Q. When do wisdom teeth need to be removed?
A. Wisdom teeth, also called third molars, appear last in the mouth, usually in the late teens and early 20s. By that time, the mouth is often crowded and most can’t fully surface from the gums — they are said to be impacted. The surrounding area can easily become infected; many people with impacted wisdom teeth need to have them removed eventually.
Thomas Dodson, an oral surgeon at Massachusetts General Hospital, says that some patients have clear symptoms: pain around the tooth, swelling, or limited jaw motion. Even those with no symptoms may have visible signs of disease upon examination; Dodson looks for disease in the gum tissue around the tooth, as well as in X-rays of the teeth. If the tooth is partly projecting from the gums, it will be harder to clean and more likely to get infected. In these cases, taking the tooth out is the best option.
When there are no signs of disease, Dodson says, “the treatment choices become: taking the tooth out to prevent a problem in the future, or leaving it in and monitoring it.” Both have risks. Surgery can be painful, but it’s often easier at younger ages. People who don’t remove an impacted wisdom tooth must be careful about hygiene and regular monitoring. Physicians and health organizations have debated which strategy is better, but Dodson says, “there’s only one person in the world who can answer that question, and that’s the person in the chair.”