Why do I need to have my wisdom teeth removed?

The third molars or wisdom teeth do not develop in some people, however, for others, these teeth will erupt normally and not result in any issues. But the majority of people will develop impacted teeth, meaning their wisdom teeth do not have enough space to erupt and develop normally in the mouth. Your wisdom teeth may therefore only erupt partially or they may not erupt at all.

A wisdom tooth that is impacted may cause the following issues:

• Growing towards the second molar causing damage to it
• Growing at a 90-degree angle to your other teeth
• Growing towards the back of your mouth
• Growing straight down or up just like your other teeth, but the wisdom tooth stays trapped under the jawbone

Can wisdom teeth cause other teeth to shift or crowd?

For a rather long time, it has been thought that wisdom teeth are able to ‘push’ the front teeth together and thus cause the teeth to crowd, as a result, a number of oral surgeons, general dentists and orthodontists have recommended that their patients have their wisdom teeth extracted so as to prevent teeth crowding, specifically after corrective orthodontic treatment has been conducted.

Recently, there has been a large amount of well-documented research done that disproves the theory of wisdom teeth exerting the amount of pressure needed to affect the front teeth and move them. This well-validated research consisted of studies tracking patients over a period of 25 years and determined that the teeth will move or drift forward naturally throughout a person’s life, regardless of any orthodontic treatment that has taken place. This natural drift is known as a ‘mesial drift’ and refers to an individual’s lower canine teeth getting narrower or constricting over time, this shift also takes place in those who are missing their back teeth.

It is still not completely understood as to why this shifting takes place, but what is known is that the wisdom teeth do not play a role in this. Therefore, wisdom teeth will only be removed if they are impacted and are currently or could potentially cause issues.

Issues with impacted wisdom teeth

In some cases, it may not be necessary to remove wisdom teeth even if they are impacted, as they may not be causing any issues or pain. Your dentist will decide on what benefit the removal of these teeth will have and evaluate the complications and risks associated with the removal.

In other situations, if wisdom teeth are impacted or haven’t broken through the gum surface fully a number of dental issues can ensue. Bacteria and food can get caught around the edges of your wisdom teeth and result in plaque accumulating. This plaque build-up may lead to one or more of the below issues:

• Dental caries (tooth decay) – Tooth decay will develop as a result of plaque destroying the tooth’s surface. As tooth decay advances, it will leave cavities (holes) in your teeth and this is able to affect the surrounding teeth. Cavities are permanently damaged areas of the teeth that are able to impact other teeth as the bacterial infection which causes cavities is able to spread to adjacent teeth.
• Periodontal disease (gum disease/gingivitis/periodontitis) – Gum disease occurs as a result of plaque build-up releasing toxins that irritate and inflame the gums, resulting in your gums becoming swollen, painful and red. This is known as gingivitis as it only affects the gum tissue which is able to progress and affect the teeth and bone as the gums recede and become further infected, this stage of progression is known as periodontitis and will need to be treated by a dental specialist.
• Pericoronitis – This is an infection that occurs when plaque causes the surrounding soft tissue of a wisdom tooth to become infected. This form of infection is commonly affects impacted wisdom teeth where the gingival tissue overlaps the crown (chewing surface) of the tooth.
• A dental abscess – An abscess is when a collection of pus occurs in the tooth or in the tissue surrounding the tooth. A dental abscess is often the result of an untreated injury or cavity and will need to be drained and treated.
• Cellulitis – This is a common bacterial skin infection that may develop in the tongue, cheek or throat as a result of an impacted tooth. This infection is caused by bacteria entering a crack or cut in the tissue and forming inflammation and redness.
• Benign growths and cysts – In rarer cases, a wisdom tooth may form a cyst when the tooth has not broken through the gum tissue. A cyst is a collection of fluid that results in swelling and pain.

The majority of the issues and infections that are associated with impacted wisdom teeth are easily treated with antiseptic mouthwash or antibiotics, therefore, the removal of your wisdom teeth will only be recommended by some dentists when the other forms of treatment have been deemed ineffective. However, a number of dentists will suggest the removal of your wisdom teeth to prevent further infection.

Preventing future dental issues

Dental specialists will often disagree about whether or not there is always value in removing impacted wisdom teeth if there are no associated issues. Impacted wisdom teeth that do not cause any issues are referred to as asymptomatic (showing no symptoms).

It is difficult for even the most experienced professionals and specialists to predict whether there will be future issues with wisdom teeth that are impacted. However, there is a rationale that is used for removal of asymptomatic wisdom teeth. This rationale is as follows:

• Wisdom teeth that are symptom-free may still be able to harbour disease and infection
• If there is not an adequate amount of space for a tooth to erupt and develop, it may be difficult to clean the tooth properly and this will allow for the accumulation of plaque
• Severe complications regarding wisdom teeth tend to occur less commonly amongst younger adults, when the teeth are removed much later in life the risks are often increased due to advanced age and decreased strength and resilience of the individual (older adults tend to take longer to recover from surgery)