What are wisdom teeth and when do they appear? 

Third molars, known as wisdom teeth, are the last teeth to break through the gums (erupt). This usually happens during the late teens or early twenties of a person’s life. Presumably, the term wisdom teeth was coined as a result of this late appearance when people tend to be a little ‘wiser’.

Dr. Hurst monitors the development of wisdom teeth throughout the teenage years. In coordination with an oral surgeon and often an orthodontist, Dr. Hurst determines if and when wisdom teeth need to be removed by assessing their position in the mouth and root development. Referrals may be made sooner if the wisdom teeth are tilted to the side or horizontal. Individuals typically have between one to four wisdom teeth, but some have more and others have none.

As children age and enter the teenage years, parents are often concerned about wisdom tooth development in their children and wonder when is the best time to have wisdom teeth removed or whether they should be removed at all.

What issues require the removal of wisdom teeth?

Roughly 85% of people will need wisdom tooth extraction at some point in their lives. Teeth which have not erupted through the gums are considered impacted. Impacted wisdom teeth are the chief cause of extraction, as impaction can cause pain, damage to neighboring teeth, cysts, decay, and gum disease. Symptoms of impaction include:

• Red or swollen gums

• Tender or bleeding gums

• Jaw pain

• Swelling around the jaw

• Bad breath

• An unpleasant taste in the mouth

• Difficulty opening the mouth

An impacted wisdom tooth can either be fully-erupted, partially-erupted, or fully-impacted. Partially-erupted wisdom teeth tend to have a higher rate of decay due to the difficulty in thoroughly cleaning the tooth surface.  Whatever the state of your child’s wisdom teeth, the teeth can:

• Grow at an angle toward the neighboring tooth

• Grow at an angle toward the back of the mouth

• Grow at a right angle to the other teeth, in a horizontal position

• Grow vertically but stay trapped within the jawbone

Wisdom teeth are usually removed following orthodontic treatment. Periodic panoramic x-rays will show the number of wisdom teeth and their position. It is prudent to get them removed before the roots develop significantly.  

If the teeth remain impacted (unerupted), the patient doesn’t have sufficient space, or the teeth are positioned unfavorably as determined on x-ray, they should be extracted. In addition, if the patient is having symptoms such as pain or swelling, they should probably be extracted.

Do wisdom teeth have to be removed?

Each patient is different; some may have enough room in their jaw to accommodate the eruption of wisdom teeth, while others may have a smaller jawline requiring extraction. Although there may be enough room in the jaw, the wisdom teeth may not necessarily come in straight, affecting the second molars which could shift all the other teeth. 

Occasionally a patient will have enough room and the wisdom teeth will erupt into the proper position and not cause problems.  In that case, the teeth don’t necessarily need to be removed as long as the patient remains asymptomatic and can adequately clean the teeth. 

If you decide not to have your child’s wisdom teeth removed, they need to be monitored closely by your dentist. Wisdom teeth tend to become more problematic over time.

How to prevent problems with wisdom teeth

It’s important to have regular dental examinations, x-rays, and cleanings for the overall health of the teeth and to track the development of wisdom teeth in the jawline.  Many problems can be avoided by removing the wisdom teeth as soon as they are fully developed. Be sure to check with Dr. Hurst to learn the developmental status of your child’s wisdom teeth and the recommendations for their removal.