When to remove wisdom teeth


Because many people whose wisdom teeth don’t cause them any pain will nevertheless agree to have them removed to avoid possible problems later on, a researcher from the Netherlands has investigated the risk of complications associated with the procedure, such as infection and nerve damage.

When oral and maxillofacial surgeon Dr Hossein Ghaeminia from the Radboud University Nijmegen Medical Centre conducted a systematic review of the relevant research, he found there was insufficient evidence supporting removal in all such cases.

He then conducted his own research, and concluded that each patient must be considered individually.

“On the one hand, surgical intervention is accompanied by a risk of complications, such as infection of the wound and damage to the sensory nerve of the lip and chin,” Dr Ghaeminia said. “On the other hand, leaving a problem-free wisdom tooth in place may eventually lead to more damage to the neighbouring teeth.”

Since one of the most frequent complications after removing wisdom teeth is infection, Dr Ghaeminia examined which factors contribute most to this problem.

“People who are 26 or older and women run a greater risk of infection, but smoking also appears to be a risk factor,” he said.

Dr Ghaeminia also looked at whether infection can be prevented by rinsing the cavity that once held the tooth with tap water. “Compared with other options, such as antibiotics, rinsing with tap water is a relatively cheap and simple way to prevent infection after removal of the tooth. Patients can also do this at home,” he advised.

Dr Ghaeminia has summarised his findings in a pamphlet, which can be used to better evaluate the risks for each patient. The pamphlet consists of a decision tree with arguments for and against the removal of wisdom teeth, risk factors for complications and methods for preventing infection.

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  1. The issue is this . It is recognized that if a tooth is lost mid arch (say a premolar) the the adjacent teeth will move and tilt into the extraction space, what is not recognized is that if the last tooth in the arch is lost ( say an upper third molar) . The adjacent tooth will also tip. .
    I can not understand why the dental profession has not picked up on this.
    Also in at least some cases when an upper third molar is present but the lower third molar is congenitally missing. The upper third molar is a functional tooth meaning it takes part in the mastication process. This can been seen by simply chewing on some gum. It is so simple to see. All the dentist has to do is give the patient some sugar free gum and observe.
    If the upper third molar is removed in this case then following can happen .
    1. the upper second molar will tilt distally (I assume because the upper arch in now shorter than nature intended.
    2. the lower second molar will tilt towards the mid-line I suppose because because the lower arch is now too long in relation to the upper arch.
    I speak from experience because that is what happen to me.
    Please investigate.

  2. Above comment is very interesting. I’ve never come across anyone who has second molar migrating distally due to missing third molar. I would presume the tuberosity or the ramus will stop that from happening. However, it would be interesting to investigate on this matter. Do update me.


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