Why do some experts say not to remove wisdom teeth?

What the evidence says

A 2020 Cochrane review compared removing with keeping asymptomatic, disease-free impacted wisdom teeth in adolescents and adults. It included two studies, found no study measuring health-related quality of life, rated the evidence for other outcomes as low to very low certainty, and concluded that the evidence is insufficient to decide whether these teeth should be removed or retained. It said patient values and clinical expertise should guide shared decision-making and, if teeth are retained, clinical assessment at regular intervals is advisable. A BMJ Clinical Evidence review reached a similar conclusion, saying that current evidence neither refutes nor confirms the practice of prophylactic removal, based mainly on one randomized trial of 164 people rated very low quality.

So do experts say not to remove them?

Not exactly. The reviews say the evidence does not show a clear benefit from removing healthy teeth, and that it does not show harm from keeping them either. The BMJ review says symptomatic or diseased impacted wisdom teeth should be recommended for removal, and for asymptomatic, disease-free teeth, no trial data guide the choice, so patient preference should drive the decision after weighing risks and benefits. Cleveland Clinic similarly says removal is usually recommended if the teeth cause pain, infection or damage, that some dentists recommend it preventively, and that if the teeth cause no problems it is often unnecessary.

Risks of removal

The BMJ review lists general surgical harms such as pain and swelling, lost work or school time and unnecessary surgery, and nerve injury: inferior alveolar nerve injury in 1 to 8 percent of people, permanent in up to 1 percent, and permanent lingual nerve damage in up to 1 percent. It says risk appears higher with deeper impaction, less experienced operators and older patients with deeply impacted teeth. Cleveland Clinic lists dry socket, infection and injury to nerves, the jawbone, sinuses or other teeth.

Risks of keeping them

The BMJ review says about one third of asymptomatic unerupted teeth change position over time, becoming partially erupted and non-functional or non-hygienic, and that between 30 and 60 percent of people with asymptomatic teeth later need extraction of one or more teeth, between 4 and 12 years after first assessment. It says delayed extraction may increase the risk of postoperative complications and prolonged recovery, and that extraction after age 24 may be associated with lower postoperative quality of life. The Cochrane review notes a cohort study suggesting retained teeth may be linked to long-term periodontitis in the adjacent second molar, but the evidence is very uncertain.

What happens if you do not remove them

Often nothing, for a time, and sometimes problems. Cleveland Clinic lists complications of impacted teeth: pain, infection, abscesses, tooth decay, gum disease and damage to neighboring teeth. Healthline says impacted teeth may cause no symptoms at all, though infection or damage can develop without warning, and that dentists monitor wisdom teeth for improper position, crooked growth, partial eruption and lack of space. That is why regular checkups and X-rays matter if you keep them.

Does a wisdom tooth cause bad breath?

It can. Healthline lists a bad taste and bad breath among the signs of wisdom teeth coming in, and describes partial eruption leaving a flap of gum that traps food and bacteria and can cause infection, and Cleveland Clinic lists bad breath or a bad taste among the symptoms of impacted wisdom teeth. Our guides on wisdom tooth pain cover infection and pericoronitis.

What makes you loopy after wisdom teeth removal?

Sedation or general anesthesia and some pain medicines can leave you drowsy. Cleveland Clinic's sedation article says oral and IV sedation can make you drowsy or cause you to fall asleep, and that common side effects include lingering drowsiness, headaches and nausea, most of which resolve within a day, and to contact your dentist if you are still groggy after 24 hours. Healthline advises arranging a ride home after sedation, and the NHS says not to drive for 48 hours after a general anesthetic or 24 hours after a sedative injection.

How to decide

Ask your dentist to show you the X-ray, explain the position of each tooth and say whether it is causing or likely to cause problems. If you keep them, ask how often to be checked. If you choose removal, ask about the surgeon's experience, the anesthesia and the risk of nerve injury for your teeth. Our wisdom teeth guide and removal cost guide explain more.

Frequently asked questions