Wisdom Teeth
Wisdom teeth should be removed when they are causing problems, such as infection, decay, gum disease, cysts, or damage to neighbouring teeth, or when X-rays show they are impacted and likely to cause problems in the future. Most people are best evaluated in their mid-to-late teens, when roots are still forming and recovery tends to be easier. Healthy, fully erupted wisdom teeth that can be cleaned well may not need to come out.
Key takeaways
- The ideal time to have wisdom teeth assessed is the mid-teenage years, usually with a panoramic X-ray.
- Removal is recommended for wisdom teeth that are causing disease or that are impacted in a position likely to cause problems.
- Healthy, upright, fully erupted wisdom teeth that you can keep clean may be monitored instead.
- Wisdom tooth removal is the most common procedure performed at our Waterloo office, with local anesthetic, IV sedation, or general anesthesia available.
What Are Wisdom Teeth, And Why Do They Cause Problems?
Wisdom teeth are the third molars, the last teeth to develop, usually appearing between about age 17 and 25. Most mouths are built to hold about 28 teeth comfortably. When four more molars try to fit at the back of the jaw, there is often not enough room.
A wisdom tooth that cannot come in fully is called impacted. It may be:
- Soft tissue impacted: through the bone but still partly covered by gum
- Partially bony impacted: partly trapped in the jawbone
- Fully bony impacted: completely encased in bone
- Angled: tilted toward the molar in front (mesioangular), backward (distoangular), or lying sideways (horizontal)
Partly erupted teeth are hard to clean, which allows food and bacteria to collect under the gum. Teeth pushing against the molar in front can cause decay or bone loss on that tooth.
Signs Your Wisdom Teeth May Need To Come Out
- Pain, swelling, or tenderness at the back of the jaw
- Swollen gum over a partly erupted tooth, sometimes with a bad taste; see our guide to pericoronitis
- Food trapping and decay in the wisdom tooth or the molar in front of it
- Gum disease or bone loss around the back molars
- A cyst or other change around the tooth seen on X-ray
- Difficulty opening your mouth fully during a flare-up
Many impacted wisdom teeth cause no symptoms at all and are found on routine dental X-rays. That is why early evaluation matters.
What Is The Best Age To Remove Wisdom Teeth?
Most patients are first evaluated in their mid-teenage years by their dentist, orthodontist, or an oral and maxillofacial surgeon. At this stage, the roots are often only partly formed and the surrounding bone is softer, which generally makes surgery more straightforward and recovery quicker.
As patients get older, roots lengthen and may come closer to the nerve in the lower jaw or the sinus above the upper teeth, and bone becomes denser. Surgery is still very common and safe in adults, but recovery can take a little longer.
| Age range | What usually happens | Typical recommendation |
|---|---|---|
| Early teens | Wisdom teeth are forming in the jaw | Monitor on routine dental X-rays |
| Mid-to-late teens | Roots are developing; position becomes clearer | Ideal time for an oral surgery evaluation |
| 20s | Roots are usually complete; problems often begin | Remove teeth that are impacted or causing disease |
| 30s and older | Bone is denser; roots are longer | Remove teeth causing problems; monitor healthy teeth |
Do All Wisdom Teeth Need To Be Removed?
No. Evidence and guidelines support a case-by-case decision. A 2020 Cochrane review found insufficient evidence to support or refute the routine removal of wisdom teeth that are impacted but completely free of disease. The UK's NICE guidance recommends removal when there is pathology, such as repeated pericoronitis, decay that cannot be repaired, cysts, or damage to adjacent teeth.
In practice, your surgeon weighs:
- Whether the tooth is healthy and can erupt fully
- Whether you can keep it clean
- Its position relative to the nerve and sinus
- Your age and medical history
- Orthodontic treatment plans
If your wisdom teeth are healthy and functional, they can be monitored with regular dental visits and periodic X-rays.
"Patient values should be considered and clinical expertise used to guide shared decision-making." — Ghaeminia et al., Cochrane Database of Systematic Reviews, 2020
How Is Wisdom Tooth Removal Done?
- Consultation. The surgeon reviews your medical history, examines your mouth, and evaluates imaging. Some cases need 3D cone beam imaging to see the nerve and sinus clearly.
- Anesthesia choice. Wisdom teeth can be removed with local anesthetic, IV sedation, or general anesthesia. See IV sedation vs general anesthesia.
- Surgery. The teeth are removed, sometimes in sections to protect the surrounding bone, and the gum is usually closed with stitches.
- Recovery. The nursing team reviews home care before you leave. See our wisdom tooth recovery timeline and what to eat after wisdom teeth removal.
Possible risks, including temporary or, rarely, lasting numbness from nerve irritation and sinus involvement for upper teeth, are explained before surgery based on your imaging.
Wisdom Teeth Removal In Waterloo And Kitchener
Wisdom tooth removal is the most common procedure at our office at 96 Union Street East, near Uptown Waterloo. We see teens and adults from Waterloo, Kitchener, Cambridge, Guelph, Stratford, and surrounding communities, usually on referral from their dentist or orthodontist. Dr. Kevin J. McCann has provided oral and maxillofacial surgery and anesthesia care in Kitchener-Waterloo since 1994.
Wondering about fees and insurance? Read wisdom teeth removal cost in Ontario. To book, call +1 (519)-743-7811 or ask your dentist to send a referral. More details are on our wisdom teeth page.
Sources
- Ghaeminia H, Nienhuijs MEL, Toedtling V, et al. Surgical removal versus retention for the management of asymptomatic disease-free impacted wisdom teeth. Cochrane Database of Systematic Reviews, 2020.
- National Institute for Health and Care Excellence. Guidance on the extraction of wisdom teeth (TA1). 2000.
- Wisdom teeth, Dr. Kevin J. McCann Oral & Maxillofacial Surgery.
FAQ
At What Age Should Wisdom Teeth Be Removed?
Evaluation is ideal in the mid-to-late teens, when roots are still developing. Teeth that are impacted or likely to cause problems are often removed in the late teens or early twenties, when recovery tends to be easier.
Can I Keep My Wisdom Teeth?
Yes, if they are healthy, fully erupted, in a good position, and you can clean them well. They should be monitored with regular dental checkups and periodic X-rays.
Should All Four Wisdom Teeth Be Removed At Once?
Often, yes. Removing all teeth that need treatment in one appointment means one anesthetic and one recovery period. Your surgeon may recommend removing only some teeth depending on their position and health.
Is Wisdom Teeth Removal Painful?
The procedure itself is done with local anesthetic, and IV sedation or general anesthesia is available, so you should not feel pain during surgery. Afterward, soreness and swelling are normal for several days and are managed with a pain plan.
Do I Need A Referral For Wisdom Teeth Removal In Waterloo?
Most patients are referred by their dentist or orthodontist, which lets the surgeon review X-rays in advance. If you do not have a referral, call the office to ask about next steps.
This article is general patient education and does not replace an examination, diagnosis, or the written instructions from your own surgeon or dentist. If you have heavy bleeding, trouble breathing or swallowing, or rapidly spreading swelling, call the office or go to the nearest emergency department.