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The following information is aimed at helping patients distinguish the proper timing for the removal of wisdom teeth. The most common question asked is when wisdom teeth should be removed.

The timing for removal of wisdom teeth is based on two things, the age of the patient, and root formation. As far as the age of the patient goes, the younger the better. Younger patients do better for surgical procedures, they have lower overall complications. Regarding root formation; the ideal time to remove wisdom teeth is when there is one third root formation. On a panaramic x-ray the patient’s wisdom teeth would look squar-ish. It is also a good time to remove wisdom teeth between one third and two thirds root formation. When there is more than two thirds root formation we find that there is an increase of risk for removing wisdom teeth, especially nerve injury to the inferior alveolar nerve, and maxillary sinus involvement.

One of the considerations when looking at the wisdom teeth is whether they will be able to erupt into a more easily removable position. The root formation brings the tooth up to the surface causing the eruption of the tooth. However in cases of wisdom teeth when there is insufficient space, the tooth may not be able to erupt no matter how much root formation we wait for, and that root formation can make them more likely to have nerve injury, or sinus complications.

In certain cases, when the patient has zero root formation but has partially formed crowns, if we are doing some other surgical procedure that requires IV sedation, and the wisdom teeth are in a position that might be easily accessed, it may be a consideration to remove the wisdom teeth at the same time. Often I’ve had to do an exposure and ligation procedure on a canine of a young patient around twelve years old, who has requested IV sedation, and because of the level of sedation, it was advantageous to remove the wisdom teeth at the same time. When the wisdom teeth are blocking out second molars they should be removed early.

Wisdom teeth have the greatest variability in time of eruption and root formation of any tooth. I have removed wisdom teeth which were considered to be in the ideal root formation category, (from one third to two thirds root formation), that were in patients as young as eleven years old. And I have also seen patients that were twenty-five and who still have had only two thirds root formation. The most common age for wisdom teeth to be in the 1/3rd to 2/3rds root formation stage is sixteen years old.

My recommendation is to have patients get a panaramic x-ray at the age of fifteen years old, and be prepared to have them out around sixteen. This is the most common time for removal of wisdom teeth.

Ralph R. Reynolds, DMD, MD

References:

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