Can I Keep My Wisdom Teeth?

There really three basic situations that need to be considered when you’re answering the question: Can I keep my wisdom teeth? In one case, you have enough room for them, and they are erupting or coming in good alignment and with good access for cleaning.

Image Of Wisdom Tooth With Cleaning Access Not Blocked By Jaw Bone

Image of Wisdom Tooth, Cleaning Access Partially Blocked By Jaw Bone

Image of Wisdom Tooth, Cleaning Access Completely Blocked By Jaw Bone

  In another case, you may have limited room for them, but they are still coming in or erupting with good alignment.  Here they may be a little bit more difficult to clean and maintain because the cheek side of the lower jawbone blocks your ability to get a toothbrush alongside the wisdom tooth.

And then there’s the third situation, in which you don’t have enough room for them, or they are coming in with very bad alignment. In this case, it’s almost impossible to clean or maintain them.

1.)So let’s get started with the first of these. You’ve got room for them. Great! They are well aligned and you have good access for cleaning. You selected the right parents. And they have blessed you with a combination of a large enough jaw size and small enough teeth for all of your wisdom teeth to come in.  Its celebration time!

Image Of Wisdom Tooth With Cleaning Access Not Blocked By Jaw Bone

Now, it’s just a matter of exercising good habits to minimize your chances of having problems with your wisdom teeth.

A number of my patients do have straight teeth and enough room for all of their wisdom teeth to erupt and contact with their biting partners.  In other words, their wisdom teeth are useful and available for chewing .

And a number of those patients have excellent dental home-care knowledge and skills.  They will still have their teeth baring accidents or other unforeseen circumstances for a lifetime.

One of my favorite patients was a gentleman named Bill.  Bill was 100 years old when he passed away. I enjoyed him.  His mind was sharp, he was full of life and he was always a joy to be around.

I was Bill’s dentist for about 11 years and last saw him about a month before he died. Except for two teeth that were knocked out in an accident in his teens, he had maintained all of his teeth, (including his wisdom teeth), for a lifetime.

Bill executed his home-care well and a number dentists, including myself, provided dental care and guidance over his lifetime.

Bill was a photographer for much of his life.  At 100 years of age, he was still working four hours a day, five days a week as a photographer for an art exhibit center, cataloging all new exhibits.  I would run into him in a local photography store and say “Hi, Bill” and he would turn around and instantly say”Hi Doctor, How are you doing?”  Once, I followed him out of the parking lot on my way home, and observed that he was still driving very well. Not at all typical of many that age.

I would attribute some of his mental acuity to his keeping his teeth and gums in excellent shape. Since tooth and gum infections can affect your entire body’s health adversely by increasing inflammation in the brain, blood vessels, heart and other organs, a healthy mouth leads to a healthy body.  I would also attribute his health to perhaps a less obvious benefit of having most of his natural teeth in good order, is that he had choices when selecting foods. Teeth are designed to chewing  healthy foods. He was not a fast food junky, and he did not have to choose the macaroni and cheese soft food diet that leads to tooth decay and cognitive impairment.

2.)  Okay. Now let’s look at the situation where you have limited room for wisdom teeth but, they are coming in with good alignment.  They’re still difficult to clean and maintain properly. This is the category in which the vast majority of our patients fall that elect to keep wisdom teeth with less than an ideal amount of room for them.

Image of Wisdom Tooth, Cleaning Access Partially Blocked By Jaw BoneFor lower wisdom teeth, it is the relative position of the side of the lower jaw and the position of the wisdom tooth itself.  If it is in front of the leading edge of the jawbone, it is possible to clean the wisdom tooth.  But, if the jawbone hides or partially hides the side of the wisdom tooth, less room is left for toothbrush access.

For upper wisdom teeth, this often occurs when you have a wide upper jaw at the back of your mouth.  The upper wisdom teeth are so close to the inside of the lower jaw bone it’s very difficult for you to get a toothbrush in a position that will effectively clean the cheek sides of the wisdom teeth.  Even if you are brushing with your mouth almost closed and your lower jaw moved sideways to accommodate the toothbrush, it’s often not effective.

These cases with limited room require excellent home care to maintain wisdom teeth for a lifetime. It requires a significant amount of time and effort to avoid cavities and gum troubles. And this is where receive a reward  for diligence in learning and practicing the finer points of brushing and dental flossing.

Consistent, effective daily efforts yield the best results.  More commonly these difficult to clean wisdom teeth situations lead to cavities, pain and eventually tooth removal.  In some situations, especially in the case of a lack of knowledge or resources, after years of pain, your body may eventually shed the decayed and infected tooth.  Waiting patiently for painful teeth to fall out is not generally a good idea.

