The third molars, commonly known as wisdom teeth, typically emerge in the late teens or early twenties, often presenting problems due to insufficient space in the jaw. When these teeth are impacted—meaning they are trapped beneath the gum line or bone—or erupt at an abnormal angle, they can create significant oral health issues. Postponing the recommended removal of problematic wisdom teeth is not a harmless choice and can lead to complications that worsen over time. Delaying the procedure can transform a routine extraction into a complex surgical event with heightened risks to the surrounding structures.
Damage to Adjacent Teeth and Structures
An impacted wisdom tooth exerts continuous pressure against the second molar positioned next to it. This pressure can cause the second molar to shift, potentially leading to the misalignment or crowding of other teeth. The resulting tooth movement may undo previous orthodontic work, necessitating expensive corrective treatments.
The angular positioning of a problematic third molar also creates a difficult-to-clean space that traps food debris and bacteria, significantly increasing the risk of decay. This decay often develops on the back surface of the second molar, a location that is hard to access for repair and may compromise the tooth’s long-term health. Furthermore, the chronic pressure can cause root resorption, which is the dissolution or damage of the second molar’s root structure. This damage permanently weakens the adjacent tooth and may ultimately require its extraction alongside the problematic wisdom tooth.
Increased Risk of Infection and Inflammation
A partially erupted wisdom tooth carries a high risk of infection and inflammation. When the tooth is only partly visible, a flap of gum tissue, called an operculum, often covers the crown, creating a deep pocket. This sheltered space becomes a breeding ground for bacteria, leading to a localized infection known as pericoronitis.
Pericoronitis causes the surrounding gum tissue to become swollen, painful, and tender, often accompanied by a foul taste or pus discharge. While the infection may respond to initial treatment, it frequently recurs if the wisdom tooth is not removed, creating a cycle of pain and swelling. If left untreated, the infection can progress into a more serious abscess or spread into the deeper tissues of the face and neck, requiring emergency intervention. Chronic inflammation from a retained wisdom tooth can also contribute to overall periodontal disease and bone loss in the back of the mouth.
Surgical Complexity and Prolonged Recovery
Waiting to remove wisdom teeth until later adulthood significantly increases the difficulty and risks of the surgical procedure. As a person ages, the bone surrounding the tooth root becomes denser and less elastic. Denser bone requires more aggressive surgical techniques for removal, which can lead to increased post-operative swelling and discomfort.
The roots of the third molars also become fully developed, longer, and sometimes more curved with age. These mature root structures often lie in closer proximity to the inferior alveolar nerve, which runs along the lower jaw and controls sensation in the lower lip and chin. The increased proximity heightens the risk of temporary or permanent nerve damage during the extraction. Recovery is generally faster and less complicated for younger patients, whose softer bone and less-developed roots simplify the extraction. Older patients face a more prolonged healing period and a higher risk of complications, such as dry socket.
Formation of Cysts and Tumors
A less frequent but more serious consequence of prolonged impaction is the formation of cysts and, in rare instances, tumors. The most common development is an odontogenic cyst, specifically a dentigerous cyst. This fluid-filled sac forms around the crown of the impacted tooth, developing from the tissues that protected the tooth during its formation.
As the dentigerous cyst slowly expands, it creates pressure that can erode and destroy the surrounding jawbone and damage the roots of adjacent teeth. While these cysts are typically benign, their continuous growth can weaken the jaw, increasing the risk of a fracture. In extremely rare cases, the cells lining the cyst can transform into a more aggressive type of cyst or a benign tumor, which necessitates extensive surgical intervention and potential bone grafting for reconstruction.