Should I remove a wisdom tooth that doesn’t hurt?
Why some guidelines say not to remove healthy wisdom teeth
Removing wisdom teeth “just in case” was once common. Some health authorities now advise against it. The UK’s National Institute for Health and Care Excellence (NICE), for example, recommends that impacted wisdom teeth that are free of disease should not be removed routinely, and that surgery be limited to teeth with evidence of a problem. Every operation carries some risk, such as temporary or, rarely, lasting numbness from the nerve in the lower jaw, so removing a healthy tooth that may never cause trouble is not always the right trade-off.
Why a pain-free wisdom tooth may still need to come out
Pain is a late signal. Several common problems develop quietly:
- Decay at the back of the second molar. A wisdom tooth angled forward against the molar in front traps food in a spot you cannot clean. Decay there often causes no pain until it is deep, and can cost you the second molar too.
- Bone loss behind the second molar, which may not fully recover even after the wisdom tooth is removed.
- Decay in the wisdom tooth itself, which is hard to fill because of its position.
- Repeated gum infections around a partly erupted tooth. See swollen gum around a wisdom tooth.
- Cysts around a buried tooth, found on X-ray.
How the decision is usually made
| Situation | Usual advice |
|---|---|
| Fully erupted, upright, opposing tooth present, easy to clean, no decay | Keep and check at routine visits |
| Completely buried in bone, no disease on X-ray | Often monitored with X-rays from time to time |
| Partly erupted, angled into the second molar, food trapping | Removal often advised, especially if decay or bone loss is starting |
| Two or more episodes of gum infection, or one severe episode | Removal usually advised |
| Decay in the wisdom tooth or the tooth in front, cyst, or damage to the neighbouring root | Removal advised |
Does age matter?
Yes. In the late teens and early twenties the roots are shorter and the bone is more flexible, so surgery is generally simpler and healing faster. That is a reason to make the decision early when a tooth is clearly likely to cause problems, not a reason to remove every wisdom tooth.
What to ask your dentist
- What does the X-ray show about the position of the tooth and its roots, and how close they are to the nerve?
- Is there any decay or bone loss now, on the wisdom tooth or the molar in front?
- What is likely to happen if I leave it, and how will we monitor it?
- Would this be a simple extraction or surgery, and what are the costs and the MediSave position?
Costs
At Toothsmith, an erupted wisdom tooth removed as a simple extraction is $150 per tooth; surgical removal is $1,362.50 for one tooth or $2,343.50 for two in one sitting, and is MediSave-claimable. See wisdom tooth removal and MediSave for wisdom tooth surgery.
Frequently asked questions
Is it okay to never remove my wisdom teeth?
Yes, if they are healthy, can be kept clean and are checked regularly. Many people keep their wisdom teeth for life.
Why are dentists keen to remove wisdom teeth?
Because partly erupted wisdom teeth commonly cause decay, gum infections and bone loss around the molar in front, often without pain until late. A good recommendation is based on what the X-ray shows, and you should be told what happens if you choose to wait.
Should I remove wisdom teeth before braces?
Not routinely. Whether wisdom teeth need removing before or after orthodontic treatment depends on their position and the treatment plan; your dentist will advise case by case.
Do I need to remove all four wisdom teeth at once?
No. Only the teeth with a problem need to come out. Sometimes an upper tooth is removed with a lower one so that it does not over-erupt or bite into the gum.
Sources
- NICE, Guidance on the extraction of wisdom teeth (TA1, 2000), via INAHTA summary
Questions about your teeth?
Book a check-up. You will hear what we find, the options and the fee before anything is done.