Wisdom tooth extraction is common. Not everyone agrees it's necessary.

Leora Leavey, 17, a rising high school senior from Bethesda, Md., had her wisdom teeth removed just before Memorial Day, hoping to use the long holiday weekend to recover. X-rays showed that two of the teeth were impacted and they’d gotten painful. The oral surgeon said it was time for her wisdom teeth to go.

Unfortunately, things didn’t go as planned. Leavey developed a post-surgical infection, which was treated, but that cost her additional time off from school. Even so, her mother was glad she had it done.

“At least she won’t have to deal with it later,” Becky Leavey says.

Many parents opt to have their teenagers’ wisdom teeth removed, frequently before they go off to college, and often even before the teeth start to cause trouble — and while the child is still covered by parental health insurance.

Experts say the teeth should come out when they’re coming in at an odd angle, causing pain, tooth decay, inflammation, damage to adjacent teeth or other signs of disease. But no one agrees on whether it’s good medicine to extract them preemptively when there are no such issues.

“The oral surgeon needs to survey the territory and make an educated decision based on a clinical exam and X-rays,” says Dena Fischer, director of the Center for Clinical Research at the National Institute of Dental and Craniofacial Research. “There may be dentists who make their decisions differently, but hopefully most are making them based on the clinical clues.”

Wisdom teeth, also known as third molars, are the four teeth that come in last — usually in a child’s late teens — and are farthest back in the mouth, one each in the upper and lower jaw behind the second molars. Experts say there are no reliable statistics on how many wisdom teeth come out every year, although some journal articles estimate about 10 million teeth from 5 million patients annually.

Those who favor early extraction say it is generally easier, safer and results in quicker recovery when patients are young, between 15 and 25, although, as with all surgery — as the Leaveys found out — there can be risks. When patients are young, the roots of the teeth are small and simpler to remove, they say.

“Think of a tree,” says Louis Rafetto, a spokesman for the American Dental Association. “It’s better to remove or uproot the tree before the roots are fully formed. Roots grow into things — nerves, the sinuses. You want to take the teeth out before the roots reach full maturity,” usually by the mid-20s.

Opponents — including the American Public Health Association — regard such prophylactic extractions as unnecessary surgery. At least one paper says there are no scientifically proven health benefits to removing wisdom teeth that don’t cause problems. A National Institutes of Health consensus conference urged against the practice as far back as 1980, and several recent studies suggest there is no compelling reason to do so.

“I think sometimes in dentistry we also fall into this trap of, well, ‘If one needs to come out, let’s just take them all out.’ If there’s an issue with one, they predict there will be issues with the others,” says William Love, director of dental services at the University of California Davis Health Medical Center. The reason often is because general anesthesia is involved, making it more efficient to remove all four at once, he says. “That’s an okay approach, but if medicine is based on diagnosis, you shouldn’t take out the other three based on the diagnosis of one,” Love says. “And when all four are asymptomatic, I think it’s fair to ask, ‘Why are we doing this?’”

But “no symptoms doesn’t mean no problems,” says Raymond White Jr., the Dalton L. McMichael distinguished professor of oral and maxillofacial surgery at the University of North Carolina’s Adams School of Dentistry, and its former dean.

Most people “will have problems and need to have them taken out,” says White, who has conducted more than 100 peer-reviewed wisdom teeth-related studies. “Older patients will take longer to get back to their normal lifestyle than younger patients. It will take longer for them to get back to being able to open their mouths and eat their usual foods.”

The ADA agreed in a 2014 paper that asymptomatic wisdom teeth weren’t necessarily disease- or problem-free, but added there was insufficient evidence to conclude that prophylactic removal was better than continued monitoring.

A 2016 white paper on management of wisdom teeth by the American Association of Oral and Maxillofacial Surgeons (AAOMS) was similarly ambivalent. It said that not all wisdom teeth needed removal, but warned that the longer patients wait, the more difficult removal and recovery become if a problem develops. But it also acknowledged the possibility that patients who retain disease-free wisdom teeth “could live their entire lives” without incident.

“I think it’s fair to say that not everybody needs to have them removed, but everyone should have them evaluated,” says Rafetto, also a past president of AAOMS. “It should always be a discussion between the patient and the doctor over the risks and benefits of taking them out. Many people in the United States will have them taken out sooner or later, the question is: When is the most fortuitous time?”

Faisal A. Quereshy, a professor in Case Western Reserve University’s School of Dental Medicine, thinks that time is when patients are young. “This summer, we will do almost 24 surgeries per week, all kids home from college or home on break, which is the ideal time to get it done,” says Quereshy, who is also president-elect of the American College of Oral and Maxillofacial Surgeons.

He and other experts point out that the human jaw has shrunk over thousands of years, leaving less room for wisdom teeth. Also, thanks to fluoride, there is less tooth decay, so people aren’t losing as many teeth as they did years ago, another reason the mouth may be crowded.

“We are still growing the same number of teeth in our jaw, but our jaws have changed,” Quereshy says. “If they do pop through, they are way in the back of the mouth in a very difficult area to keep clean. Often, people come in with infection and decay. The infection can travel into the neck and throat. This can lead to a true medical emergency.”

Still, risks can occur, even when extraction is clearly necessary.

The most serious is potential damage to the inferior alveolar nerve, “which gives you feeling,” Love says. “The third molar on the bottom is often close to that nerve. If it happens, you can have what’s known as paresthesia [a burning, prickly or numbing sensation, often like pins and needles]. It’s much more likely to be temporary the younger you are. When you are older, it’s more likely to be permanent.”

Joana Cunha-Cruz, a professor at the University of Alabama at Birmingham School of Dentistry, cites a 2020 study that found “a small but increased risk of complications associated with prophylactic removal, such as bleeding, infection and dry socket,” she says, the latter referring to a painful condition when a blood clot necessary for healing after a tooth removal doesn’t form or dissolves too soon, leaving bone and nerves exposed to the air.

Experts say parents and clinicians need to consider multiple factors before deciding what to do and, if the teeth remain, engage in vigilant monitoring.

It’s important to evaluate the position and condition of the teeth, determine how often the patient sees a dentist and how well the patient practices home care, that is, regular brushing and flossing.

If a patient is careless about tooth care, cavities may form, not just in the wisdom teeth but in the adjacent teeth as well, one reason it might be better to remove them. But if they brush twice a day, morning and night, floss before bed and the position of the teeth are aligned with the mouth, it’s fine to hold off extracting them, they say.

Yes, some third molars should be removed, says Cunha-Cruz, who is also an assistant director for the south central region of the National Dental Practice-Based Research Network. “However, it also seems likely that in some individuals third molars might have sufficient space and exist for a lifetime as healthy, functional teeth.”

Carol Rogers, 79, of D.C. is among them. She lost one of her wisdom teeth last year due to a difficult-to-fill cavity in one, but the others are fine. “One or two dentists over the years have suggested I get them out, but I resisted,” she says. “I have never regretted my decision to leave them alone.”

Well+Being shares news and advice for living well every day. Sign up for our newsletter to get tips directly in your inbox.

You don’t have to take 10,000 daily steps for good health.

For weight loss, feed your gut microbiome-high calories.

Avoidance can lead to more anxiety and problems.

Intergenerational trauma can explain poor mental health.

Older adults who feel young at heart may live longer, have better health.