Do we need our wisdom teeth removed? Experts say this common procedure may be unnecessary

There is nothing wise about the way humans view wisdom teeth, according to many experts.

Wisdom teeth, or a person's third and final set of back molars, are the last teeth to grow in one's mouth. As far back as the 4th century BC, the Greek philosopher and polymath Aristotle chronicled how these teeth usually erupt around the age of twenty, although he noted cases of wisdom tooth eruptions in people as old as their eighties. Humans evolved wisdom teeth to better grind down hard foods like raw plants, tough meats and nuts, but as our diets became softer and our brains bigger, our species developed larger craniums and smaller jaws.

This leaves wisdom teeth as unwanted tenants in our mouths, taking up precious space and causing pain because they have not taken the hint they are no longer welcome. They can become overcrowded in a person's jaws, causing chronic pain. If they are impacted (pushing against a gum or another tooth), they can cause health issues like decay and infection. People with wisdom tooth problems often struggle with chewing and develop halitosis (bad breath).

As a result, odontectomies — that is, tooth removal surgery —is quite common. For decades, people all over the world often choose to have their wisdom teeth surgically removed because they serve no further purpose and can lead to so many health issues.

Yet some experts say that the procedure is overused. One of those expert is Dr. Edmund Bailey —  an oral surgeon, the lead for globalization for dentistry at the Institute of Dentistry and a faculty member teaching medicine and dentistry at Queen Mary University of London.

"We know that a large proportion of young adults suffer with issues from their wisdom teeth," Bailey said, estimating that roughly 70% of the population undergoes odontectomies for their wisdom teeth. If there is already pain and infection, Bailey thinks this surgery is necessary, but he is concerned that the procedure is often performed preventatively rather than because there are symptoms.

"Removal of impacted teeth where there is no disease is controversial," Bailey said. "Some surgeons will remove the teeth in order to prevent problems in the future; however, the side effects can be significant. These side effects include [not only] pain, but long term problems which include numbness of the lip, chin and tongue can also occur."

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Part of the problem is that people assume wisdom teeth are always damaging to the mouth, but Bailey said this is not true. Some of the "crowding" caused by wisdom teeth occurs because the jaw changes shape in adulthood; for people who do not experience those changes to their jaws, the wisdom teeth could occupy space in their mouth for long periods without incident.

"People are often very anxious about having their wisdom teeth removed. This can be due to listening to people who have had bad experiences with their own wisdom teeth," Bailey said. "Some people also think that crowding of their front teeth as adults is due to the wisdom teeth ‘pushing’ on them. The evidence shows that this is not the case — instead, it appears that the jaw changes shape in adulthood causing the crowding."

Because this science is not widely understood, experts struggle to understand the true extent to which wisdom teeth are being unnecessarily removed. A 2021 study in the Annals of Medicine and Surgery (London) studied 106 patients who underwent wisdom tooth extractions in the year 2020. They found that only slightly more than three out of four people (76.4%) had wisdom teeth extracted for medically legitimate reasons. The others were removed as a preventative measure even when the patients were not suffering any health issues.

"Monitoring asymptomatic wisdom teeth appears to be an appropriate strategy," the authors write. "Regarding retention versus prophylactic extraction of asymptomatic wisdom teeth, decision-making should be based on the best evidence combined with clinical experience."

Unfortunately for the general public, the medical and dental industries have a financial incentive to continue removing wisdom teeth regardless of whether doing so is wisest for their patient. Dentist Dr. Jay Friedman, a longtime crusader against wisdom tooth extraction, pointed this out in a 2007 article in the American Journal of Public Health. He wrote at the time that 50% of upper third molars classified as impactions are in fact normally developing teeth which would otherwise erupt with minimal discomfort, while only 12% were truly associated with pathological conditions like tooth damage and cysts.

While preventative surgery might still be justified if it was harmless, Friedman wrote that patients often suffer short-term side effects like pain, swelling, bruising and malaise as well as possible long-term conditions like permanent paresthesia, or numbness of the lip, tongue and cheek.

"Third-molar surgery is a multibillion-dollar industry that generates significant income for the dental profession, particularly oral and maxillofacial surgeons," Friedman writes. "It is driven by misinformation and myths that have been exposed before but that continue to be promulgated by the profession."

In the end, perhaps the wisest practice for people who still have their wisdom teeth is to make sure they choose their doctors and dentists wisely. Because every human mouth is different, only a qualified and honest surgeon can assess whether a specific patient needs to have theirs removed.

"The success of the surgery is linked to the experience of the surgeon," Bailey said. "So choose your surgeon carefully!"