Orthodontics is the dental specialty focused on correcting misaligned teeth and jaws to improve function and appearance. This process often involves managing the presence of third molars, commonly known as wisdom teeth, which are the last set of teeth to develop, typically emerging between the ages of 17 and 25. A frequent question among patients is whether their orthodontist will remove these molars if they pose a problem to the alignment plan. The distinction in professional roles is important: an orthodontist diagnoses the need for removal, but they do not perform the surgical extraction.
The Specialists Responsible for Extractions
Orthodontists specialize in the movement of teeth using non-surgical appliances like braces and aligners, but they are not trained to perform complex surgical extractions. The professional responsible for surgically removing wisdom teeth is typically an Oral and Maxillofacial Surgeon (OMS). An OMS is a dental specialist who completes additional hospital-based surgical residency, granting them the expertise to manage complex extractions, especially those involving impacted teeth.
Impacted wisdom teeth, trapped beneath the gum line or bone, require a surgical approach that falls within the OMS’s scope of practice. General dentists are capable of performing simpler extractions for fully erupted teeth that are not deeply impacted. However, for most problematic wisdom teeth—particularly those that are partially erupted or angled—the orthodontist refers the patient to an OMS to ensure the highest level of surgical care.
Why Wisdom Teeth Impact Orthodontic Treatment
The presence of third molars can significantly influence the success and stability of orthodontic treatment, often necessitating their removal. While the belief that erupting wisdom teeth cause late-life crowding is not widely supported by modern research, they still pose mechanical risks. One primary concern is the potential for an impacted molar to damage the roots of the adjacent second molar. This pressure can lead to root resorption or decay, threatening the health of the tooth.
Removal is also often a prerequisite for specific orthodontic movements designed to fix a bite problem or relieve crowding. An orthodontist may need to move the entire row of molars backward, a technique called distalization, to create space in the arch. The wisdom tooth physically occupies the space needed for this planned movement, requiring its extraction to clear the path for the second molar. Furthermore, a poorly positioned wisdom tooth can interfere with the long-term stability of a newly aligned smile, potentially leading to relapse.
The Orthodontist’s Role in the Treatment Plan
The orthodontist’s involvement with wisdom teeth is diagnostic and managerial, making them the coordinator of the patient’s care. They monitor the development and position of the third molars using regular panoramic X-rays, which provide a full view of the jaw and roots. This imaging allows the orthodontist to assess the trajectory of the developing tooth and determine if there is sufficient space for it to erupt normally.
Based on this diagnostic information, the orthodontist assesses the risk the wisdom teeth pose to the overall treatment plan and the health of the other teeth. If the molars are impacted, angled toward the second molar, or interfere with planned tooth movement, the orthodontist initiates the referral process. This advisory role involves communicating the specific clinical reasons for the extraction to the patient and the surgical specialist, ensuring the removal serves the ultimate goal of achieving a stable, aligned bite.
Timing the Removal and Post-Procedure Coordination
The timing of wisdom tooth removal relative to orthodontic treatment is individualized and dictated by the treatment goals. The removal can occur in three general phases: pre-treatment, mid-treatment, or post-treatment. Removal is most common pre-treatment if the molars are severely impacted or if the space they occupy is needed immediately to begin correcting a severe bite issue.
In some cases, the teeth are removed mid-treatment if they begin to erupt or cause discomfort while the patient is wearing braces. Post-procedure coordination between the orthodontist and the oral surgeon is crucial, involving the sharing of surgical records and imaging. Patients are generally advised to wait approximately two to four weeks after surgery before the orthodontist continues with active treatment, allowing the extraction sites to heal and stabilize.