The wisdom tooth is the last tooth to appear in the mouth. It usually erupts in late adolescence or early adulthood, but in some people it appears later, and in others it never fully erupts.
For some people, wisdom teeth don’t cause any problems at all. They grow in normally, can be brushed properly, and remain healthy for a lifetime.
For others, however, wisdom teeth can cause pain, inflammation, cavities, or repeated infections.
The question most patients have is simple:
„Should it be removed, or can it stay?”
The correct answer is that not every wisdom tooth needs to be extracted.
However, there are certain situations in which extraction is recommended or even necessary to avoid more serious complications. Common reasons include pain, swelling, gum infections, cavities, cysts, or damage to the adjacent tooth.
Why do problems with wisdom teeth occur?
The main problem is, more often than not, space.
Many people’s jaws do not have enough room for another tooth. For this reason, a wisdom tooth may:
- grow crooked
- gets stuck in the bone
- erupts only partially
- affect the adjacent tooth
- cause inflammation and infections
- be difficult to clean properly
In many cases, the patient doesn't even realize that the tooth is growing in the wrong position until pain sets in or until they have an X-ray taken.
Sometimes, the tooth remains completely embedded in the bone and causes no symptoms for years.
Other times, it only erupts halfway, and the gum that remains over the tooth becomes a place where bacteria and food particles can accumulate.
When should a wisdom tooth be removed?
1. When the pain occurs
Pain is one of the most common reasons why patients visit the doctor.
The following may occur:
- at the back of the mouth
- in the jaw
- toward the ear
- when chewing
- when opening the mouth
Sometimes, the pain comes and goes. Other times, it becomes constant.
Many patients notice that their symptoms come and go. The area swells for a few days, then seems to go back to normal.
That doesn't necessarily mean the problem is over.
Often, inflammation or infection can recur, especially if the tooth is only partially erupted and the area remains difficult to clean.
2. When the gums become inflamed frequently
When a molar erupts only partially, the gum may remain over part of the tooth.
The following can get trapped under that gum:
- bacteria
- food scraps
- dental plaque
The area becomes difficult to clean.
Inflammation occurs, and the patient may experience:
- swollen gums
- bad breath
- unpleasant taste
- sensitivity when chewing
- difficulty opening the mouth
This condition is called pericoronitis and is commonly seen in partially erupted wisdom teeth. Pericoronitis is one of the common indications for extraction, especially when episodes recur.
In many cases, the problem recurs periodically until the underlying cause is addressed.
3. When does tooth decay occur?
Wisdom teeth are among the hardest teeth to clean.
It's hard for a toothbrush and dental floss to reach that area, and bacteria can build up quickly.
May appear:
- cavities on the wisdom teeth
- cavity on the adjacent tooth
- gum inflammation
- infections
Sometimes, tooth decay is detected late because the affected area is difficult to see, even for the patient.
In some cases, the adjacent tooth is so severely affected that it may require more complex treatment.
4. When it affects the adjacent tooth
Sometimes, a wisdom tooth doesn't have enough room to erupt properly and may end up tilted toward the molar in front of it.
In this situation, the main problem isn’t necessarily that it „pushes” all the teeth, but rather that it can contribute to:
- cavity on the adjacent tooth
- damage to the root of the adjacent tooth
- local gum inflammation
- bone loss in that area
- significant cleaning difficulties
In the past, it was often said that wisdom teeth cause crowding of the front teeth. Today, the view is more nuanced. Tooth crowding can have many causes, and wisdom teeth are not always the main cause.
For people who have worn braces, the decision to extract wisdom teeth is made following a consultation and an X-ray, not merely as a preventive measure. Cochrane evidence shows that there is insufficient data to clearly support the claim that removing asymptomatic wisdom teeth prevents crowding of the teeth.
5. When cysts or infections occur
In rare cases, a wisdom tooth can cause:
- cysts
- abscesses
- damage to the surrounding bone
- damage to the roots of adjacent teeth
The problem is that some of these complications may develop without any obvious symptoms at first.
That is why X-rays and regular checkups are important.
A dental checkup can determine whether the wisdom tooth is positioned correctly or if there are any risks to the surrounding teeth.
