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Oral health education · Oral surgery

Do Wisdom Teeth Always Have to Come Out?

Not always. A wisdom tooth that is already causing trouble — repeated flare-ups of swelling and pain, decay in the tooth itself or in its neighbour, damage from pressing against the tooth in front, a cyst visible on imaging — will usually need dealing with. But whether to remove or keep an impacted wisdom tooth that has neither symptoms nor disease is genuinely unsettled in the evidence: a Cochrane systematic review concluded that the available evidence is insufficient to decide, and although retention may be associated with an increased long-term risk of periodontitis on the adjacent tooth, the certainty of that evidence was rated very low. So the sensible approach is to judge by your own situation rather than applying a blanket rule — neither "wisdom teeth all have to come out" nor "if it does not hurt, leave it alone".

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Cross-section diagram of four growth angles: an upright erupted wisdom tooth, one tilted forwards, one lying horizontally and one fully buried
Wisdom teeth erupt at widely differing angles, and the way each is handled — along with how difficult it is — differs accordingly. Illustrative diagram, not an image of any particular patient.

Usually treated

The situations that generally do call for extraction

What they have in common: the problem has already occurred, or the imaging shows damage about to occur.

01

Repeated inflammation around the crown

When a wisdom tooth erupts only partly, the gum around its crown forms a pocket that cannot be cleaned; food and bacteria collect there and swelling and pain return again and again. This kind of inflammation recurs, and each episode may be worse than the last.

02

Decay in the wisdom tooth or in its neighbour

A wisdom tooth sits furthest back and often at an awkward angle, which makes it the hardest tooth in the mouth to clean. Once it decays it is also hard to fill; more troubling still is when the second molar it presses against decays on the contact surface — and that is the tooth genuinely worth saving.

03

Damage to the root or bone of the tooth in front

A wisdom tooth growing horizontally or tilted forwards can press directly on the root of the tooth in front, or cause a bone defect at that point. These changes show up on an X-ray, but the person concerned usually feels nothing.

04

A cyst or lesion found on imaging

The follicle around a buried wisdom tooth can develop into a cyst that gradually enlarges and destroys the surrounding bone. Cases of this kind are usually treated even when there are no symptoms at all.

When there are no symptoms

What the evidence says about a wisdom tooth you cannot feel

This is the question people ask most often, and the one with the least settled answer. A Cochrane systematic review compared surgical removal with watchful monitoring for asymptomatic, disease-free impacted wisdom teeth, and concluded that the available evidence is insufficient to determine which approach is better.

The same review noted that retaining an asymptomatic, disease-free impacted wisdom tooth may be associated with an increased long-term risk of periodontitis on the adjacent second molar — but the authors explicitly rated the certainty of that evidence as very low, and called for well-designed long-term randomised controlled trials.

What does that mean in practice? It means that anyone telling you "an asymptomatic wisdom tooth definitely has to come out", or "if it does not hurt you can certainly ignore it", has gone beyond what the current evidence supports. The real judgement comes back to individual circumstances: the angle and depth of the tooth, its position relative to the neighbouring tooth and the nerve, whether it can realistically be kept clean, your age, and your willingness to come back for review.

Age is worth a mention of its own. In younger patients the roots are not yet fully formed and the bone is more elastic, so extraction tends to be less difficult and recovery more straightforward; as the years pass the surgical conditions change. That is not a reason to say "have them out while you are young", but if an assessment does conclude that a tooth needs to come out, timing is part of the judgement.

Keeping it under review is a legitimate choice — but the review has to actually happen

A wisdom tooth you decide to keep needs to be brought into your regular check-ups: looking at whether decay is starting on the contact surface with the neighbouring tooth, at the gum health around it, and at whether anything has changed on imaging.

The problem in practice is rarely the decision to keep the tooth; it is that after deciding to keep it, people never come back. By the time symptoms appear some years later, the neighbouring tooth may already have been affected. If you choose not to have it out, regular review is what makes that decision work.

Cross-section diagram of the uncleanable pocket that forms between a partly erupted wisdom tooth and the gum
When a wisdom tooth erupts only partly, the gum around the crown forms a pocket a brush cannot reach, where food and bacteria readily collect. Illustrative diagram, not an image of any particular patient.

Aftercare

If you do go ahead, what to watch for in the days that follow

What follows are general aftercare principles; the instructions that apply to you are the ones your dentist gives for your own procedure.

