Question

During the examination of our son (18), the dentist found that the lower wisdom teeth in particular had hardly any room and would cause problems over time because they would press on the front teeth. He therefore suggests removing the wisdom teeth, even though they are not causing any problems at the moment. Does this make sense? Shouldn't we wait? 

Short answer

If the wisdom tooth has enough space and can fit into the row of teeth, it does not need to be removed. However, if the wisdom teeth do not manage to break through completely, they remain partially covered by the gums halfway through. Gum pockets form along the hidden part of the tooth crown, which represent permanent bacterial deposits. As it is not possible to clean the teeth properly, the bacteria growing there can trigger infections and inflammation. 

The removal of wisdom teeth is a dental surgical procedure for which a justification (indication) is required. Not every wisdom tooth needs to be extracted: If the wisdom tooth has enough space and can fit into the row of teeth normally, it does not need to be removed. The reasons given by your dentist speak in favor of removal. Why? If the wisdom teeth do not manage to break through completely because they cannot find a place or grow in the wrong direction (which is the case with your son), they will get stuck halfway through, partially covered by the gums. Gum pockets form along the hidden part of the tooth crown, which are permanent bacterial deposits. 

Infections and inflammations 

As it is not possible to clean the teeth properly, the bacteria growing there can cause infections and painful inflammation. In the worst case, a local abscess with pus can develop, which is extremely painful and would require an emergency visit to the dentist. The removal of the wisdom tooth, which is then necessary, is associated with higher risks than a planned removal in a healthy environment due to the existing infection. The neighboring tooth can also be damaged by the accumulation of bacteria and the poor cleaning possibilities due to caries and the formation of gum pockets. 

Complications very rare 

As with any surgical procedure, the extraction of a wisdom tooth is not without risk. The dentist always takes an X-ray beforehand to assess the risk. Complications are very rare if the surgical technique is correct and a precise diagnosis is made (prior examination and clarification). Many scientific studies show that the risk of nerve injury is lowest between the ages of 17 and 24. It is therefore advisable, if necessary, to remove the wisdom teeth before the age of 25. Moreover, if the roots are not yet fully grown, the tooth is easier to remove. In the present situation, it seems advisable to remove the wisdom teeth occasionally and not to wait until an acute emergency situation arises. Compulsory health insurance only covers the removal of so-called "displaced teeth with pathological value", which is not the case for most wisdom teeth. For this reason, health insurance companies generally refuse to reimburse the costs. 

Author: Dr. med. dent. Jürg Eppenberger
Published in: Neue Luzerner Zeitung on March 05, 2012