Wisdom teeth: facts, symptoms and when removal is needed

Wisdom teeth do not always cause problems, and having one that has not fully come through does not automatically mean you need surgery. The decision to remove a tooth depends on its health, its effect on nearby teeth and the risks of treatment.

Some common claims about wisdom teeth can make that decision sound more straightforward than it is. Here is what to look out for and what to discuss with your dentist.

Does everyone have wisdom teeth?

Wisdom teeth are the third molars at the back of the mouth. They usually come through in the late teens or early twenties, although the timing varies. Some people do not develop all four.

A tooth may also be present without being visible. If it cannot come through normally because of its position or lack of space, it is described as impacted. Your dentist can examine the area and arrange an X-ray if it is needed to assess the tooth.

Wisdom teeth should not be removed routinely just to prevent the front teeth becoming crowded. If your teeth are moving or your bite concerns you, ask for an assessment of that problem rather than assuming the wisdom teeth are responsible.

Are wisdom teeth more likely to decay?

Their position can make them difficult to brush, especially when only part of the tooth has emerged. Plaque and trapped food can contribute to decay or inflammation around the gum. A neighbouring molar may also be affected.

Decay does not simply jump from one tooth to another. Teeth exposed to the same plaque and dietary conditions can develop problems, so cleaning the area and checking both teeth matter.

Brush twice daily with fluoride toothpaste and ask your dentist how to reach the back of your mouth comfortably. If the gum is sore or swollen, have it checked rather than repeatedly forcing a brush into the area.

Which symptoms need attention?

Pain, swelling, an unpleasant taste or difficulty opening your mouth can occur with inflammation or infection around a partly erupted wisdom tooth. This is called pericoronitis. Restricted mouth opening is sometimes called trismus; it is a symptom, not another name for the jaw joint.

Do not assume severe pain, facial swelling or fever is normal tooth eruption. Seek an urgent dental appointment, or contact NHS 111 if you cannot get help. Headaches, ear pain and sinus symptoms can have other causes and should not automatically be blamed on wisdom teeth.

Call 999 or go to A&E if swelling makes it difficult to breathe, speak or swallow, affects the eye or vision, or is extensive inside the mouth. Significant difficulty opening your mouth with a suspected dental infection also needs emergency assessment.

When might removal be recommended?

A healthy wisdom tooth can often be kept and reviewed during routine dental care. NICE guidance advises against routinely removing impacted wisdom teeth that have no disease.

Reasons to consider removal include decay that cannot be repaired, recurrent or severe infection around the tooth, an abscess, a cyst or damage to a neighbouring tooth. One mild episode of pericoronitis does not usually mean extraction is necessary; your dentist will consider its severity and whether it returns.

A wisdom tooth with decay does not always need extracting. Whether a filling or root canal treatment is practical depends on access, the tooth’s condition and its usefulness. Your dentist should explain the available options and their likely outcomes.

Removal also has risks, including bleeding, infection, dry socket and, for some lower wisdom teeth, altered sensation in the lip, chin or tongue from nerve injury. The risks depend on the tooth’s position and are part of the decision, not a reason to avoid a necessary assessment. The NHS overview of wisdom tooth removal explains the procedure and recovery.

If a wisdom tooth is troubling you, contact the practice for an assessment. You do not need to wait until the pain becomes severe.