient’s overall oral health and the stability of the orthodontic result.
How Wisdom Teeth Influence Orthodontic Alignment
The rationale for removing wisdom teeth is rooted in preventing future complications and ensuring the successful outcome of the alignment process. While the idea that erupting wisdom teeth are the single cause of late-life crowding is often debated, their presence can certainly jeopardize a carefully aligned smile.
The main concern is not the forward pressure exerted on the entire arch, but the localized impact on adjacent second molars and the overall dental structure. An impacted third molar, trapped against the second molar, can cause root damage or create areas where bacteria and food debris accumulate, leading to infection or cysts. When the orthodontist’s plan involves moving molars backward to create space, the wisdom teeth are physically in the way, requiring their removal for the necessary tooth movement to occur.
If left in place, poorly positioned or erupting wisdom teeth can contribute to a relapse in the orthodontic result, particularly in the lower arch. Removing these teeth eliminates a potential point of instability and a health risk. The decision is therefore a proactive measure to protect the investment in orthodontic care and the long-term integrity of the patient’s bite.