I am not against the removal of wisdom teeth.

But even so, I am probably going to be known as “the dentist that is against wisdom teeth removals”. I guess that is fine. I would surely prefer a positive tag, such as “the dentist that is in favor of preserving wisdom teeth”, or a more specific tag, like “the dentist that criticizes unnecessary wisdom teeth removals”. But people tend to simply stuff.

Whatever the case, understand this: I am not against removing wisdom teeth. If somebody says that I oppose removing wisdom teeth, this person is confused or lying. I hope this article will help clarify this.

I don’t oppose, criticize or advice against the removal of third molars as a whole. How would that make any sense? It is obvious: sometimes, removing a wisdom tooth is actually necessary. When my patients need it, I remove wisdom teeth. Or I send them to a more skilled maxillofacial surgeon, depending on the complexity of the case.

What I oppose is unnecessary wisdom teeth removals. Which are actually many, if not most of the removals performed in multiple environments. You have the rest of the articles published on this website to learn more about this, so I won’t extend myself here. Just know that I oppose preventive removals. And that “No place”, “preventing crowding”, “I’m getting or I’ve had braces”, “my insurance will stop covering the removal” or “it will have no antagonist” are not valid reasons on their own to remove a wisdom tooth. Let alone all four of them!

So, when is it acceptable to remove a wisdom tooth? The core of my philosophy is simple: wisdom teeth are teeth like any other. Therefore, it is acceptable to remove them for the exact same reasons we would remove any other tooth. Any justification for the removal that is “exclusive” to wisdom teeth is almost guaranteed to be nonsense. Justifications that could apply to removing other teeth might be alright.

On a regular basis, I see patients with severely destroyed teeth from cavities. So destroyed, that even a crown isn’t possible to restore them. In such cases, the only possibility is removing the tooth. Be it a wisdom tooth or any other: if a tooth is destroyed to the point of not being restorable, it needs to be removed. So, I regularly remove wisdom teeth (and plenty of other teeth too) for this reason.

Another very typical reason for removing teeth is periodontal disease: the chronic inflammation of the tissues around the tooth. It ends up in the destruction of the support tissues. When periodontal disease is very advanced, we often have no choice but to remove the affected teeth, as they might be painful, severely infected, or wiggling like piano keys. And yes, this obviously applies to wisdom teeth too. So, I regularly remove wisdom teeth (and plenty of other teeth) for periodontal reasons.

When a cavity or fracture reaches the dental pulp, the living soft tissue inside the tooth, it might become infected and inflamed. The technical term for this is pulpitis, and the treatment required is a root canal. If for whatever reason a root canal is not possible, then the tooth would most likely need to be removed. A root canal is very complicated to do, and wisdom teeth are complicated to access, so doing root canals on them is hardly ever an option. In this case, they would need to be removed. This is the closest thing to an “exclusive” justification for the removal of only wisdom teeth I can think of. But not really, because when root canals are counter-indicated for whatever reason on other teeth, it is also indicated to extract them. If a second molar had an extremely complicated access and needed a root canal, depending on the case, any dentist could be tempted to recommend its removal too.

A tooth may erupt in an unfavorable position so that it hurts the cheek when chewing. I would try reducing the cusps a bit, to see if this can be solved in a minimally invasive way. But if that didn’t work, then, of course, the tooth would need to be removed, because a cheek getting continuously wounded is dangerous. This is not common, and, so far, I have only seen a single patient that needed to get a wisdom tooth removed for this reason.

In very rare cases, an impacted wisdom tooth may be painful or infected. Yes, you heard me right: these cases are rare, and their importance and frequency, hugely overestimated. In most patients, impacted wisdom teeth just stay there without ever causing any issues. But sometimes, such issues do happen. I personally have tools and strategies to deal with this without jumping straight to removing the tooth, in line with my minimally invasive philosophy. A good dentist is there to preserve teeth. But I still understand other dentists that simply prefer to remove the wisdom tooth. In doing so, they remove a pathological tooth, so, nothing to object there. Furthermore, if my minimally invasive measures didn’t work to solve the problems, or the problems reoccurred, then I would agree: the wisdom tooth absolutely needs to be taken out. I don’t consider this to be a problem exclusive to wisdom teeth either, because impacted wisdom teeth are exactly the same as crooked incisors: both show a lack of proper maxillary development and chewing stimuli while growing up. And if a severely crooked incisor was infected and painful, any dentist would be more tempted to remove it when compared to a perfectly positioned incisor. So, a similar principle could apply regarding impacted wisdom teeth.

