Wisdom teeth are the third set of molars that typically emerge between the ages of 17 and 25 – the so-called “age of wisdom.” Wisdom teeth are the last teeth to erupt, and often cause problems when they finally emerge. In some cases, wisdom teeth come through the gums only partially or not at all (impaction). When a wisdom tooth is impacted, it usually must be removed (extracted).

Some experts believe wisdom teeth developed when early humans needed additional biting power to consume a rougher type of diet than that of today’s humans. Others point out that the eruption of an extra set of molar in late adolescence to early adulthood may compensate for teeth lost due to poor dental care. Over time evolution of jaw size, improvements in dental care and changes in diet have combined to reduce the space in the dental arch for wisdom teeth to emerge. This has led to complications.

In some cases, wisdom teeth emerge normally and do not cause any pain or other symptoms. However, many patients do experience symptoms. A tooth that only partially erupts creates an opening for bacteria to create an infection (pericoronitis), leading to tenderness or swelling around the gums, jaw stiffness and general illness.  

Wisdom teeth that emerge in a poorly aligned fashion may damage adjacent teeth. Wisdom teeth often are difficult to reach during brushing, which can leave them vulnerable to tooth decay. In some cases, a cyst may form near the tooth that destroys bone or tooth roots.

A dental examination can reveal signs that a patient’s wisdom teeth have erupted. The dentist may take x-rays of the teeth to check for signs of impaction. If the dentist believes the wisdom teeth may be difficult to remove, the patient may be referred to an oral surgeon for further evaluation.

There are two approaches to treat impacted wisdom teeth. In the more conservative approach, the teeth are simply monitored unless they cause symptoms that begin to create problems. The more common and more active approach is to remove the teeth. Controversy remains on whether wisdom teeth that are not causing any problems should be removed.

Many dentists believe that impacted wisdom teeth are almost certain to cause problems at some point, and recommend surgical extraction regardless of whether or not the patient is experiencing symptoms. Dentists typically prefer to remove wisdom teeth when the patient is between the ages of 16 and 21, before the tooth roots become implanted in the jawbone. Adults may also have wisdom teeth extracted if they are not extracted during adolescence. Extraction usually takes between five and 30 minutes. In cases of more serious impaction, an oral surgeon may have to perform the extraction.

Following extraction, patients may experience a temporary period of minor pain, swelling and bleeding. However, the prognosis following extraction usually is excellent.