When a wisdom tooth should NOT be removed
Not all wisdom teeth need to be removed as a preventive measure.
If the tooth:
- is completely broken
- can be cleaned thoroughly
- has no cavities
- it doesn't hurt
- does not affect the other teeth
- shows no signs of disease on the X-ray
…then it can stay on the arch.
In these cases, the doctor may recommend only periodic monitoring.
For impacted wisdom teeth that are asymptomatic and show no signs of disease, there isn’t always a clear benefit to preventive extraction. Therefore, the decision is made on a case-by-case basis, depending on the tooth’s position, the patient’s age, the risks involved, and the dentist’s recommendation.
Does the extraction hurt?
This is one of the most common fears.
The procedure is done under local anesthesia.
During the extraction, the patient may feel:
- pressure
- vibrations
- move
But he shouldn't feel any pain.
After the procedure, it is normal to experience:
- sensitivity
- swell
- discomfort for a few days
Most patients say that the anxiety leading up to the procedure was worse than the extraction itself.
What is recovery like after an extraction?
The first 2–3 days are usually the most sensitive.
Important:
- follow your doctor's recommendations
- avoid smoking
- Avoid eating very hot food
- Avoid vigorous rinsing during the first few hours
- maintain good oral hygiene as directed
It takes a few weeks for the gums to heal.
Recovery is usually easier when the extraction is performed before severe infections or local complications develop.
However, every case is different. A simple extraction may heal more easily, while an impacted tooth or one in a difficult position may require more careful recovery.
Why it's not a good idea to put things off for too long
Many patients put off seeing a doctor because the pain goes away temporarily.
The problem is that the symptoms may return.
Repeated infections or untreated cavities can lead to:
- damage to the adjacent tooth
- bone damage
- more severe pain
- recurrent inflammation
- more complex treatments
The earlier the problem is detected, the simpler the treatment can be.
A dental X-ray and a dental exam can determine whether the wisdom tooth needs to be removed or simply monitored.
Conclusion
Wisdom teeth do not need to be removed in all cases.
If it is healthy, fully erupted, easy to clean, and does not affect the adjacent teeth, it can remain in the mouth.
Extraction is recommended when pain, recurrent infections, cavities, damage to adjacent teeth, cysts, or other complications arise.
The surest way to determine whether a wisdom tooth needs to be removed is to see a dentist and have an X-ray taken.
Article written by the Smile City medical team. The information presented is for educational purposes and does not replace a personalized dental consultation.
Frequently Asked Questions About the Wisdom Tooth
At what age do wisdom teeth come in?
They usually appear between late adolescence and early adulthood. However, there is variation from person to person.
Do all wisdom teeth need to be removed?
No. A fully erupted, healthy wisdom tooth that is easy to clean and does not affect the adjacent teeth can remain in the mouth.
If it is present but does not cause symptoms and there are no signs of disease on the X-ray, your doctor may recommend regular monitoring.
How long does the extraction take?
Depending on the complexity, the procedure can take between 20 and 60 minutes.
A simple extraction may be quicker. An impacted tooth or one that is difficult to access may take longer.
Can I go to work tomorrow?
Many patients return to their normal activities quickly, but this depends on the difficulty of the extraction and how the body responds after the procedure.
If the extraction was more complicated, you may need 1–2 days of rest.
Can antibiotics solve the problem?
Antibiotics may be necessary for certain infections, but they do not address the underlying cause if the tooth remains partially erupted, difficult to clean, or stuck in a problematic position.
That is why symptoms may return after a while.
The appropriate treatment is determined during the consultation, based on the infection, X-ray results, and the patient’s overall condition.
Could I have a problem even if it doesn't hurt?
Yes. Some wisdom teeth can cause problems without any obvious symptoms at first.
For example, there may be cavities, inflammation, or damage to an adjacent tooth that can only be detected during an examination or on an X-ray.
Is it harder to remove a wisdom tooth in adults?
In general, extraction can become more difficult with age, especially if the roots are fully developed or if the bone is denser.
However, it is not age alone that determines the difficulty of the extraction, but rather the position of the tooth, the shape of the roots, its proximity to the nerve, and the condition of the surrounding area.