A wisdom tooth may need to be removed – even when there are no symptoms. STACEY CHIA finds out

Pain can be a sign that something is wrong. But even if your wisdom teeth are not hurting you, your dentist might suggest an extraction.

Wisdom teeth, also known as third molars, develop between the ages of 16 and 21. Because they appear late, they may be “impacted”, that is, they fail to settle in properly and may grow sideways.

When impacted wisdom teeth cause pain and recurring gum infection, extraction is a necessary.

However, even if these symptoms are absent, it does not imply an absence of disease, said Dr Danny Tan, an associate consultant with the department of oral and maxillofacial surgery at National Dental Centre of Singapore.He said dentists can identify the early stages of diseases due to impacted wisdom teeth by looking at radiographs. These diseases, which include tooth decay and gum diseases, can develop without any symptoms or pain.

Removal of such wisdom teeth will prevent disease progression.

Dr S.L. Chan, an oral and maxillofacial surgeon at Aesthetic Reconstructive Jaw Surgery, said a decision to remove a pain-free wisdom tooth depends largely on the judgment of a dentist.

“If the tooth has erupted halfway and is blocked by the second molar, there is a high chance for food to be trapped between the two teeth and cause problems in future,” he said.

People who have undergone orthodontic treatment may also be advised to have their non-problematic wisdom teeth removed later on, said Dr Chin Yee Fatt from TP Dental Surgeons.

“There is a risk of teeth migration – crowding of the front teeth, which would mean a waste of time, effort and money spent on getting straight teeth,” he said.

Dr Chan and Dr Tan said there is no strong scientific evidence for doing this as a matter of course.

Dr Chan said that the management of wisdom teeth for patients who have had orthodontic treatment does not have to be different from the general population.

Dr Tan said that wisdom tooth surgery is minor and can be done under local or general anaesthesia.

The procedure involves making an incision in the gums around the tooth to expose the tooth and bone.

If necessary, the tooth may then be divided into small pieces before it is removed, after which the wound is stitched. It takes about a month for the wound to heal completely.

The risk of complications are fairly low but increases with age.

“It becomes riskier as the bone gets denser with age and the tooth is not as easily dislodged,” said Dr Tan.

For wisdom teeth in the lower jaw, injury to either the inferior dental nerve or lingual nerve could result in numbness to the lip or tongue respectively.

The numbness may be permanent in a small number of cases.

But only about 1 per cent of patients experience this, Dr Tan said.

Also rare is the development of sinusitis. As the upper wisdom teeth are close to the sinus, the sinus may be perforated during surgery.

For both the lower and upper wisdom teeth wounds, infection may also develop if the wound is not properly cared for.

While pre-emptive removal of wisdom teeth can have benefits, it is not necessary for everyone.

“Many of my patients have kept these teeth throughout their lives but they have to pay more attention to dental hygiene,” said Dr Chin.

According to the Ministry of Health website, an impacted wisdom tooth surgery costs about $500 to $700 per tooth at most public dental clinics.