Vhi Chief Dental Officer, Dr Gina Kilfeather, sat with us to talk all things wisdom teeth, including surgical removal and the role of evolution in why we need them or not!

What are wisdom teeth and why do they cause issues for some people?

Wisdom teeth are essentially third molars. We all have our first and second molars, and your wisdom teeth are your third molars. Not everyone has these third molars, and not everyone who does have them will experience problems. On average, they ‘erupt’ or come through between ages 17 and 25, but some people get them outside this bracket.

The reason we have them is quite interesting and down to evolution. Our ancestors needed larger jaws and more teeth to chew through the raw, tougher foods they ate. Over time, our diets have changed, and our jaws have evolved to be smaller as a result. So, our mouths have less room for these third molars. Thanks to evolution, some people are born without wisdom teeth, or maybe two or three, rather than a full set of four. It’s this lack of space that causes the issues some people experience with their wisdom teeth.

How do we know when they need to be removed?

When a wisdom tooth can't fully erupt into the mouth, we say it’s impacted. A tooth can be partially impacted ─ that's when you can feel them at your gums or you can even see them ─ or they can be fully impacted and buried under the gum and bone. Historically, wisdom teeth were nearly always removed, whether they were causing problems or not. But now, we only remove them if they're causing symptoms. So generally, the symptoms that might indicate removal include:

• Pain around the wisdom tooth area
• Inflammation of the gum and bleeding from the area when you're brushing
• Pain with eating
• Development of an infection (called pericoronitis) around the wisdom tooth

As a rule of thumb, if these symptoms happen twice, your dentist will look at removing it. If your dentist can see from X-rays that you have a fully impacted wisdom tooth, but it's not causing you any hassle, they might still suggest removal. This is because the tooth might be likely to cause a problem with the tooth beside it, down the line. So, imagine if you've got your second molar sitting nice and straight. And your wisdom tooth is positioned at an angle beside it ─ food and bacteria will get caught down between the two, no matter how good you are at cleaning. Your second molar is at a risk of getting a cavity now, so your dentist might recommend removing it.

Does wisdom tooth removal always require surgery?

It will depend on how difficult the extraction is going to be, but the biggest determining factor is the patient. How nervous are they about dental appointments? How anxious are they about the procedure? What’s their current medical fitness like? If a patient has a bleeding condition, for instance, or they're on medication that puts them at risk, we will consider a hospital environment. But if you’re medically clear and don’t mind dental procedures, you could have it done under local anaesthetic in a dental surgery, probably with an oral surgeon. If there’s an infection around the wisdom tooth, we’ll manage that first with cleaning and antibiotics, and then we plan the removal.

What’s the recovery time for wisdom tooth removal?

The dentist performing the procedure will advise you on the expected recovery time, but you may need to plan annual leave. If you have a surgical removal, the risk of a dry socket is much higher. Dry socket happens when the blood clot in your gum (which is needed for healing) doesn’t form properly or gets lost from the socket. It’s extremely painful and delays healing, so you may need additional recovery time.

Can some people keep all wisdom teeth without issues?

Yes, they can. Some people will have impacted wisdom teeth that don't give them any issues, and don't need removal. Even if you have no pain or inflammation, but you’re worried about overcrowding or notice any changes in a wisdom tooth, visit your dentist so they can take a look.

This content is for information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Always seek advice from your GP or an appropriate medical professional if you have concerns about your health, or before commencing a new healthcare regime. If you believe that you are experiencing a medical emergency call 999 / 112 or seek emergency assistance immediately.