Another popular reason brought up to justify removing impacted wisdom teeth is a supposed risk of damage to the second molar. Like, a risk of wisdom teeth reabsorbing a part of the second molar, similarly to how the roots of baby teeth get reabsorbed before they fall. I have literally never seen this since I began working. Never. And no clinical guideline recommends removing wisdom teeth preventively for this reason, as you can consult on the Resources section. It is simply not justified to remove an impacted, asymptomatic wisdom tooth “just in case” for this reason. But, apparently, it is something that can happen. If this was your unfortunate case, well, of course, the removal of the wisdom tooth would be clearly justified. And if in some overly weird case a patient had an impacted second molar that was reabsorbing the first one, then, I would also agree with removing the second molar under the exact same logic.

A slightly more likely problem seems to be a cavity forming in the unnatural point of contact between an impacted wisdom tooth and a second molar, affecting the second molar only. I have seen this only once in my life so far. This article will get updated, if necessary. But I am very sure that this is, statistically, a rare event. If you were unlucky enough that this happened to you, then the removal of the impacted wisdom tooth would also be justified to repair the second molar. And you may want to begin flossing a bit more frequently! Because wisdom teeth are not any kind of magical exception to how things are going in your mouth. This means that if the point of contact between one of them and a second molar has gotten cavities, you may be at risk of getting even more interdental cavities in other locations. So, yeah, if I were you, I would floss.

If your cavity risk in general is very high, for once, I guess a preventive removal can make some sense, if the wisdom tooth is impacted, and a cavity can be expected to form in its point of contact with the second molar. This would be a highly subjective decision to take. Hopefully, if necessary, you will be able to discuss it with a respectful and ethical dentist.

And speaking of cavities, I also know that many dentists will never bother to fill wisdom teeth with cavities, even when they are easily accessible. I do fill wisdom teeth with cavities as long as they are not impacted. And I think any good dentist should attempt to do so, at least if the access is easy enough. But if the tooth already has a cavity (another pathological condition), I can’t really say it’s wrong to remove it. At least, it is clearly not as wrong as a purely preventive removal.

Beyond the cases clearly linked to dental or oral pathology, there might be a few other, rare reasons, that may justify removing a third molar. For instance, a jaw fracture affecting the third molar area: sadly, the bone will not heal properly if there is a tooth on the way, so it needs to be removed. Teeth other than wisdom teeth may also need to get extracted if this happened.

There might also be a rare orthodontic need. Indeed, having an orthodontic need to remove a wisdom tooth is rare, but it might happen. Just having, planning to have or having had braces is not a proper reason to remove any wisdom tooth. But, for instance, if a third molar was preventing its neighbour, the second molar, from properly erupting, then it would of course be indicated to remove that third molar. Or, if your orthodontist was somehow planning to pull back the entire dental arches, or at least the second molars, then yes, removing the wisdom teeth BEFORE the treatment would be justified. Never after!

In this article, I have kind of gone against the general philosophy of this website. I clearly stated that this site is not about the removal of wisdom teeth, and yet, here I am, dedicating a whole article to talk about it. I think this clarification was necessary, in any case. And did you notice how I have often spoken of wisdom teeth in the singular? I strongly believe that only the wisdom teeth that are problematic should be removed, and no other. In fact, so far, I have never recommended a patient to get all his or her four wisdom teeth removed at the same time.

This is what you should look for yourself too, as a patient. Don’t let anybody convince you to get any removal done “just in case”: you get removed the teeth that you actually need to get removed, when and if you ever need to, and no other. What is wrong with actually treating the problem when it is there, anyway? No other body part gets so commonly removed “just in case” as third molars.

In my opinion, not any more valid than your dentist’s opinion, this is wrong. And this needs to change. My paisano David Bisbal is not a better singer than Ed Sheeran, and I am not a better dentist than yours, but you can still count on me for any further insight you may want to get about your case. Don’t hesitate to contact me.

So, this is the end. Since I consider this to be, for the most part, a clarifying article, I will bid farewell with a Spanish proverb that tells us of the importance of building a correct image around ourselves: Cría fama y échate a dormir. Meaning: Get yourself a reputation, and go to sleep. Mark Twain has a phrase with a similar meaning: Give a man a reputation as an early riser and he can sleep 'til noon.

Saludos cordales.