Wisdom teeth, also known as third molars, are the last teeth to erupt, typically appearing between the ages of 17 and 25. Most adults have four of these molars. While some people’s third molars emerge fully without issue, the majority experience complications that necessitate their removal. This extraction procedure is one of the most common forms of oral surgery performed today.
Why Wisdom Teeth Get Stuck
The main anatomical reason wisdom teeth become problematic is a simple lack of space in the jawbone. Because the third molars are the final teeth to arrive, they often find that the available space has already been claimed by the other 28 teeth.
This spatial restriction leads to a condition called impaction, where the tooth is trapped beneath the gum line or bone and cannot erupt fully or correctly. Impaction is classified by the tooth’s angle and depth, such as a mesial impaction where the tooth leans forward toward the adjacent molar, or a horizontal impaction where the tooth lies completely sideways. A tooth may also be vertically impacted, meaning it is positioned straight but remains stuck beneath the surface. Whether the tooth is blocked only by soft tissue or by both soft tissue and bone determines the complexity of its removal.
Health Risks Associated with Retaining Problematic Teeth
Retaining wisdom teeth that are impacted or only partially erupted poses health risks. One of the most common problems is pericoronitis, a painful infection and inflammation of the gum tissue surrounding a partially erupted tooth. Food debris and bacteria easily become trapped under the gum flap, leading to swelling, pus formation, and an unpleasant taste.
Impacted wisdom teeth can also directly damage the adjacent second molar. The pressure exerted by a sideways-growing third molar can lead to the erosion of the second molar’s root or cause decay on its back surface, as the area becomes nearly impossible to clean effectively. In rare instances, the sac of tissue that forms around the developing, unerupted tooth can fill with fluid, creating a cyst or benign tumor. If left untreated, this growing sac can destroy surrounding jawbone and damage nearby nerves, requiring more extensive surgical intervention.
Criteria for Monitoring Versus Removal
A dentist or oral surgeon may recommend monitoring a wisdom tooth if it is fully erupted, completely functional, and aligned properly with the opposing tooth. The tooth must also be fully accessible for daily brushing and flossing to ensure the surrounding gum tissue remains healthy.
Removal is generally advised when a tooth is associated with current pathology or is deemed a high risk for future problems. Criteria for extraction include:
- The presence of pain.
- Repeated episodes of infection (pericoronitis).
- The development of cysts or tumors.
- Documented damage to neighboring teeth or bone.
In younger patients, removal is often recommended preventatively because the procedure is typically easier when the tooth roots are less developed, and recovery is faster.
What to Expect During the Removal Procedure
The process begins with a consultation where the surgeon examines the teeth and uses X-ray imaging to determine the position and root structure. Anesthesia options are discussed, commonly including local anesthetic to numb the area, intravenous (IV) sedation to help you feel calm, or general anesthesia for complex cases.
During surgery, the surgeon administers the chosen anesthetic. If the tooth is impacted, a small incision is made in the gum tissue, and any overlying bone is carefully removed to gain access. The tooth may be divided into smaller pieces to facilitate extraction. After removal, the socket is cleaned, and the gum tissue is often closed with dissolvable stitches. You receive immediate post-operative instructions, such as managing bleeding with gauze and swelling with ice packs, before recovering at home.