It has no room.

It is impacted.

It is only partially erupted.

There is not enough space back there.

Your mouth is too small.

It is leaning against the second molar.

It is sideways! (Insert screaming emoji here).

It is never going to come in anyway.

No.

None of these justifies the removal of a wisdom tooth.

You heard me right.

Believing otherwise is arguably the most harmful idea surrounding wisdom teeth. Arguably, because the myth of wisdom teeth causing the incisors to crowd is a serious competitor.

To put it in simple words: what justifies removing a tooth, wisdom tooth or other, is a specific problem: a pathology.

Lacking space or having an impacted tooth is not a pathological condition. Therefore, the removal is not justified for that reason alone. In dentistry, we say a tooth is “impacted” when it hasn’t been able to come in normally.

If we were talking about an impacted wisdom tooth that is also painful or infected, or has cavities (another form of infection), by all means, yes, get it removed. There isn’t much to argue there. For impacted wisdom teeth that also have cavities, even I wouldn’t bother to fill them. The removal is clearly indicated.

For other kinds of infections, I might still consider treating them in a less invasive way before recommending the removal. And I may instruct you to improve your hygiene back there and to disinfect the impacted wisdom tooth. After all, taking care of your gums means also taking care of your impacted wisdom teeth.

But even so, I understand that removing the problematic wisdom tooth in such situations is totally reasonable.

However, if the tooth is healthy and asymptomatic, the removal is not justified.

I can’t emphasize this enough: it is perfectly fine, acceptable and reasonable to simply leave an impacted wisdom tooth there. Forget about scary stories! No matter if it is totally impacted (the tooth isn’t visible at all) or partially (the tooth has only partially come in), near the surface or deep in the bone: if it is healthy and asymptomatic, you don’t need to get it removed. Would you remove any other tooth that was also healthy and asymptomatic?

I am aware that this is a controversial topic. One of the biggest controversies in dentistry, actually. And you should be aware that here I am only expressing my personal opinion, as a dentist. Antoni Gaudí was not a better architect than Frank Lloyd Wright, and I am not a better dentist than yours.

But, in my opinion, there is no reason to extract a healthy and asymptomatic tooth just because it has no place. Impacted wisdom teeth rarely become a problem. I regularly see patients over 60, 70 or 80 years old, that kept their impacted wisdom teeth, and up to this day, they are still perfectly fine. They never needed to get them removed.

You heard me right. No matter what kind of scary stories your dentist or surgeon might have told you. This is the norm. Pathological cases are the exception. I have actually seen very few cases of impacted wisdom teeth becoming infected throughout my career. Cases that were easily solved by removing the wisdom tooth when it was necessary to do so, not before. Just like we would do with any other tooth!

Your dentist may disagree with my statements that impacted wisdom teeth are not risky. Maybe he recommends their removal quite frequently. However, be aware of this, my dear reader: if your dentist is a highly proactive professional that removes all or most impacted wisdom teeth, this also means that your dentist has little experience with their preservation. So, essentially, a dentist who has no clue about preserving wisdom teeth is telling you that preserving them is a bad idea. Does that make any sense?

I would further inquire: what is your dentist’s experience with impacted wisdom teeth left unextracted, exactly? Why is he or she so convinced that keeping impacted wisdom teeth is a bad idea? Does he have actual experience with preserving impacted, asymptomatic wisdom teeth? I mean, if he’s so convinced that keeping them is not worth it… it must be because, at some point during his career, he advocated for preserving them, like I do, right? And in doing so, he saw in real life that the approach I defend doesn’t work, right? It’s not like he’s been removing impacted wisdom teeth systematically since he got out of dental school, right? And it’s not as if he’s never had a chance to properly monitor them because he always removes them. Right?

And no, it is not better to get them out while you are young, “for better healing”, or whatever reason you might have heard. First off, because, I insist, they rarely cause problems at all. If yours did, you are an exception to the rule. Just like having appendicitis, gallstones or recurring tonsillitis are exceptions to the rule. So, just like you are not thinking of removing your healthy gallbladder, tonsils or appendix, you should not be thinking of extracting your healthy and asymptomatic wisdom teeth. Even if they are impacted. A preventive removal is an unjustified removal.

Second, because an early removal doesn’t necessarily mean an easier removal. Removing a healthy wisdom tooth could very well be HARDER than removing it when there is already some infection or inflammation around it. This would be especially true if an osteotomy (bone removal) was necessary to get to the impacted tooth. I wrote a whole article covering the topic of early removals. I invite you to check it out for further insight. Just know that, the longer you wait, the easier removing your wisdom teeth might be, in many cases.

There are also two conditions that extraction proponents love bringing up to justify the removal of impacted wisdom teeth: reabsorption of the second molar and cysts. I also talked about them on a dedicated article, that I invite you to read.

For now, let’s just say that these conditions are incredibly rare. So much so, that I have personally never seen them in real life yet. That’s right: as a dentist, I have never seen an impacted wisdom tooth reabsorbing a second molar, and I have never seen a cyst associated to an impacted wisdom tooth. The risk for these issues is so low, that they also don’t justify a prophylactic removal.

