If you got one of your wisdom teeth removed, you don’t need to get the opposing wisdom tooth removed too.

At least, not for that reason alone.

I have encountered many people that got one or two wisdom teeth removed, typically the bottom ones. Their dentist then told them they also need to get the opposing wisdom teeth removed, even if there is seemingly nothing wrong with them. They are told that a tooth without a contact is a tooth that will migrate slightly outside the bone, ending up at a different height from the rest of the teeth. The technical term for this phenomenon is overeruption. Many dentists advocate for the removal of wisdom teeth without a contact to prevent this.

People wonder if this phenomenon is true, and if it is a valid reason to remove their wisdom teeth. The short answers are yes and no, respectively. I will proceed to elaborate the long answers.

Yes, overeruption is a real thing, and it is of course detrimental for the stability of the teeth. It can happen to any tooth without a contact in the opposing dental arch, not just wisdom teeth. This is part of the reason why restoring lost teeth is so important: restoring contacts is a way to protect the remaining teeth.

However, I don’t believe the risk of overeruption of wisdom teeth justifies removing them. A “risk” is hardly ever a valid reason to remove a tooth. For starters, there is no certitude: the “lonely” wisdom tooth might overerupt, or not. Even if it appears as very obviously without an antagonist on the x-ray, the x-ray is a 2D static image. It doesn’t show the dynamics of jaw motion. Maybe the patient chews in a way so that the forces stabilize the position of the third molar. Or maybe there is no overeruption, even in the absence of an antagonist, for some other reason. As a non-exact science, dentistry is complex and chaotic, making predictions complicated.

But most importantly: even if it effectively overerupts, so what? An overerupted tooth is not ideal, but you can still keep it with no problems. I frequently see patients with overerupted teeth, wisdom teeth or other, with no issues. An overerupted tooth is not necessarily a problematic tooth. This includes overerupted wisdom teeth. If it isn’t broken, don’t fix it!

As I said before, any tooth can suffer this problem, not just wisdom teeth. Yet, we don’t see dentists advocating for the removal of any other tooth at risk of overeruption. It is understood that a healthy and asymptomatic tooth doesn’t need to get extracted. It is also understood that such “lonely” teeth without a contact might become useful one day, as a support for a prosthesis, for example.

This should apply to wisdom teeth. They are teeth like any other. Overerupted or not, if it they are healthy and not annoying you, just leave them there. And if you ever get a problem, you get them removed when and if you ever need to, not before. There is absolutely nothing wrong with this. It is what you would do if we were talking about any other tooth, after all. Shockers, once again: that’s what wisdom teeth are. Teeth like any other.

In fact, did you know that sometimes, the later the removal of wisdom teeth is done, the easier it is? Chances are you heard precisely the contrary: that earlier is better, for easier healing in young patients or whatnot. This is only partially true. You can check out the corresponding article for further insight.

As far as overerupted wisdom teeth are concerned, that claim of “the earlier, the easier” is a complete lie. If there is a kind of wisdom tooth that will become easier to remove with time, it is precisely the wisdom teeth that may overerupt. Think about it: as they migrate outwards, “exiting” the bone, “looking for” the contact they no longer have, they will become more loosely attached to the bone. And that means that the extraction, if ever necessary, will become easier and less traumatic with time. So, the longer you wait, the easier it will be.

Let’s imagine a 16-year-old whose upper wisdom teeth didn’t come in yet, but got a bottom wisdom tooth removed. His or her dentist might be tempted to recommend the removal of the upper one too, purely for “prevention”, so it doesn’t overerupt.

The removal of a wisdom tooth that didn’t come in, at 16 years old, is complicated and very invasive. It usually requires a complex surgery. If that wisdom tooth is left alone to evolve, and eventually overerupts, removing it later in life will be significantly easier, faster and safer. So, yes: it might be easier to remove at 60 than at 16. You heard me right!

So, if you are a teenager or a young adult, don’t rush up! You have a whole lifetime in front of you, with plenty of time to get teeth removed if you ever need to (hopefully, you won’t).

One last point to discuss: an overerupted tooth will forcibly have a less ideal point of contact with its neighbours. In the case of wisdom teeth, this might mean an increased risk of cavities forming in the point of contact between them and the second molars. This is a real risk, but I still don’t believe it justifies removing them “just in case”. You just need to keep a more conscious hygiene back there, including flossing the less ideal point of contact. I invite you to read my article on the hygiene of wisdom teeth.

I guess you could still consider the removal of an overerupted (or potentially overerupted) wisdom tooth, as long as you have an extremely high risk of cavities. If a cavity can be expected to form and also affect the second molar, for once, a preventive removal would make some sense. However, think of it this way too: if you already have had a lot of cavities and fillings, are you going to go and lose more of your precious natural dental material, by getting a tooth removed “just in case”? Not an easy choice. I would be wary before taking such a decision, or proposing it to my patient.

If you are in this situation, make sure you are seeing a respectful and minimally invasive professional. One that will consider and evaluate your case with the attention it deserves. In fact, no matter your situation: if you are seeing a dentist or surgeon that said something like “This wisdom tooth is useless, let’s just take it out”, without further analysis or reflection, run away and do not look back!

And that is everything. Remember that, as cheeky and bold as I sometimes am, I don’t intend to replace your dentist. I am only expressing my opinion, and just like Benito Pérez Galdós was not a better writer than Jane Austen, I am not a better dentist than yours.

A quote attributed to Aristotle says: The ignorant man affirms, the wise man doubts and reflects. So, I hope I will help you doubt when necessary, so that you can be wise!

Saludos cordales.

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