Whether third molars, commonly known as wisdom teeth, must be removed before or during treatment with braces is a frequent concern for patients pursuing orthodontic care. Wisdom teeth are the final set of molars to emerge, typically appearing in the late teenage years or early twenties. Braces are an orthodontic treatment designed to align teeth and correct bite issues. While their presence does not automatically require extraction for successful alignment, their potential to interfere with tooth movement or cause oral health problems makes removal a common consideration in many treatment plans.
Do Wisdom Teeth Cause Crowding
The idea that wisdom teeth forcefully push other teeth into a crowded position, undoing the results of braces, is a widely held belief, but one largely unsupported by modern orthodontic research. Scientific consensus indicates that the force exerted by erupting wisdom teeth is insufficient to cause significant shifting or crowding of the anterior teeth. Studies show that dental crowding, particularly of the lower front teeth, occurs naturally as part of the aging process, whether or not wisdom teeth are present.
This late-stage crowding, or post-orthodontic relapse, is more closely linked to maturational changes in the jaw structure and the natural tendency of teeth to drift forward over a lifetime. The timing of wisdom teeth eruption often coincides with the period when patients stop wearing their retainers consistently. This lack of consistent retainer use is the primary cause of teeth returning to their original, crowded positions. Therefore, removing third molars solely to prevent future crowding is not typically justified based on current evidence.
Pathological and Impaction Indicators
The primary reasons for wisdom tooth removal relate to addressing existing or anticipated clinical problems, not preventing crowding. An “impacted” wisdom tooth is one blocked from fully erupting into its correct position due to a lack of space or an improper angle. Impaction can occur in several ways, such as growing horizontally or vertically, and this misalignment can lead to structural damage to surrounding tissues.
Impacted teeth can cause numerous issues, including the formation of cysts or tumors around the crown, which may damage the jawbone. They can also contribute to the decay or root resorption of the adjacent second molars, as the inability to clean the area allows bacteria to thrive. When a wisdom tooth is partially erupted, a flap of gum tissue can cover it, leading to a localized infection called pericoronitis, which causes pain, swelling, and inflammation. These pathological indicators, visible on panoramic radiographs, are the drivers for mandatory removal, especially if the orthodontist requires space to move other molars during treatment.
When Removal is Not Required
Removal is not necessary if the wisdom teeth are assessed as healthy, functional, and pose no threat to the rest of the dentition or the orthodontic treatment plan. If the third molars are fully erupted, aligned correctly, and can be maintained through normal brushing and flossing, they can often remain in place. This is especially true if the patient’s jaw has adequate space to accommodate the molars without compromising the surrounding bone or gum tissue.
In some cases, the orthodontist may choose to use a fully erupted wisdom tooth as an anchor point for certain types of tooth movement, negating the need for extraction. The decision is always based on a thorough individual assessment. Leaving healthy, asymptomatic wisdom teeth in place is a common and safe approach, but they must be monitored regularly for any signs of future problems.
The Consultation and Timing of Removal
The decision to remove wisdom teeth is made collaboratively between the orthodontist and a dental surgeon, based on diagnostic tools. The most important tool is the panoramic X-ray, which provides a full view of the jawbone, the position of the unerupted teeth, and their relationship to adjacent molars and nerves. This imaging helps determine the degree of impaction and the potential for future pathology.
If removal is deemed necessary, it is often recommended before braces are placed, particularly if the orthodontist needs space to move other teeth or if the wisdom teeth are severely impacted. Removing them beforehand also prevents the risk of damaging orthodontic hardware during the extraction procedure. Extractions can be performed during orthodontic treatment without complication if a problem arises mid-treatment. If the teeth are removed before braces, patients typically wait two to six weeks for the surgical sites to heal and stabilize before orthodontic treatment begins.