The risk for decay and gum trouble skyrocket with increasing amounts of groceries left behind in nooks and crannies around and in between your teeth. I know it takes work to chase that stuff out of there.

So, like Mission Impossible, if you choose to accept the assignment of keeping wisdom teeth, you will have to execute the necessary mission objectives to completion.

Good dental health does not mean everyone gets a trophy for merely knowing what a toothbrush is and being able to distinguish dental floss from shoe laces.  In addition to recognizing two of the most common means used to clean teeth, you need to be effective at using them. I will address specific goals and techniques in another article.

Some of my patients are so disappointed when they see what I see using high-resolution closeup photography during our examinations.  But, in those cases, I need to be able to say, using the criteria we use for effective home-care, there is room for improvement.

On my kindergarten and first grade report cards there were a lot of “room for improvement” and “unsatisfactory” boxes checked.  I survived and so will you.  You cannot improve unless you measure yourself against a standard. Someone might tell you that there are places where you need to apply extra effort in maintaining your teeth. It’s best if it’s a dentist, or dental hygienist.  That’s our job. Don’t take it personally. We are on your side!

With no clear objectives from your dentist and with inadequate training, you are left in a long downhill slow-motion slide with an inevitable crash at the bottom. I don’t want to see that happen.

So if you are aware of the goals and are willing to perform up to standards, you can have  super clean teeth and a life time of comfortable use at minimal cost.

    3.)    If you do NOT have room for them and they are not erupting, or they are coming in, with bad alignment, it will be almost impossible to keep them or maintain them if they are causing pain.  Here is where you will find a variety of opinions as to what to do.

Jawbone Position Wisdom Teeth Inadequate RoomJawbone Position Wisdom Teeth Inadequate Room Bad Position3Jawbone Position Wisdom Teeth Inadequate Room Bad Position2Common sense about teeth is often, not so common. You don’t even know, what you don’t know until you start asking questions and speak to some who has good information. You improve your chances of intelligent, 2-way, conversations with doctors, by researching and reading, or perhaps consulting with multiple experts. They will discuss the risks and benefits of your procedure options necessary for pain relief.

If you include your dentist or multiple dentists among your experts, your will hear what applies in your situation based on the doctor’s education, experience, and interests. But, you still have to make the final decisions regarding your health yourself.  Not all treatments have perfect outcomes and some have substantial inherent risks.

By the same note, not treating when it is generally recommended also can bring with it inherent risk.  So be an educated consumer. Be your own health advocate. At this time, you can still chose your dentist in most cases.  With the recent changes in healthcare options in the United States your dental choices may soon be changing.  You may even have to pay out-of-pocket to receive quality care.  Again, exploring that subject may require several additional articles.

Let’s look at an example of someone who had no recollection of a dentist ever recommending his wisdom teeth be removed. Sometimes, even if you have an examination your dentist can’t see wisdom teeth on the type of x-ray being used.  This is where it gets interesting.

“I’ve got this pain on the inside of my jaw and it’s killing me,” I hear from a patient and I suggest we take a look.  After an x-ray, a visual look and a few photographs, the conclusion reached is this wisdom tooth has got to go.

This patient, a male, in his early thirties was hoping the pain would go away by itself. What we found was an upper wisdom tooth that decided to erupt straight out to the cheek side of the upper jaw.  It was on a collision course with the inside, back part of the lower jaw. This meant pain occurred constantly as he chewed. The problem: a wisdom tooth that “got lost,” erupting in the wrong direction.

To get an idea what I am talking about, put your (clean) finger in your mouth along the side of the upper teeth way in the back and push back a little further and you can feel how little room there is back there. Imagine a sharp pointed tooth digging it’s way through the cheek, and muscle into the bone of the lower jaw, just below and in front of your ear, each time you tried to chew or swallow.

That patient was unaware of what was causing his pain.  The solution: remove the offending wisdom tooth, and let the cheek and lower jaw bone heal.  He was so happy.

Not all wisdom teeth need to be removed.  If there is adequate room and a dedication to good home-care they can often be retained.  But they tend to erupt along the path they have chosen until they bump into another tooth.  If the path leads to hitting the opposing wisdom tooth, the “biting-partner,” in the proper fashion, great. If they get stuck and cause pain or are wandering off in the wrong direction you may need some professional help eventually.


In the next article in the series- Questions You Must Ask Your Dentist Before Having Your Wisdom Teeth Removed, I’ll cover the often asked question: Can’t I just take out the one that is bothering me?