About wisdom teeth

It sounds straightforward enough. There's a tooth. The eighth one, counting from the front. Sometimes it hurts; sometimes it doesn't. One dentist says it needs to come out immediately. Another looks at the very same X-ray and says, "Leave it alone. It'll outlive you." Both are convinced they're right. Such is life.

Wisdom teeth do have a peculiar reputation. Popular wisdom credits them with almost mystical powers. Dentists, I have to admit, aren't always immune either. Let's try to make sense of them without the mysticism.

Why are they called wisdom teeth? Because they arrive late, usually between the ages of sixteen and twenty-five, by which point you've learnt a thing or two about life. That money runs out faster than you'd like, for example. That marriage isn't all romance. And that your parents, infuriatingly, were right. Just then, as if to complete the picture, a wisdom tooth emerges. As though the Creator wanted one final check that you really had grown up.

Why do some people's wisdom teeth come through while others stay put? The medical answer is a lack of space. The human answer is that some people get lucky and others don't. Most people have the beginnings of wisdom teeth, but they don't come through in everyone. A tooth starts to grow, only to find the second molar already standing in front of it. "Sorry, this seat's taken," says the neighbour. "Not my problem," replies the wisdom tooth, and grows wherever it can: sideways, at an angle, or never leaving the bone at all. Dentistry calls this impaction and malposition. The basic story is simpler: the tooth wanted to come out but couldn't find room.

Occasionally nature gets carried away and supplies five or six wisdom teeth instead of four. More of a collector's edition than the standard model.

Which raises a fair question: if most of us have them, what are they actually for? Once upon a time, they were genuinely useful. Our ancestors had larger jaws, tougher food and a great deal of chewing to get through. Then we learnt to cook, acquired knives, saucepans and blenders, and no longer needed quite so much jaw. The teeth, meanwhile, stayed at thirty-two. It's rather like trying to fit a huge, solid old wardrobe into a modern studio flat. Nothing wrong with the wardrobe. Just nowhere to put it.

That's why a wisdom tooth can now seem surplus to requirements. But not always. If it has come through properly, sits in line with the other teeth, helps you chew and can be cleaned without difficulty, there's no reason to remove it simply for being eighth in the queue. A tooth that does its job well is best left alone. A fairly sound principle outside dentistry, too.

A tooth in the wrong position is a different matter. It's difficult to clean, plaque builds up between it and its neighbour, and decay develops. Sometimes it isn't the wisdom tooth that suffers but the second molar next door, which, unlike the wisdom tooth, is a tooth we need. An unfair arrangement: one does nothing, while the other pays the price. A familiar situation, and not just inside the mouth.

It can get worse. A poorly positioned tooth can disrupt the way the teeth meet, overload parts of the jaw, interfere with the jaw joint and push the teeth in front of it out of place. Muscle tension, grating, clicking and discomfort follow. The patient has the joint treated, then the muscles, then the bite. All the while, the cause is sitting quietly at the back, saying nothing. Very typical wisdom tooth behaviour.

Impacted teeth, the ones that haven't come through, are the most intriguing. You can't see them, they don't hurt, and you don't think about them. A tooth can spend years sitting in the bone, quietly making trouble. A deep pocket forms between the second and third molars, debris collects, and sooner or later inflammation develops, sometimes quietly, sometimes quite painfully. Or the tooth finally decides to emerge, and the gum over it becomes inflamed. This is called pericoronitis. The patient comes in and says, "Doctor, something hurts back here." The dentist takes a look and says, "I see." That rarely makes anyone feel better.

Pericoronitis can, of course, be treated. But if the tooth plainly has nowhere to go and is never going to become a useful member of the team, there's a simple question to ask: why keep treating the consequences when you could remove the cause, the wisdom tooth itself?

