Do wisdom teeth need to be removed?
No, not always. Wisdom teeth that have come through fully, can be cleaned and cause no problems are usually kept and checked at routine visits. Removal is usually advised when a wisdom tooth causes repeated gum infection (pericoronitis), decay that cannot be repaired, damage to the neighbouring tooth, a cyst or an abscess. At Creative Arts in Dubai, the decision follows an examination and X-ray, with a 3D CBCT scan when the roots lie near the nerve.
Who treats you here Dr. Firas Osman Oral & Maxillofacial Surgeon & Implantologist · Dr. Khalid Saeed Co-founder & Dentist · Dr. Somar Dahdal General Dentist
Every dentist’s licence can be checked on the DHA Sheryan medical directory.
Why do wisdom teeth cause problems for some people and not others?
Wisdom teeth, or third molars, are the last teeth to form and usually appear between the late teens and mid-twenties. Whether they cause trouble depends mostly on one thing: space. If the jaw has room behind the second molars, a wisdom tooth can come through upright, meet the opposing tooth and be cleaned like any other molar. Many people have exactly that, and their wisdom teeth are no more of a problem than their other back teeth.
When space is short, a wisdom tooth may stay partly or completely under the gum or bone, or tilt forwards against the tooth in front. Such a tooth is described as impacted. Impacted and partly erupted teeth are harder to clean and are the ones linked to gum infection, decay of the wisdom tooth or the second molar, and, less often, cysts.
Some people have fewer than four wisdom teeth, or none at all, and some upper wisdom teeth come through without difficulty while the lower ones do not. Each tooth is assessed on its own.
When are wisdom teeth removed, and when can they stay?
A summary of the usual reasoning. Your own advice depends on your examination and X-rays.
| Situation | Usual advice | Why |
|---|---|---|
| Fully erupted, upright, can be cleaned, no symptoms | Keep and monitor at check-ups | It works like any other molar |
| Completely buried in bone, no symptoms, no disease on X-ray | Usually keep and monitor | Surgery has risks; the tooth may never cause trouble |
| Partly through, with repeated gum infections (pericoronitis) | Removal usually advised | The gum flap keeps trapping food and bacteria |
| Decay in the wisdom tooth that cannot sensibly be repaired | Removal usually advised | It is hard to reach for a good filling and is often not needed for chewing |
| Tilted against the second molar, causing decay or bone loss there | Removal usually advised | To protect the second molar, which is more important |
| Cyst, abscess or resorption seen on X-ray | Removal usually advised | Disease around the tooth needs treating |
| Upper wisdom tooth with no opposing tooth, over-erupting or biting the cheek | Removal often considered | It has no chewing role and can traumatise the gum or cheek |
| Wisdom tooth in the way of planned orthodontic or other treatment | Decided with the treating dentist | It depends on the movement or restoration planned |
Severe or spreading swelling is an emergency whatever the tooth's position: see the warning signs below.
What does the evidence say about removing healthy wisdom teeth?
For many years it was common to remove wisdom teeth "just in case", even when they caused no problems. That approach has been questioned. In the UK, NICE guidance on the extraction of wisdom teeth states that the routine removal of pathology-free impacted wisdom teeth should be discontinued, and that surgery should be limited to teeth with evidence of disease, such as unrestorable decay, abscess, cysts or damage to neighbouring teeth. The NHS similarly says that a wisdom tooth that is not causing problems is usually left in place and monitored at routine check-ups.
A 2020 Cochrane review looked for trials comparing removal with retention of impacted wisdom teeth that were causing no symptoms or disease. It found insufficient evidence to say which approach is better. Keeping such teeth may be linked to a higher long-term risk of gum disease around the second molar, but that evidence was of very low certainty. The authors advise that decisions rely on clinical judgement and the patient's own values, and that teeth that are kept should be monitored regularly.
In practice this means there is room for a genuine discussion. A dentist recommending removal should be able to point to a reason on your X-ray or in your mouth; a dentist recommending you keep a tooth should explain how it will be watched.
What does an X-ray or CBCT scan show about wisdom teeth?
Wisdom teeth cannot be judged by looking in the mouth alone, because much of the tooth is often hidden. A panoramic X-ray shows all four wisdom teeth at once: whether they are present, how they are angled, how developed the roots are, whether there is decay in them or the second molars, and whether there is anything unusual around them.
For lower wisdom teeth, the panoramic image also shows how close the roots come to the canal that carries the inferior alveolar nerve, which gives feeling to the lower lip and chin. If the roots appear to overlap or touch that canal, a 3D CBCT scan shows their real relationship. This matters mainly when removal is being planned; our guide to nerve damage after wisdom tooth removal explains why.
Not everyone needs a CBCT scan, and X-rays are taken only when they will change a decision. Our page on dental X-rays explains the different types.
Is there a best age to have wisdom teeth removed?
There is no single right age, and age alone is not a reason to remove a healthy tooth. What age does change is how the surgery tends to go if a tooth does need to come out:
- In the late teens and early twenties, the roots are often not fully formed and the bone is more flexible. When removal is clearly needed, many surgeons find it more straightforward at this stage, and recovery is often quicker.
- Later in adult life, roots are fully formed and the bone is denser. Removal is still routinely done, but recovery can take a little longer and the roots may be closer to the nerve.
This is why a wisdom tooth that is already causing problems in a young adult is often removed sooner rather than later, while a symptom-free tooth in the same person may simply be watched. Wisdom teeth can also cause their first problems in people's thirties, forties or later, for example when gum recession exposes a partly buried tooth, so monitoring continues throughout adult life.
Do wisdom teeth cause crowding of the front teeth?
This is one of the most common reasons people ask about removal, and the evidence does not support it as a reason on its own. The lower front teeth tend to become slightly more crowded through the late teens and twenties in many people, whether or not they have wisdom teeth, as part of normal growth and ageing. Because wisdom teeth appear at the same time, they are often blamed. The 2020 Cochrane review found that the included studies showed no clinically significant effect of removing wisdom teeth on crowding.
If you have had braces or Invisalign, or are about to, our guide to wisdom teeth and braces covers what orthodontists consider. Retainers, not wisdom tooth removal, are what keeps straightened teeth in place.
Monitoring is an active decision
Keeping a wisdom tooth means checking it at regular examinations, cleaning carefully behind the last molars with a small-headed brush, and repeating an X-ray when your dentist advises. Contact the clinic during opening hours, 10:00 to 20:00 daily, if the gum at the back becomes swollen or painful. Facial swelling with fever, difficulty swallowing or breathing, or swelling spreading to the neck needs a hospital emergency department straight away.
Not sure whether your wisdom teeth should stay or go? See how wisdom teeth are assessed, planned with 3D imaging and removed at Creative Arts in Dubai.
Wisdom tooth removalWhat happens if removal is recommended?
If a wisdom tooth does need to come out, you should be told why, which teeth, what type of extraction it will be and what the recovery usually involves. Not every wisdom tooth needs surgery: a fully erupted upper wisdom tooth is often removed like any other tooth, while an impacted lower one may need the gum opened and some bone removed. Our guide to types of tooth extraction explains the difference.
At Creative Arts, complex and impacted wisdom teeth are assessed and removed by Dr. Firas Osman, Oral & Maxillofacial Surgeon & Implantologist, with Dr. Khalid Saeed and Dr. Somar Dahdal also carrying out extractions. Local anaesthetic is standard, and sedation can be discussed for anxious patients. You receive a written plan before treatment, and the guide to preparing for wisdom tooth surgery covers the practical side.