  1. The day itself: let the clot form and stay put

    Bite on the gauze as instructed to apply pressure and stop the bleeding. The clot in the socket is the foundation of healing, so on the day do not rinse forcefully, do not use a straw, and do not keep prodding the site with your tongue or finger — any of these can dislodge it.

  2. The first two or three days: the peak of the swelling

    Swelling usually peaks two to three days after surgery and then gradually subsides. Take any medication as your dentist directs, and avoid strenuous exercise and heat applied to the area (heat makes swelling more pronounced). Choose cool or lukewarm, soft foods.

  3. Throughout recovery: keep cleaning, but work around the site

    Your other teeth still need brushing as usual, simply avoiding the area of the wound. Not cleaning at all raises the risk of infection rather than lowering it. If your dentist has prescribed a mouthwash, use it as directed.

  4. Signs that mean you should be seen again

    Pain that keeps getting worse rather than gradually easing, bleeding that will not stop, fever, swelling still spreading after three days, or increasing difficulty opening your mouth — all of these warrant going back to be checked rather than waiting to see what happens.

Cost

Does national health insurance cover wisdom tooth extraction

Extraction is a treatment covered by Taiwan's National Health Insurance, including the removal of impacted teeth. The actual co-payment is calculated according to the level of the facility and the applicable rules.

Worth knowing is that certain additional items fall outside the insured scope — self-paid haemostatic or healing-promotion materials, for instance, or the choice of sedation method. If your dentist suggests something of this kind, you can ask them to explain why it is needed and what it costs before deciding whether to accept it.

In addition, if the procedure is a difficult one, or if the wisdom tooth lies very close to the inferior alveolar nerve, your dentist may suggest a CT scan first to establish the relationship in three dimensions. Whether imaging of that kind is covered depends on the indication and the applicable rules, and can be confirmed before the procedure is scheduled.

其他人也問

常見問題

Does a wisdom tooth with no symptoms need to be removed?
The evidence is unsettled. A Cochrane systematic review found the available evidence insufficient to determine whether asymptomatic, disease-free impacted wisdom teeth should be removed or retained; retention may be associated with an increased long-term risk of periodontitis on the adjacent tooth, but the certainty of that evidence was rated very low. In practice the judgement rests on individual factors: the angle of the tooth, its relationship to the neighbouring tooth and the nerve, and whether it can be kept clean.
Will a wisdom tooth that is left in push the front teeth out of line?
The idea that wisdom teeth crowd the front teeth is very widely repeated, but the research to date is not sufficient to establish that causal link. The mild crowding of the front teeth that appears with age is thought to have several contributing factors. If you are worried about your alignment changing, the practical response is regular examination and record-keeping, not extraction on that ground alone.
How long does it hurt after a wisdom tooth is taken out?
Discomfort and swelling usually peak two to three days after surgery and then gradually ease, though how it actually goes depends on the difficulty of the procedure and on the individual. If the pain is not easing but steadily worsening, or comes with fever or spreading swelling, you should go back to be checked.
Can all four wisdom teeth be taken out at once?
It depends on where they sit, how difficult they are and your general health. Doing them in stages lets one side recover while the other keeps chewing; doing them together means fewer procedures. There are considerations either way, and the arrangement is something to settle with your dentist.
Does national health insurance cover wisdom tooth extraction?
Extraction, including the removal of impacted teeth, is a treatment covered by the National Health Insurance. Certain additional items — self-paid materials, or particular imaging examinations — may fall outside the covered scope, so it is worth confirming beforehand.
Does your face get slimmer after wisdom teeth are removed?
No. Facial shape is determined mainly by the jawbone and the soft tissue, and the wisdom tooth sits right at the back of the arch, so removing it does not alter the skeletal outline. What looks like a change in the short term after surgery is mostly the swelling going down, not a change in facial shape.

延伸閱讀

相關內容

How Often Does Insurance Cover Scaling?

How to arrange regular review if you decide to keep a wisdom tooth.

Why Does a Root-Treated Tooth Need a Crown?

What to do when the neighbouring tooth has already decayed deeply.

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本頁為口腔健康知識，內容不能取代醫師的當面診察。每個人的口腔狀況、病史與用藥都不同， 實際診斷與治療方式仍需由醫師依個別情況評估。

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