by John R. Scuba, MD, DDS

Q: My daughter is only 13 and her wisdom teeth are beginning to come in. Is that normal? I’m worried because it seems like everyone has them taken out. Is it possible that she might be able to keep them?

A: Yes, wisdom teeth (third molars) can erupt any time from the early teens until the twenties. Why and particularly when “everyone seems to have them taken out” depends on getting good advice. But “keeping them” may not be best for your daughter’s oral health. Skilled clinical exams, accurate health information, good surgical judgment and knowledge of accepted and professionally recognized indications for wisdom tooth removal are essential.

Wisdom teeth begin to develop in childhood. They are out of sight, deep in the jawbone behind all other teeth. The crown of any tooth forms first, and over many years the roots then sprout and elongate deeper into the jawbone.

Unfortunately, there is often no room for wisdom teeth. Poor position often makes wisdom teeth inaccessible for good hygiene, brushing and flossing. Many erupt partially, and some remain completely buried (impacted) under gum tissue or bone. And many go undetected until problems arise, including pain, soreness, recurrent local infection, decay, a gum or bone defect around the wisdom tooth or disease around good teeth next to them. Even in the absence of symptoms there may be other reasons to remove them, including painless, but bone destructive, cysts which can and do form around impacted teeth.

Most importantly, development of wisdom teeth depends on the widely varying physical maturity of the patient and not on any particular chronological age. Early puberty brings earlier wisdom tooth development and accompanying problems. So options must be discussed in the early teens.

A casual, wait-and-see approach is not a good idea. Annual exams with common dental x-ray films used to find cavities are also not suitable. A panorex x-ray is essential and must be reviewed by an experienced surgeon. The reasons to remove wisdom teeth, timing of surgery or consequences of allowing them to remain must be discussed.

Removal is optimal when the roots are only about half formed, so they should be discussed no later than the mid teens. This is because as wisdom teeth continue development, roots become closer to vital structures—nerves in the lower jaw and the sinuses in the upper jaw. Waiting needlessly increases the possibility of injury to these vital structures and other complications.

Despite notions otherwise, removal of a wisdom tooth is not a simple tooth extraction. Due to their limited access in the back of the mouth, the surgery is challenging and can be time consuming in inexperienced hands. Problems (infections, bleeding, swelling, cyst formation, jaw fracture, etc.) can then occur, which may require hospitalization, prolonged absence from school or work and many other costly problems. An oral surgeon with years of formal residency training beyond dental school and extensive ongoing clinical experience is an excellent choice to remove wisdom teeth. In the opinion of most surgeons and their patients, the administration of sedation and/or general anesthesia is essential for safe and comfortable wisdom tooth removal.

Dr. Scuba is retired military and a Georgia licensed physician and dentist. He is a board certified oral and maxillofacial surgeon.

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