The short version here is that you either want your wisdom teeth all the way in or all the way out. If they erupt only partially, there's a risk of getting a cavity or a gum infection because food and plaque can get trapped where you can't clean it properly.
Wisdom teeth are best evaluated between the ages of 15-17.
If it's obvious that there's no room for them, having them out younger tends to be a little easier because the roots aren't as long. However, it also helps when they're closer to the surface; a good rule of thumb is they're ready when the roots are 1/3 to 1/2 formed.
As long as the wisdom teeth aren't causing any discomfort and aren't too close to the nerve in the jaw, you generally have a window between ages 15-19 where there isn't a significant difference between when you chose to have them out.
Here's a 16 year-old with roots about 1/3rd formed. This is a great time to get them evaluated by an oral surgeon.
Does everyone absolutely have to have their wisdom teeth out?
No.
If you have space so that your wisdom teeth might erupt all the way in, I'd just monitor them and see if you can keep them clean. Careful brushing around the wisdom teeth as they erupt and rinsing with a gentle over-the-counter gum medicine like Peroxyl can help reduce the risk of cavities or infection while they erupt.
Here's a 15 year-old whose wisdom teeth look to be erupting vertical and who might have space. My advice to her was to wait and see.
If I don't get my wisdom teeth out, will it make my lower teeth crowd when I'm older?
Not necessarily.
As we age, our lower front teeth naturally continue to move forward and up. It's a slow process, but the normal tendency is for them to become more crowded anyway.
There are patients with no wisdom teeth who still get relapse crowding of their lower front teeth. And, there are patients with completely horizontal wisdom teeth who have perfectly straight teeth.
Relapse crowding could be a separate blog post all on its own.
But to sum up:
1) Relapse crowding are the severity of your original crowding, how it was treated, and how was it retained. If you try to fit too many teeth into a jaw that's too small, you have a higher risk of relapse. Extraction treatment creates space, so it tends to lessen this tendency.
2) After treatment, the type of retainer and consistently its worn play a huge role. Bonded wires are the most stable, metal wires + hard acrylic are next, and the cheap plastic tray-style are the least effective.
3) The longer you keep and wear your retainers, the more stable your lower front teeth tend to be.
4) As a distant fourth, wisdom teeth _might_ contribute to crowding, but the effects are nearly impossible to measure and are far less significant than #'s 1-3.
Is it really painful to get your wisdom teeth out?
If you're having them done by a good oral surgeon under general anesthesia, the experience is quite literally:
…Okay, I'm lying in a weird chair and they're giving me a mask. It smells like pine needles. I'm supposed to count down from 10…9...
…
…
…Uh. I'm waking up in another room now?
In most cases, you actually feel pretty good the day you get them out. However, swelling increases over the first 72 hours so you have to plan ahead and know that you're going to feel worse before you feel better. Extractions vary by complexity, so there are some that are more uncomfortable than others. Your surgeon should be able to give you an idea of where you fall on the routine to difficult spectrum.
The quick secrets to recovering from wisdom teeth:
1) Ice is your friend. The better you follow the 10 minutes on/10 minutes off regimen, the better you control your swelling. Less swelling = less discomfort
2) Plan to take it easy for at least a couple of days and follow your oral surgeon's instructions carefully.
3) Be sure to keep the healing sockets clean, but be gentle when irrigating. You do not want to get an infection in the socket!
4) If warm salt water rinses aren't your thing (blech), the aforementioned Peroxyl rinse is a nice alternative. (No, I'm not sponsored by them or anyone for that matter.)
I have three quick examples of good, not-so good, and just plain idiotic.
One of my sisters had her wisdom teeth out on a Friday afternoon. I sat on her all weekend while watching DVDs, resting, and icing. She was fine by Monday.
The other sister had her wisdom teeth out…and felt good enough that she decided to go do something with her friends. She swelled up like a chipmunk.
And then there's me. Supposed dental professional who should know better. One of my patients begged me to fill in a spot on his bass fishing team for the Northern California Club Classic. They were short a man and would be disqualified otherwise. And so it was that I woke up at 3am the day after my extractions and went fishing in 40 degree weather with heavy winds. We ended up winning the tournament by two ounces…and at the victory barbecue, my mouth was swollen shut to the point where I couldn't even eat baked beans.
So there you have it, folks. Have a good oral surgeon evaluate your teeth between age 15-17, remember that ice is your friend, and don't go fishing afterwards like your favorite orthodontist did.
If you have any other questions, please feel free to drop me a line on the office Facebook page.
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