Should wisdom teeth be removed?

Photo of a man with a toothache (PantherMedia / Dunca Daniel)

Some people believe that removing wisdom teeth is a waste of time if they aren't causing any problems. Others think that the teeth will only cause trouble and have no real function anyway. There are actually good reasons to carefully consider whether you should have them removed.

There are still many unanswered questions about wisdom teeth. This is one of the reasons why there are so many contradictory opinions about them. Some dentists recommend removing wisdom teeth no matter what – even if they aren't causing any problems. Their reasoning is that the wisdom teeth will usually end up causing problems anyway and leave you with unattractive teeth. Another argument is that we simply no longer need wisdom teeth.

It has now become common to only recommend pulling wisdom teeth if they have already caused problems or are highly likely to. Removing the teeth is quite unpleasant and may cause side effects. What's more, pulling wisdom teeth that don't cause any problems hasn't been proven to have any health benefits. So it's a good idea to weigh the pros and cons of having an operation.

What happens if a wisdom tooth doesn't break through the gum?

Wisdom teeth often do not come in or they only partially break through the gum. Up to 80% of young people in Europe have at least one wisdom tooth that hasn't broken through. This is more common in the lower jaw than it is in the upper jaw. The reason is usually that there isn't enough room in the jaw. This can mean that other teeth get in the way of the wisdom tooth, or that it comes in crooked.

Wisdom teeth that don't break through (sometimes also called “impacted” wisdom teeth) might not cause any problems. But some people have pain, swelling or inflamed gums. Impacted wisdom teeth may also push other teeth out of the way.

But even wisdom teeth that have already come in can also push against other teeth, grow in the wrong direction, and cause inflammation, tooth decay or other complications.

When is it a good idea to have your wisdom teeth pulled?

The decision about whether or not to have wisdom teeth pulled will mainly depend on whether they are already causing trouble or whether it is highly likely that they will in the future. It is important to get answers to the following questions before having any wisdom teeth removed:

  • Have your wisdom teeth already caused pain or damage to your jaw or neighboring teeth, or is there an increased risk of that happening?
  • Are the wisdom teeth preventing the other teeth from developing properly?
  • Might the wisdom teeth interfere with other dental or jaw-related treatments that are already planned?
  • What risks are involved?
  • Could the wisdom teeth be used to replace other lost or badly damaged molars (back teeth)?

People who have crooked incisors (front teeth) or a small jawbone sometimes worry that their teeth may start pushing each other to the side even more when their wisdom teeth grow out of the gum. But that's not necessarily the case. The same is true for those people: Their wisdom teeth can be left in if the dentist doesn't expect them to affect other teeth.

What are the potential side effects of having wisdom teeth removed?

Nerves and blood vessels can be damaged during the procedure. This can cause bleeding and usually temporary numbness in the tongue or face. In very rare cases it may cause a serious infection. Up to 1 out of 100 people may have permanent problems related to the procedure, such as numbness or damage to neighboring teeth. The risk will depend on how extensive the procedure needs to be.

Most people have swelling around their mouth or cheeks after surgery and can't fully open their mouth for a few hours or even a few days. Many have pain right after the operation, but it doesn't last long.

If the pain returns after four or five days, though, and also gets worse and is accompanied by swelling or bad breath, the wound could be infected. This can happen if the dried blood that closes the wound comes off too soon, leaving the wound unprotected. Antiseptic mouthwashes or gels can help to prevent these kinds of complications. There's no need to routinely take antibiotics.

Wisdom teeth are typically removed under local anesthesia. General anesthesia may be used for more complex procedures.

What can you do about pain after the operation?

Many people use painkillers after they have had wisdom teeth pulled, and sometimes pain relief medication is also given before the procedure. Both ibuprofen and acetaminophen (paracetamol) can help relieve pain after surgery. ASA (the drug in “Aspirin”) is not suitable before or afterwards because it can increase the risk of bleeding.

Research shows that a 400 mg dose of ibuprofen relieves pain better than a 1,000 mg dose of acetaminophen does. A combination of 1,000 mg acetaminophen and 400 mg ibuprofen relieves pain better than an equal dose of acetaminophen or ibuprofen on their own, and the effect lasts longer too. Adults should only take this combination every eight hours at the most to avoid going over the maximum dose for both drugs. The maximum dose of ibuprofen in adults is 800 to 1,200 mg in 24 hours. The maximum dose of acetaminophen is 4,000 mg in 24 hours.

For a few days after the procedure, holding an ice pack against your cheek can help to reduce swelling. Smoking, fruit juices and hot drinks should be avoided at first as they can slow down the healing process. Hard foods also sometimes cause problems. Soups and foods that can be crushed using your tongue are easier to eat, like potatoes, fish or pasta.

It's better to avoid doing strenuous physical activities like sports or going to the sauna in the first few days after having your teeth pulled – even if you're already starting to feel better – because that could also affect the healing process.