Is it necessary to extract your wisdom tooth if it is not causing any problems?

Thanks for your question and I understand you have a question about wisdom tooth removal even if the wisdom tooth is not causing any pain.

Firstly, it's really important to be seen by dentist for any current wisdom teeth condition, even if there is no pain.

There are many ways that wisdom teeth can be in positions affecting surrounding structures, such as:

- caries (decay) on a wisdom tooth
- impacted wisdom teeth with gum infection
- wisdom teeth causing caries on the second last molar

Interestingly, most cases do not cause any obvious symptoms such as pain even if there are dental diseases caused by the wisdom tooth.

The most worrying thing is if it is too late to save even the second last molar once a patient experiences any symptoms around their wisdom teeth.

In most cases, if a patient has a severe gum infection around the wisdom tooth, including the second last molar, or has severe caries on a wisdom tooth, pain may come from the second last molar.

Therefore, the main purpose of wisdom tooth extraction is more to prevent the loss of the second last molar or serious gum infections, which most likely would happen based on research.

These cases are typical examples where a dentist may recommend wisdom tooth extraction even though there may be no pain:

1. Caries (decay) on a wisdom tooth

In this case, a filling can be done if necessary or the wisdom tooth is fully erupted in the right position.

2. Gum infection around wisdom tooth (including the second last molar engaged)

3. Impacted wisdom tooth (not fully erupted). In this case, part of the wisdom tooth is visible.

- If a wisdom tooth is impacted, the area around the wisdom tooth is most likely not easy to clean.
This includes the wisdom tooth itself and especially in between the second last molar and wisdom tooth.
- This can cause bone resorption of the second last molar, which cause the shaking and loss of the second last molar
- This can cause decay on the root area of the second last molar, which cannot be treated by filling, so it should only be extracted.
- Constant trapping of food in between the wisdom tooth and second last molar could potentially cause gum infection and caries on wisdom tooth and second last molar, which will cause the loss of both teeth.

4. Dental cysts or tumors around wisdom tooth (this does not happen very often)

Number 1 and 3 occur the most often at my dental practice in cases of wisdom tooth removal before the wisdom teeth cause any pain, from my experiences.

The above are very simple examples. The wisdom tooth is sometimes like a "bomb" which potentially causes many problems for those cases.

So it is advised to get a proper examination with an X-ray and get wisdom teeth removed for above cases to prevent from further pain. This is especially since healing time is longer after wisdom tooth extraction if the wisdom teeth caused pain, compared to if the wisdom teeth caused no pain.

Preventing complications is better than wisdom tooth removal after symptoms occur if it is a very obvious case.

Thanks for your valuable question about wisdom teeth and I hope my answer is helpful for you.

Please feel free to contact us or leave further question if there are further questions.

Thanks so much.

Warm regards,

Ryan Yun (Dr)

The best way to know if a wisdom tooth extraction is necessary would be to visit a dentist/oral surgeon for a thorough examination of your wisdom teeth.

If your wisdom tooth is in a proper position like other regular teeth, it may be retained. Nonetheless, a wisdom tooth's status may change over time, for example the formation of cysts/tumours or decay. Therefore, any wisdom tooth that is not removed should be re-evaluated during your six monthly visits to the dentist.

However, if your wisdom tooth fails to fully erupt or is not growing in a proper position, it becomes hard to clean and a potential food (bacteria) trap. In such cases, to reduce the risk of tooth decay or infections on the wisdom tooth and adjacent tooth, it is advisable to remove such wisdom tooth.

Best regards,

Dr Ho Kok Sen

Hi Cerise

Yes good question. It is quite important to understand why you have such a concern in the first place. If a dentist has recommended this to you, then I would presume a dental xray has been done and there might be a reason as to why he or she has advised removal in the absence of any pain.

Many patients have come in with wisdom tooth pain and said to me: "Doctor… there has been no pain in the wisdom tooth area until TODAY….WHY ???"

Worse…such patients may already have had irreversible damage to the 2nd molar (in front of the wisdom tooth). Sometimes they might require removal of both the wisdom tooth (3rd molar) and the 2nd molar at the same time !! Of course this thankfully does not happen to every single person.

But it is true, due to our refined diets these days, most of us do not have space in our jaws for full normal eruption of wisdom teeth.

If a large (panoramic) xray called an OPG is done for the detection of decay or gum disease, many dentists typically would comment on the status of the wisdom teeth. Since wisdom teeth typically erupt from 18-24 years of age, it would be quite easy to advise if there are any early or potential problems such as confirming the likelihood of the wisdom tooth being impacted (normal eruption being affected by the 2nd molar)

I am a firm believer of the prevention of further damage to good teeth for example the 2nd molar.

We routinely do OPGs (large xrays) at 3 year intervals (National Institute of Clinical Excellence Guidelines) where the wisdom teeth are assessed.

During your 6 monthly examinations and cleaning, your risk profile will then be assessed based on a number of other factors including how well you keep your mouth and in particular whether you are able to keep your wisdom teeth clean.

An early assessment is quite important as both you and I do not want undetected surprises

Yours

Dr Samintharaj KUMAR

Thank you for your question! This is one of the most common questions that patients ask me in my practice and i would be happy to share with you my opinions on the matter.

When you say : " doesn't cause any problems " i am assuming that you are referring to not having any pain or discomfort.

I would like to share with you that many dental problems associated with wisdom teeth can be absolutely painless in the early stages of the disease. And symptoms only occur when its too late.

Some examples of dental problems around wisdom teeth that can be painless ( in the early stages )are:

1. Dental Cysts and Tumours around buried wisdom teeth.

2. Dental Decay on wisdom teeth

3. Gum disease around the wisdom tooth

4. Impacted wisdom teeth causing root resorption of neighbouring molar teeth

5. Impacted wisdom teeth causing decay on neighbouring molar teeth

6. Impacted wisdom teeth that are partially erupted with constant food trap

If you have any of these painless conditions around your wisdom teeth, your dentist may advise you to consider having your wisdom teeth removed to avoid worsening of your condition, despite not having any discomfort at the present moment. This preventive mindset may benefit patients who want to avoid dealing with the problem only when pain and discomfort starts to happen. Treatment is often more extensive and complicated if the condition is left to fester and deteriorate until pain finally occurs.

I hope you found my answer useful and i wish you all the best in finding a dentist that you can trust and have rapport with !

Kind Regards,

Dr Gerald Tan