Wisdom teeth, the third molars, are frequently the subject of much consideration and discussion during dental visits. The last teeth in your mouth to develop, they often do not have enough room to fully erupt or may be growing in the wrong direction. These issues can lead to problems that can affect your dental health as well as your overall well being. To avoid the complications that your wisdom teeth may cause, your dentist will monitor their development, location, and condition at your check-up exams.

It is interesting to note that the impaction and alignment problems that we associate with our wisdom teeth today may be linked to evolution. This is because the size of our jaws has decreased since prehistoric times. Our early human predecessors needed larger jaws and a robust full set of teeth to process the coarse plant materials that made up their diet. However, once humans started to eat meat, learn to cook, and use sharp tools it became easier to chew and process food. Since we no longer needed as large a jaw for survival, and the fact that our increasingly complex and larger brain was requiring more space in our skull, the size of our jawbones over thousands of years began to decrease. However, despite the fact that human jaws were downsizing, the vast majority of people still developed wisdom teeth. Smaller jaws with essentially the same number of teeth set the stage for potential space shortages.

Our wisdom teeth are the last molars on each side of our upper and lower jaws and are the last of our adult permanent teeth to develop. All of our other permanent teeth are typically in place by the age of 13 years. If wisdom teeth are not fully impacted, they tend to erupt and emerge through the gums at the back of our mouths between the ages of 17 and 21 years. Our third molars are referred to as wisdom teeth because their eruption coincides with our transition from teen years into adulthood, a time of life known as the “Age of Wisdom.”

Most individuals develop four wisdom teeth. However, there are cases of individuals who do not develop wisdom teeth at all, or those who develop fewer than four, as well as rare situations where individuals develop extra ones. The wisdom teeth, just as the other teeth in our mouths, develop from a tooth bud. Your dentist may detect evidence of wisdom tooth development on a panoramic x-ray (a single x-ray picture of the jaws and all of the teeth both above and below the gums) at around 10-12 years of age. As it will take the tooth bud several years to mature into a full sized tooth, your dentist may periodically order a panoramic x-ray to assess the position and health of your developing wisdom teeth.

If your wisdom teeth are able to come into place, align correctly, do not have large cavities, the surrounding gum tissue is healthy, and they are not causing damage to the adjacent teeth, they do not need to be removed. However, this does not usually happen. Wisdom teeth are often unable to erupt properly due to a lack of space or having developed in an abnormal position.

A wisdom tooth is considered impacted when it is submerged under gum tissue or bone and is unable to erupt. There are a few types of impactions based on the type and amount of overlying tissue. Soft tissue impactions are when a wisdom tooth is remains covered by gum tissue. If a wisdom tooth remains fully or partially obstructed by bone, it is referred to as a bony impaction.

Impacted wisdom teeth can potentially cause many problems. According to the American Dental Association wisdom teeth may need to be removed when they are the source of:

• Pain
• Infection
• Cysts
• Tumors
• Damage to adjacent teeth
• Gum disease
• Extensive tooth decay

Although wisdom teeth extractions can be performed when needed at all ages, early removal of problematic or potentially problematic wisdom teeth in young adults is often recommended. Among the reasons for this approach are that these extractions may be easier because the roots of the wisdom teeth are not yet fully formed and patients at this age generally heal with a shorter recovery time and with fewer complications.

It is important to keep in mind that every mouth is unique. There are many individuals who have erupted or impacted wisdom teeth that are not causing acute problems and are still in place. However, because the condition of the mouth can change over time, it is important that your dentist see you to continue to monitor these wisdom teeth as well as the tissue and teeth adjacent to them. With regular evaluation and timely treatment future problems can be avoided.