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Our third molars, or wisdom teeth as they are commonly called, are evolutionary remnants from a time when humans had a predominantly raw and uncooked diet. It is universally accepted that wisdom teeth are superfluous to our needs and that patients do not lose anything by having them extracted.

Here are some commonly asked questions about wisdom teeth answered.

When Should Wisdom Teeth Be Extracted?

There are two schools of thought in this matter. One is that the wisdom teeth should be removed prophylactically so that they do not have the chance to cause pain, discomfort or other problems to patients at all. They can also be extracted if they are in improper occlusion, erupting at a poor angle, causing food debris to be accumulated or impinging on neighboring teeth.

The other school of thought is that only those wisdom teeth that are causing some trouble should be extracted. Most wisdom teeth that are completely submerged in the bone do not cause any trouble and remain dormant throughout life.

Both schools of thought have equal proponents.

Why Do Wisdom Teeth Often Cause Pain?

The cause of pain is twofold. Wisdom teeth can cause physical discomfort as they apply pressure to the neighboring structures and cause chronic trauma to the inside of the cheek, restrict mouth mobility and even cause trouble in swallowing. Apart from this, they have a tendency to get infected, especially if they are partially erupted, because patients are unable to maintain proper oral hygiene in that area.

Is Extraction The Only Solution?

For a large majority of cases, it is. Keeping wisdom teeth in the mouth and possibly moving them to another position through the use of orthodontic forces is done in rare cases where either the adjacent teeth are missing, or there is enough space in the jaws for the teeth to function harmoniously.

Sometimes if the doctor feels that the path of eruption is good and the tooth is likely to erupt in a proper position, then the tooth is not extracted. Extraction can also sometimes be delayed with the use of antibiotics and anti-inflammatory drugs to provide relief to the patient. Usually, however the pain, inflammation and swelling will return within a couple of months.

Even if an extraction has to be done, the presence of a large abscess or swelling may require the procedure to be delayed until oral medication helps bring the infection under control.

Should Wisdom Teeth Be Extracted Even If They Are Fully Erupted And Asymptomatic?

In some situations, yes. Our teeth exist and function in pairs, so if the lower wisdom teeth have to be extracted for any reason, then there is no point in keeping the upper wisdom teeth in the mouth. Teeth which do not have an antagonist cannot help a person in chewing, erupts out of their socket over a period of time and becomes extremely prone to develop sensitivity and decay.

If for some reason your doctor has advised you not to get your wisdom teeth extracted even if you are having some pain, then it is probably based on the assumption that this discomfort is transient and that there is adequate space for the wisdom teeth to function properly. If over a period of time this does not subside, then your doctor will advise extraction. 

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