I haven’t seen “clean” reabsorptions, but I have seen a few cases of cavities forming between an impacted third molar and a second molar. This seems to be a bit more likely. And it is the only condition that may justify a purely preventive extraction. I would still not recommend it automatically: if your risk of cavities is low, I really don’t think one is going to form because of an impacted wisdom tooth. And in any case, you would probably only need to improve your hygiene back there. Having an impacted wisdom tooth simply means having a less ideal point of contact between it and the second molar. And that means that you have to be a bit extra attentive to keep it clean. So, don’t be afraid to brush back there for a bit longer, to floss and even to use a waterpik.

In a sense, I see it like having a crowned tooth: cavities are a bit more likely to affect the points of contact between a crown and its neighbours. But this doesn’t mean a crown is a bad idea. You just need to pay a bit extra attention and clean its non-natural points of contact more consciously. Exactly like for an impacted wisdom tooth. I invite you to also read my article on gum health and the hygiene of wisdom teeth.

If for some reason you were completely unable to maintain a good hygiene back there, or the impaction happened in a very unfavorable way (with food getting stuck and whatnot), or you had a crazy high risk of cavities in general, then, for once, a prophylactic removal could be considered. If this is your unfortunate (and also rare) case, I hope you will be able to discuss your options with an ethical and respectful dentist in real life. Remember that I am not here to substitute your dentist.

If this is not your case, again: you don’t need to get your impacted wisdom teeth removed. And this feels like a good moment to remind and insist about another important point, so important, that I dedicated one of the most important articles on this website to it: wisdom teeth do not push the other teeth, do not cause crowding, and do not ruin orthodontic treatments. And this applies to impacted wisdom teeth too, even horizontally impacted wisdom teeth. They don’t push. No matter how incredibly odd-looking your impacted wisdom teeth may appear on the x-ray: they are not going to push the other teeth, causing them to move and crowd. This is a complete urban legend. Erupting teeth don’t have a force. Check out the corresponding article for further insight and comments about this myth.

Also, remember that the points I bring up in my articles aren’t based on my personal experience alone. They are also based on studies and clinical guidelines. You can consult everything on the Resources section. The clinical guidelines of multiple countries specifically advise against removing impacted wisdom teeth, as long as they are healthy and asymptomatic.

So, maybe, if you were in a different country, with your mouth being exactly like it is, your dentist or surgeon wouldn’t be suggesting you to get your wisdom teeth removed. Isn’t that absurd? I think it perfectly shows how nonsensical the prophylactic removal of healthy teeth is. Something tells me that if it was actually good and necessary, it would be a universal practice. Thankfully, it is not. In fact, let’s open our local minds and adopt a global mind: on a worldwide scale, it is only a tiny minority of people that are getting their wisdom teeth extracted for purely prophylactic reasons.

To me, impacted wisdom teeth indicate a lack of maxillary development. Similar to crowded incisors. This is not “evolutionary” or genetic in any way: I think it just indicates that the person didn’t eat a tough enough diet while growing up. As a consequence, the lack of a proper muscular function caused the maxillary and jaw bones to not develop properly, and the teeth to not adopt a proper position along the dental arch. I have another article where I expose my reflections about this idea in particular. For now, let’s just say that just like you wouldn’t remove a crooked incisor “because it has no space”, the exact same principle applies to impacted wisdom teeth. Because, believe it or not, wisdom teeth are nothing more than teeth like any other. And they should be considered and treated as such.

Beware of wrong diagnoses of impacted wisdom teeth, too. It is not only that impaction alone doesn’t justify removing a wisdom tooth: there is also a chance your dentist has failed to correctly diagnose the tooth as normal!

Sometimes, normally positioned or normally developing wisdom teeth get wrongly diagnosed as impacted. You should not let this happen to you. I have another article on this issue too. Be aware that a certain degree of inclination is normal for wisdom teeth. They should be neither too straight, nor too inclined towards the second molar. To be sure: refuse the removal of wisdom teeth altogether if you have no symptoms or pathology.

None of my patients ever gets a wisdom tooth removed unless the removal is perfectly justified. And impaction, on its own, doesn’t justify it. My patients keep their impacted wisdom teeth, they skip the risky surgery, and they are perfectly fine. And if there is ever a problem, I will be there for them, being their dentist, ready to help and assist with any dental issue that may arise. Isn’t that what dentists are for, anyway? We are dentists, not tooth pullers!

And I am here for you too. If you have impacted wisdom teeth and have questions, don’t hesitate to contact me. I will be pleased to help you and give you more insight about your case.

And that will be everything. It is the manual and proactive nature of dentistry that often pushes dentists towards performing or recommending treatments that are not entirely needed. I genuinely believe that the main reason for the widespread, unnecessary removal of impacted wisdom teeth in some countries (America among them) is that they look “too obvious” on x-rays. So, I will bid farewell with this Spanish proverb, that, in my opinion, describes very well the issue that affects many dentists, and especially, oral surgeons: Si tienes un martillo, todo te parecerá un clavo. Meaning: If you have a hammer, everything will look like a nail to you.

Saludos cordales.