Pre-Emptive Removal of Wisdom Teeth

Q: My dentist recommends that my 17-year-old daughter have all of her wisdom teeth removed. She is not having any problems. Is this necessary?
– Donna, North Carolina

A: Third molars ("wisdom teeth") normally erupt around 18 years of age, but the eruption can range from 17 years to 21 years of age. Dentists have different philosophies regarding removal of third molars based on their experience in practice and the type of dentist they are, e.g. oral surgeon, general dentist, periodontist, orthodontist, etc.

I am a periodontist and for the most part, I favor saving teeth, even third molars. If there is pathology, decay, poor eruption pattern leading to bone loss, a cyst, or chronic infection, then I would agree there is a reason to extract third molars. Of course, there are some exceptions to all guidelines, so each situation must be handled individually.

Third molars that are preserved can help keep a patient's bite or vertical dimension of their face intact. They can act as a back abutment tooth for a permanent fixed bridge in places that implants sometimes can't be placed. And they are perfectly fine teeth to chew with as long as they erupt in proper alignment.

Premature extraction of third molars can be an option, but I would want to know what the justification is before I would agree with that plan of action. One can always seek a second opinion from another dentist if unsure. As a general rule, I would not perform pre-emptive extractions of third molars except on an individual basis. In other words, I would not do this to my patients or my children unless there was a clear indication for it.
Dr. James E. Jacobs