Many people assume wisdom teeth have to come out sooner or later. They do not. A wisdom tooth that is healthy, easy to clean and showing no disease on X-rays can often be left alone and checked at your regular visits. Pain is a poor guide either way, though: some wisdom teeth cause trouble quietly, and a few are worth removing even before they hurt.
The research does not support removing healthy wisdom teeth as a routine
The question of whether to take out impacted wisdom teeth that have no symptoms and no disease has been studied closely. A Cochrane review by Ghaeminia and colleagues (2020) found too little good evidence to say whether such teeth should be removed or kept. The only long-term study it found suggested, with very low certainty, that keeping them may be linked to a higher risk of gum disease around the molar in front over many years. One trial in teenagers found no evidence that removing them changed crowding of the other teeth.
The reviewers concluded that, without stronger evidence, the decision should be shared between patient and clinician, taking into account the person's values and the dentist's assessment. In practice, that means looking at each tooth rather than following a blanket rule.
Problems that develop without pain
Two quiet problems explain why "it does not hurt" is not the whole story.
A wisdom tooth that has only partly come through often has a flap of gum over it. Food and plaque collect underneath, and the area can become inflamed again and again, a condition called pericoronitis. Between flare-ups it may feel completely normal.
A wisdom tooth that leans forward against the molar in front creates a narrow gap that neither toothbrush nor floss reaches well. Decay or gum disease can start on the back of that molar, out of sight. Because the molar in front is the more valuable tooth, damage there is one of the stronger reasons to act.
Weighing up keeping versus removing
| Points towards monitoring | Points towards removal |
|---|---|
| Tooth fully through and in a useful position | Repeated infection or swelling of the gum over the tooth |
| You can clean around it well | Decay in the wisdom tooth or the back of the molar in front |
| X-rays show no decay, cyst or bone loss | A cyst or other change around the tooth on X-ray |
| Stable from one check-up to the next | Gum pockets around the molar in front that do not improve |
| Older adult with little sign of change | A tooth that cannot be cleaned and is getting worse |
Age plays a part too. Recovery after removal tends to be easier in younger adults, which is sometimes a reason to act earlier on a tooth that is already showing problems. It is not, on its own, a reason to remove a tooth that is healthy. In older adults, the risks and recovery of surgery are weighed against what is often a low chance of future trouble.
Keeping a wisdom tooth means keeping an eye on it
Deciding to keep a wisdom tooth is an active choice. It involves regular check-ups so the area can be examined, an X-ray from time to time to look for hidden decay or changes around the roots, and careful cleaning at the back of the mouth every day. A bad taste that keeps returning, swelling or tenderness at the back of the jaw is worth booking in for rather than waiting until your next routine visit. Our guide to impacted wisdom teeth describes these warning signs in more detail, and our article on swollen gums covers other causes of gum swelling.
If removal is recommended
Most wisdom teeth are removed in a single visit under local anaesthetic; if you are anxious, ask us about sedation options. When the roots of a lower wisdom tooth sit very close to the nerve, a coronectomy, where the crown is removed and the roots are left in place, may be offered at Lumi for suitable cases. Complex cases may be referred to an oral surgeon. For recovery, see our articles on what to eat after wisdom teeth removal and flying after wisdom teeth removal.
Common questions
Do wisdom teeth push the front teeth out of line?
This is a common belief, but the evidence does not show that removing wisdom teeth prevents crowding of the front teeth. Removal is considered for problems such as decay, infection or damage to the molar in front, not to stop crowding.
How often should a kept wisdom tooth be checked?
Usually at your routine check-ups, with an X-ray from time to time. Your dentist will suggest an interval based on how the tooth looks and your risk of decay and gum disease.
Should I wait until it hurts?
Not necessarily. Some problems, such as decay on the molar in front, are better treated before pain starts, while others never develop. A check-up and X-ray are the way to tell.
If you are unsure about your wisdom teeth, a check-up at Lumi Dental with an X-ray can show their position and health, and the dentist will talk you through the options. Any current offers are on the deals page.
This article is general information only and is not a substitute for personalised dental advice. Please see a dentist for advice about your own situation.
