Wisdom Teeth: Do They Always Need to Come Out?

Wisdom teeth, the third molars at the very back of the mouth, usually arrive between the late teens and mid-twenties. For some people they come in straight and cause no trouble. For others they don't have room, grow in at an angle or stay trapped under the gum. Whether yours need to come out depends on how they're developing, not on a fixed rule.

When wisdom teeth can stay

Wisdom teeth may not need removal if they:

• Have fully come in and are upright
• Fit without crowding the teeth next to them
• Can be cleaned well with brushing and flossing
• Are healthy, with no decay or gum problems around them

Even then, we'll keep an eye on them at checkups and with X-rays, because they're harder to clean and more prone to problems later.

When removal is usually recommended

Removal is often the better choice when wisdom teeth:

• Are impacted, meaning trapped in the jawbone or under the gum
• Come in partially, leaving a flap of gum where bacteria and food collect and infections start
• Grow in at an angle, pushing against or damaging the neighboring molar
• Have cavities or gum disease that can't be managed well that far back
• Cause repeated pain, swelling or infection
• Form a cyst, which can damage bone and nearby teeth (uncommon, but serious)

Many dentists suggest evaluating wisdom teeth in the late teens or early twenties. At that age the roots aren't fully formed and the bone is less dense, which tends to make removal and healing easier.

Signs your wisdom teeth are causing trouble

• Pain or tenderness at the back of the mouth
• Red, swollen or bleeding gums behind the last molar
• A bad taste or bad breath that won't go away
• Jaw stiffness or trouble opening your mouth fully
• Swelling in the jaw or face

Facial swelling with fever, or trouble swallowing or breathing, can mean a spreading infection. Seek emergency medical care right away.

How we evaluate wisdom teeth

At Zen Family Dental, evaluation starts with an exam and X-rays. A panoramic X-ray shows all of your wisdom teeth, their angles and their roots in one image. When a tooth sits close to the nerve or the sinus, 3D cone beam CT imaging gives a much more detailed view for planning. Learn more about this equipment on our dental technology page.

Dr. Kour will explain what she sees and whether the teeth should stay, be watched or come out. Many straightforward extractions can be done in our office, and we offer sedation options for patients who are anxious. For complex cases, such as deeply impacted teeth or teeth close to the nerve, we'll refer you to an oral surgeon. Our extractions and oral surgery page has more detail.

What recovery is like

Most people feel back to normal within a few days to a week. To heal well:

• Bite gently on gauze to control bleeding for the first few hours.
• Use cold packs on your cheek to limit swelling during the first day or two.
• Take pain relievers exactly as directed.
• Stick to soft, cool foods at first, such as yogurt, smoothies (eaten with a spoon), soup and eggs.
• Avoid straws, smoking and vigorous rinsing for the first few days. Suction can dislodge the healing blood clot and cause a painful dry socket.
• After the first day, rinse gently with warm salt water, especially after meals.

Call us if pain gets worse after the third day, if bleeding won't stop, or if you develop fever or increasing swelling.

Get a clear answer about your wisdom teeth

If you or your teenager haven't had wisdom teeth evaluated, or if you're feeling pain at the back of your mouth, request an appointment online or call Zen Family Dental at (703) 385-2772.