There's a less pleasant possibility, too: cysts. A developing tooth has a surrounding sac, which normally disappears once the tooth comes through. If the tooth is impacted, that sac may remain and eventually develop into a cyst. Sometimes it's small; sometimes it grows large enough to need a serious operation. This is usually when the patient asks, "Why didn't anyone tell me sooner?" Because nothing hurt before.

So when should a wisdom tooth actually come out? This is where dentists particularly enjoy disagreeing. One says remove it. Another says monitor it. A third says leave it until it hurts. A fourth studies the X-ray in silence. A fifth removes the tooth before anyone can ask. All remain entirely confident in their expertise. In practice, the principle is simple: if a tooth is already causing trouble, damaging its neighbour or very likely to lead to complications, it is removed. If it's healthy, correctly positioned, doing its job and easy to clean, being a wisdom tooth is not, in itself, a reason to remove it. That's the whole philosophy.

Let's look at a few everyday examples.

First: the wisdom tooth has come through properly, helps with chewing, has no decay and is being kept clean. Removing it merely to make the dental chart look symmetrical serves no purpose. If decay develops, it can be treated, although root canal treatment on a wisdom tooth takes a certain strength of character. The roots are complicated, access is awkward, the patient has been holding their mouth open for forty minutes, and everyone in the room is developing a fresh appreciation of prevention.

Second: the tooth is poorly positioned, tilted, partly covered by gum, unlikely to function properly and difficult to clean. The second molar next door is suffering. Removal is usually the most logical answer.

Third: the tooth is impacted. It doesn't hurt, doesn't help with chewing and sits quietly in the bone. "If it's not bothering me, why touch it?" is a perfectly reasonable question. But the decision isn't based solely on whether it hurts. It depends on the tooth's position, its relationship with its neighbour and the likelihood of complications. Sometimes monitoring is sensible. Sometimes removal is. A wisdom tooth doesn't get a lifetime pardon for good behaviour.

Fourth: the tooth is coming through, the gum becomes inflamed, and the dentist diagnoses pericoronitis. Treatment settles the problem. Then it returns, settles again and returns again. A bad television series, endlessly repeated. If there's no room for the tooth to emerge properly, simply removing the flap of gum over it usually won't solve things. Removing the tooth itself makes more sense.

Should wisdom teeth ever be removed before they cause trouble? Sometimes, yes. Not because they're wisdom teeth, or because all wisdom teeth are bad, but because a particular tooth could become a source of problems and clearly won't develop into a normally functioning tooth. We base our conclusions on a clinical examination and cone beam computed tomography (CBCT). Prevention is a good thing, but it doesn't mean removing everything that might conceivably hurt one day. We'd run out of important body parts rather quickly.

A healthy wisdom tooth in the right position can lead a perfectly peaceful life. A badly positioned one that bothers its neighbours and is hard to clean is another story. An impacted one is a third. And one that regularly stages an inflammatory episode is a fourth. Every tooth has its own biography, even the eighth in line.

One final point. Many people fear having a wisdom tooth removed more than they fear the trouble the tooth itself can cause. Understandably: the procedure sounds rather like a punishment for insufficient wisdom. But modern diagnostic tools, anaesthesia and surgical techniques make it a reasonably predictable procedure, especially when the dentist knows in advance exactly what they intend to remove. Not a bad starting point for any operation, incidentally.

At Mickiewicz Dental Clinic, wisdom tooth removal is part of everyday practice, from straightforward cases to complicated ones. The procedure takes between ten minutes and an hour and costs roughly PLN 800–1,500, depending on how determined the tooth is to make everyone's life difficult. If you're very anxious, we can help with inhalation sedation: you breathe in nitrous oxide, and the fear gradually takes a back seat.

So if an impacted wisdom tooth has been sitting somewhere deep in your jaw for years, you don't necessarily have to wait for it to announce itself. Sometimes a CBCT scan, a careful look at it and a decision are all that's needed.

P.S. A wisdom tooth isn't a diagnosis. It's just a tooth. Sometimes a good one, sometimes not so good. Rather like the rest of us.