The third set of molars, commonly known as wisdom teeth, typically emerge between the ages of 17 and 25. While removal is frequently recommended, the decision to keep them is not universal. Whether wisdom teeth remain in the mouth depends entirely on an individualized assessment of their condition and effect on surrounding oral structures. Retention is possible, but it relies on specific dental criteria that determine if the teeth are healthy and functional.
The Criteria for Keeping Wisdom Teeth
A small percentage of the population can safely retain their wisdom teeth if they meet specific criteria that ensure they do not threaten oral health. For retention, the tooth must be fully erupted, meaning it has completely broken through the gum line and is visible. It also needs to be properly positioned and aligned, functioning correctly in the bite without crowding neighboring teeth.
These third molars must be healthy and maintainable, showing no signs of decay or periodontal disease. Because they are located at the back of the mouth, the ability to clean them thoroughly with regular brushing and flossing is a requirement for long-term retention. If these conditions are met and the tooth is asymptomatic, a dentist may recommend a monitored retention plan.
Risks Associated with Retaining Problematic Wisdom Teeth
Wisdom teeth are most often removed because they are not properly aligned, a condition known as impaction. Impaction occurs when the tooth is partially or fully trapped beneath the gums or jawbone. Retaining an impacted tooth creates a high risk of developing pericoronitis, which is the painful inflammation of the gum tissue surrounding a partially erupted tooth. This exposed area easily traps food debris and bacteria, leading to recurring infections.
The back location makes wisdom teeth highly susceptible to decay, as maintaining proper oral hygiene is difficult even with a fully erupted tooth. When an impacted tooth pushes against the adjacent second molar, it can cause significant damage. This damage includes enamel wear, cavities, or root resorption in the neighboring tooth.
Untreated impacted teeth can also lead to the formation of cysts or, in rare cases, tumors. These growths can cause extensive damage to the jawbone and surrounding nerves. Even without pain, an impacted wisdom tooth can contribute to gum disease, as chronic inflammation and bacterial buildup progress to a severe periodontal condition.
This progressive bone loss and tissue damage around the third molar can compromise the health of the entire back section of the jaw. Therefore, extraction is often a proactive measure to prevent these long-term complications from escalating into serious health issues.
Monitoring and Long-Term Dental Management
For individuals who meet the strict criteria for retention, keeping wisdom teeth requires rigorous and ongoing professional management. Regular dental check-ups are necessary to continuously monitor the health of the teeth and surrounding gum tissue. These appointments allow dentists to detect any changes before they become symptomatic or cause irreversible damage.
Long-term monitoring involves periodic dental X-rays, also known as radiographs, which provide a view of the tooth’s internal structure and its relationship with the jawbone. These images check for internal issues like decay, subtle shifts in alignment, or the beginning stages of cyst formation around the root. Individuals must be meticulous with their daily oral hygiene routine due to the difficulty in cleaning the back of the mouth. Even a healthy, retained wisdom tooth may eventually require removal if new problems, such as late-onset decay or periodontal disease, begin to develop.