Wisdom teeth, i.e. upper and lower third molars quite often remain un-erupted due to lack of space in the jaws. These teeth which erupt at a much later age (usually 17-21 years) can remain locked between the adjacent tooth and the bone. The cause for this impaction as it is known as, is very interesting and has been linked with evolution. It is believed that in humans, there has been a gradual shift in diet from fibrous to more refined food. Simply stated, the amount of force that we use for chewing food is much less than that of our forefathers. Over the years (in fact centuries), this has led to a gradual reduction in jaw size. However the number of teeth has remained the same, leading to a discrepancy between demand and supply of space.

Those teeth which fail to erupt even after their normal age of eruption has passed are known as impacted teeth and can cause all sorts of problems. These range from infection, caries, pocket formation in the gums, crowding of other teeth, resorption of roots of adjacent teeth and increased risk of jaw fracture. Chronic infection from an impacted wisdom tooth has even been linked to an increased risk of heart attack due to dislodged clot. Therefore, problematic impacted wisdom teeth should be removed at the earliest. However, the big question is should they be removed even if they are not causing a problem?

Research has shown that they are likely to cause some problem or the other in the future. This may remain undetected because one does not generally feel any symptoms, unless it progresses quite a bit. For example, caries occurring behind the adjacent tooth (second molar) may go undetected until it becomes deep enough to expose the pulp which will be felt as severe pain one fine day. It is likely to require not just removal of the impacted wisdom tooth but also root canal treatment and capping of the second molar, and that too if it can be saved at this stage. Secondly, removal becomes more difficult as the age advances and surgery can be more complicated.

So, it is a choice between preventive surgical removal of these impacted wisdom teeth at an early age or waiting for some problem to set in and then getting them out at a later age when surgery becomes more difficult. Remember, a stitch in time saves nine and prevention is always better than cure.