Wisdom tooth: does it always need to be removed?
Wisdom tooth: does it always need to be removed?
The topic of wisdom teeth often raises questions and anxiety.
As a practicing dentist, I often hear: “I was told that all wisdom teeth should be removed — is that true?”
The short answer is no — wisdom teeth are not removed “by default.”
The decision depends on the position of the tooth, the condition of the surrounding tissues, and future risks.
Why wisdom teeth raise so many questions
Wisdom teeth erupt later in life, when space in the jaw is already limited.
Because of this, they often grow at an angle, partially, or fail to erupt completely.
Many myths are associated with them: “they are always removed,” “they will definitely damage the neighboring tooth.”
In reality, each situation is individual and must be evaluated accordingly.
Most problems occur with wisdom teeth because access to them is limited.
They are harder to clean, harder to treat, and harder to monitor without imaging.
When a wisdom tooth CAN be left in place
There are situations where a wisdom tooth does not cause problems and can function normally.
In such cases, preventive removal “just in case” is not required.
Fully erupted
The tooth is fully visible in the mouth and accessible for examination.
Proper alignment
It does not press on neighboring teeth or injure the gum.
Involved in chewing
There is contact with the opposing tooth.
No inflammation
The surrounding tissues are calm, without swelling or pain.
Easy to clean
The tooth can be properly cleaned with a toothbrush and floss.
Important: such teeth are not removed “as a precaution.”
We monitor them and periodically check their condition.
When removal is truly necessary
There are indications where removal helps prevent complications.
Below are the most common reasons.
If the gum over the tooth becomes inflamed repeatedly, it means self-cleaning is impaired.
Recurring episodes are a strong argument in favor of removal.
An angled wisdom tooth may press against the second molar.
This can lead to pain, enamel damage, and gum problems.
Due to difficult access, cavities may develop on the neighboring tooth.
If treatment is not possible or the risk is high, removing the wisdom tooth is justified.
If the wisdom tooth itself is affected by decay but cannot be accessed for proper treatment, preserving it makes little sense.
In such cases, removal is the more reliable option.
During preparation for braces or tooth alignment, wisdom teeth may interfere.
The decision is made together with the orthodontist.
If inflammatory changes are present around the root, action is required.
Such conditions should not be left without control.
Difference between upper and lower wisdom teeth
Lower and upper wisdom teeth behave differently, so the approach may vary.
Lower wisdom teeth are more often complex in position and located deeper.
Because of this, the risk of inflammation and significant swelling is higher.
They may be closer to nerve structures, so careful planning is especially important.
We always evaluate imaging and choose the safest approach.
Upper wisdom teeth are often easier to remove, but not always.
Their position may be unusual, and access can be limited.
Even when removal seems simple, the decision is made only after examination and imaging.
This helps avoid unexpected difficulties.
Should a wisdom tooth be removed if it doesn’t hurt?
The absence of pain does not mean there is no problem.
Some complications develop silently and are detected only on imaging.
Important: no pain ≠ no problem.
For example:
- hidden inflammation around the root;
- pressure on a neighboring tooth without obvious symptoms;
- risk of future problems due to complex positioning.
If the tooth does not hurt, this is a reason to assess the situation calmly and without haste.
The decision should still be well-founded and individualized.
What happens if a problematic wisdom tooth is not removed
If a tooth has clear indications for removal, delaying usually leads to complications.
This is not meant to scare — it is typical clinical logic.
The most common consequences include:
Inflammation
Recurring gum inflammation and discomfort.
Damage to the second molar
Risk of decay and destruction of the neighboring tooth.
Tooth shifting
Gradual changes in tooth position and bite.
More difficult removal later
With age, extraction may become more complex.
In such cases, it is better to act in a planned manner rather than wait for an acute situation.
Planned treatment is usually calmer and more predictable.
How the decision to remove is made
The process starts with a clinical examination.
Next, imaging is required — a panoramic X-ray or CT scan — to assess the tooth position.
Examination
We collect complaints and assess the condition of the gums and neighboring teeth.
Imaging
We determine the exact position of the wisdom tooth and its relationship to surrounding structures.
Risk assessment
We evaluate inflammation, decay, and the possibility of proper hygiene.
Personalized decision
We discuss the options and choose the best path specifically for you.
Important: the decision is always individualized.
Two people with similar complaints may receive different recommendations.
Common patient questions
Usually no.
Anesthesia blocks pain, leaving only pressure and movement sensations.
No.
Only those that cause problems now or pose a risk in the future are removed.
Sometimes yes, but this depends on the extent of the procedure and your condition.
The decision is made individually.
Often the optimal period is when the roots are not yet fully formed.
However, age alone is not the main criterion — the condition of the tooth is more important.
Summary
Not all wisdom teeth are a problem.
If a wisdom tooth is properly positioned, participates in chewing, and does not cause inflammation, it can be preserved.
If you are unsure whether your wisdom tooth needs to be removed, it is better to discuss this during a consultation and review imaging rather than guess or wait for complications.