Most patients who are referred to the oral and maxillofacial surgeon (OMS) specialist do not have healthy wisdom teeth that have erupted, or grown into a cleansable and/or functional position in the mouth.

By healthy we mean free of gum disease and caries (dental decay). So there are no pockets present in the gums between the wisdom tooth and the next tooth forward, or around the wisdom tooth itself, and there will be no redness or swelling or other signs of infection. A healthy wisdom tooth will have no cavities, or there was a cavity that has been treated successfully with a dental filling.

By cleansable, we mean that the wisdom tooth is in a position in the mouth where all the surfaces of the tooth can be successfully maintained, at home, by brushing and flossing. If the area is difficult to clean, then bacteria can colonize and create gum disease.

By functional, we mean that the tooth contacts another tooth during chewing. Usually, but not always, a non-functional tooth will be in a location that is not normal and will become bothersome because it causes cheek biting, ulcerations or other related problem.

So, removal of wisdom teeth is always appropriate when there is pathology present such as gum disease, dental decay, or infection. Another obvious reason to remove wisdom teeth is when there is a cyst or a tumor present at or around the wisdom tooth, or if the wisdom tooth is causing damage to a neighboring tooth.

However, if your dentist or orthodontist determines that your wisdom teeth are not healthy, cleansable or functional, or that retaining your wisdom teeth may lead to these problems in the future, you will need expert consultation to further review your options and seek treatment.

Pain free doesn’t necessarily mean disease free

Dr. Banks was a member of the American Association of Oral and Maxillofacial Surgeons (AAOMS) Task Force on Third Molar Clinical Trials in 2011 and 2012. The Task Force was charged with reviewing some 80 different scientific publications resulting from a long term, ongoing study of third molars (wisdom teeth) conducted at the University of Kentucky and the University of North Carolina. Importantly, part of project concentrated on what happens when third molars are not removed.

Third molars with periodontal infection don’t necessarily cause pain or show overt signs of infection like swelling or pus. The studies mentioned above actually show that some 60% of patients with asymptomatic third molars (wisdom teeth with no symptoms of pain) had signs of infection with increased pocketing depths-- and that the periodontal status is expected to worsen in the area of the second and third molars in about 40% of the patients within 2 years. The good news is that the study also showed that the periodontal disease is likely to improve following removal of the third molars.

The study also showed that among the patients whose third molars were visible in the mouth, 28-77% of the patients will have cavities in these teeth, depending on their age.

In patients who chose to retain their third molars, it was shown that mechanical cleaning of the third molar teeth did not lower the levels of pathogenic bacteria and inflammatory mediators. There is new evidence that these bacteria can travel from the mouth to the bloodstream, and may cause illnesses affecting the heart, kidneys and other organs.

And finally, the study showed that the third molars change position in the mouth over time, the eruption of these teeth is unpredictable. There are other publications that discuss the movement, or eruption of third molars; generally speaking, the position and angulation of the wisdom tooth within the jaws, and the presence or absence of available space to accommodate the teeth, seem to be the best predictive factors. But again, there is no formula for predicting what a wisdom tooth is going to do.