Wisdom teeth often become a problem because there is not enough space to allow them to erupt normally. A space shortage will cause them to get trapped behind the existing teeth, becoming impacted. This could lead to the tooth either erupting partially or not at all.

A partially erupted tooth is tough to keep clean through normal brushing and flossing. Over time, the accumulation of bacteria, sugars and acids may cause a cavity to form, leading to decay of the impacted tooth and possibly its healthy neighbour. The trapped bacteria and food debris can also cause bad breath (halitosis) or gum infection around the wisdom tooth (pericoronitis).

If the tooth is completely impacted, it can cause a deep bony ache as it pushes against the roots of its neighbour. This can also destroy the neighbour’s roots in some cases. It is also believed that this vertical force can contribute to the crowding of the front teeth, causing them to overlap or appear twisted.

There are a few things to consider when deciding on whether to remove the wisdom teeth or not. It generally comes down to how effectively you can look after these teeth and how much discomfort they cause.

• Severe pain caused by pressure.
  This is probably the most common problem warranting the removal of wisdom teeth.

• Inability to keep them clean
  A partially exposed tooth can harbour a magnitude of bacteria that could cause problems at any stage. It is this unpredictability that has prompted surgeons to encourage patients to have them removed. Each case is unique.

• Recurrent gum infections
  If the tooth, however, causes symptoms, for instance, a recurrent gum infection, you are sometimes better off having the tooth removed rather than run the risk of developing more severe symptoms in the future. Three episodes of infection is normally a high-risk case.

• Damage to a neighbouring tooth
  Another indication for removal is the likelihood to cause damage to the otherwise sound neighbouring tooth. This can happen either because of decay that has set in or the reabsorbing of the neighbouring tooth’s root by the wisdom tooth. If there is a high likelihood of damage to the neighbouring tooth, it is better to sacrifice a problematic tooth for the wellbeing of the whole mouth. 

• Overcrowding of teeth
  Orthodontists may also request the wisdom teeth to be removed as they might interfere with their treatment.

Although horror stories are plentiful, the vast majority of wisdom teeth extractions are relatively simple, and recovery is fast. This is, however, dependent on the size, shape and position of the tooth. With simple extractions, there is usually little swelling, bruising and/or bleeding and can normally be performed by your own dentist in the dental chair. More complex extraction where the tooth is severely trapped is generally carried out by a specialist and may require special treatment. This can result in more bruising and swelling and is sometimes carried out in a surgical environment. Your dentist will be able to use x-rays to determine the complexity of your extraction and advise you on what to expect.

An unfortunate complication of any extraction is the possibility of developing a condition called 'dry socket'. If the blood clot that formed in the extraction area becomes dislodged, it exposes the underlying bone, leading to the inflammation. This condition can be excruciating but resolves after a few days. By following some simple post-treatment instructions that your dentist will provide you, you should be able to prevent this from happening.

In severe impactions, the roots of the lower wisdom tooth may lie near the main nerve to the lower jaw or the crowns may be near the nerve to the tongue. In about 1 to 2% of the cases, these nerves could be damaged during the removal of the tooth. The result would be numbness in the lips, chin, teeth or the tongue on the side affected. The movement would not be affected, only the sensation. In most cases, sensation returns after a few months.

The majority of problems occur when a tooth is partially erupted, thereby increasing the risk of developing gum infection and decay. By being extra vigilant in cleaning this area, these teeth can remain dormant for many years without giving any problems. Even if gum infection develops, early treatment with antiseptic mouth rinses and tissue salts can often clear the symptoms within a few days. With fully impacted teeth, there is less risk of developing an infection, and they are generally, therefore, less of a problem. However, in both cases, if there is a risk of damage to the neighbouring tooth or surrounding structures, it is sometimes advisable to sacrifice a problematic tooth for the well-being of the whole mouth.

As in most aspects of dentistry, the goal of treatment is to maintain a comfortable and disease-free environment. When considering the treatment for your wisdom teeth, it is important to ascertain how much their presence impacts on your life and what risk there is of developing a complication. Just because they are present does not always mean that they have to be removed.