This is a very common question that I get from patients and their loved ones.  In my practice, I generally see three types of wisdom teeth patients:

1. The first (and most common) type of wisdom teeth patients I see are younger patients, aged 14-19, who do not have pain or symptoms from their wisdom teeth. They are sent to see me because either their dentist or orthodontist recommended removal due to not enough room for the wisdom teeth to completely come through the gums (or erupt).  These teeth are on their way to becoming impacted.  

These types of patients usually are the easiest to treat, have the shortest recovery times, and most importantly have the lowest rate of surgical complications.  This is when the roots of the wisdom teeth are about 2/3 formed. Their wisdom teeth are not fully formed, thus have not extended into the areas of the sinus in the upper jaw or around the nerves in the lower jaw.  

Because of these reasons, it is recommended that patients who do not have the room for proper eruption of their wisdom teeth have them removed in their late teenage years.   

2. The second type of wisdom teeth patients are a little older, in their mid 20’s to late 30’s.  These patients might have had recommendations to have their wisdom teeth removed in the past but did not do so for a variety of reasons.  Their wisdom teeth never caused serious problems but the difficulty in keeping them clean has finally led to the deep cavities or serious gum infections which brings them to see me. These patients are usually in pain, sometimes swollen, and are exhausted because they haven’t slept the entire night prior.  They are missing work due to pain and are in desperate need for pain relief.

These  patients usually have fully formed wisdom teeth, in various positions. Some might be partially erupted or halfway through the gums.  Partially erupted wisdom teeth trap food and often get infected, causing the gum tissue to swelling and become very painful.  Sometimes the upper wisdom teeth have come through but are pointing towards the cheek tissue, causing painful trauma to the tissue and literally chewing the cheek raw.  Also cavities may be now forming around the wisdom teeth.  These cavities tend to be in very difficult areas to access and are not able to be filled by a dentist.

The green arrow is pointing to a deep pocket behind this partially erupted lower wisdom tooth.  This is a food trap and will often become infected and very painful.  These can also lead to serious infections that can spread to the throat and neck.

For whatever reason the pain is occurring, it is best to have an evaluation and to discuss treatment options.  Some wisdom teeth are very deeply impacted and will likely never cause a problem, however one can never guarantee that cysts or other lesions will not form around these teeth so it is best to have yearly x-rays to follow these teeth.  Other wisdom teeth however, especially those with active disease, should be removed.  The risks of surgical complications are higher than with younger patients, however are still relatively low.  The benefit of surgery and the risks of surgery are always thoroughly reviewed with the patient by myself and ultimately the decision is up to you, the patient!

3.   The third group of patients are patients who have not had problems with their wisdom teeth for many years until now. They range in age from their 40’s to even age 96! That is the oldest age I’ve removed wisdom teeth! There are many reasons that wisdom teeth can become problematic in a patient’s later years.

As we get older, our mouths change.  We sometimes develop chronic illnesses that require medication and this medication can at times lead to dry mouth. Dry mouth creates an environment for increased cavities and gum disease. Now teeth that were generally doing OK have become big problems.  In addition, as gum disease worsens, wisdom teeth that were fully impacted begin to surface through the gum and are now partially erupted.  These food traps then become infected and painful.  Also wisdom teeth can become sources of pain in patients wearing dentures, the denture now pressing down on thin gum tissue over an otherwise quiet impacted wisdom tooth. 

These patients have the most difficult time with surgery.  The risk of complications is the highest and the presence of medical issues in addition to the painful wisdom teeth can make anesthesia more challenging as well. This is the group that you do not want to be in.

I hope this helps to answer a common question. Remember if you ever have any questions you can always reach out to us via email or by calling the clinic.  We are more than happy to help you understand every aspect of your surgical care.