Ask the Expert: Wisdom Tooth Extraction

Dr. Emily Van Heukelom, an oral and maxillofacial surgeon at the Center for Oral Surgery and Dental Implants, answers your questions about wisdom teeth.

What are wisdom teeth, and where are they?

Most people have 4 wisdom teeth at the back of the mouth. One on each side, top and bottom.

Do everyone’s wisdom teeth need to be removed?

Many people wonder about this or wonder if their kids need to undergo a procedure even when there may be no pain or symptoms. While it is true that some people have room for their wisdom teeth, they often still have problems that require removal. They do not need to be removed if they grow in completely, chew well, don’t have signs of decay or gum disease, and don’t cause pain. Like other teeth, good daily care at home, annual check-ups, and periodic X-rays are recommended to keep erupted wisdom teeth healthy. 

How common is it that there isn’t enough space for wisdom teeth?

A majority of people do not have enough room for all of their wisdom teeth to erupt fully and be maintained in a state of health. Even when wisdom teeth erupt all the way into the mouth, they’re often so far back that it’s hard to clean them well, making wisdom teeth more vulnerable to gum disease or tooth decay. For some people, wisdom teeth remain impacted, meaning the teeth can’t break through the gums all the way due to lack of space or poor alignment. Like some other medical conditions, such as high blood pressure and diabetes, problems with wisdom teeth can exist for a long time without causing pain. In other words, pain free doesn’t mean problem free.

When is the right time to get wisdom teeth checked?

If the wisdom teeth are erupted, your dentist can evaluate them at regular cleaning and exam appointments. For younger patients, the professional organization of the American Association of Oral and Maxillofacial Surgeons (AAOMS) has conducted studies of wisdom teeth, and strongly recommends that third molars be evaluated by an oral surgeon by the time a patient is a young adult. The goal is to assess the wisdom teeth and the potential for issues, and to recommend management options specific to the patient. It’s important to have this evaluation as the teeth are developing because if surgery is recommended, the risk of complications and speed of recovery is typically more favorable before the tooth roots are fully developed. Reasons wisdom teeth may need to be removed include:

• Infections and/or periodontal (gum) disease
• Cavities that cannot be restored
• Pathologies, such as cysts and tumors
• Damage to neighboring teeth

If wisdom teeth need to be removed, how can a patient get into your office?

Many patients receive a referral from their regular dentist, though some call us directly to set up the first visit. We invite patients to our office or suggest a telehealth consultation to review their medical history and X-rays, and to evaluate the mouth. Then we discuss the patient’s unique situation and treatment recommendation—there’s no one-size-fits all. For some people needing one tooth removed, we’re able to use local numbing and they can drive to/from the appointment themselves. In other situations, we talk about additional options to keep our patients comfortable, including medication for anxiety, nitrous oxide (“laughing gas”), and sedation anesthesia.

About Dr. Van Heukelom

Dr. Emily Van Heukelom practices general oral and maxillofacial surgery at the Center for Oral Surgery and Dental Implants, with interests in dentoalveolar/dental implant surgery, full mouth rehabilitation, anesthesia, and hospital-based procedures. She is a graduate of the University of Iowa College of Dentistry, followed by residencies at the University of Iowa Hospitals & Clinics and Boston University Medical Center. Read more about Dr. Van Heukelom.