SHOULD I REMOVE MY WISDOM TEETH EVEN IF I’VE HAD BRACES?

This is a question that I get a lot and it really makes me crazy. The answer is Yes you still usually need to have your wisdom teeth removed even if you have had braces.

As a general rule, orthodontists will guide their patients to put off removal of their third molar teeth “until they cause a problem”. This is not malicious, they are just thinking of this from the patients’ perspective and an “orthodontic perspective” rather than from the standpoint of surgical risks and problems. If there is an arch length concern the orthodontist may guide the patient to have a bicuspid tooth removal in each quadrant to gain arch length to straighten the teeth. This may result in some additional arch length where they might suggest keeping the third molars. (JADA 148 (12) December, 2017; Pages 903-912).

The truth is that the condition that leads to the bicuspid tooth extractions in the first place (arch length deficiency) is only partially improved by those extractions and as the wisdom teeth try to come in they are in a poor position (poor tissue contours – a lack of attached mucosa) which will lead to problems with cleansing and possible periodontal disease as you age.

Again, the recommendation from the orthodontist relates to their orthodontic care and whether keeping the third molars will adversely affect their care. The whole idea is frustrating to me in that the person that is hurt is the patient as wisdom tooth problems are often progressive and once the damage is done you cannot go back. Again, as I have preached so often – if you still have your wisdom teeth and you want a long term healthy mouth, get them evaluated by a competent OMS. In cases where there are risks get them out. It is much easier, safer, lower risk and less expensive the younger you are.