How do I know if my teenager will need his wisdom teeth removed?

 Wisdom teeth — the third molars in the very back of your mouth — don't have room to grow properly and cause problems. Erupting wisdom teeth can grow at various angles in the jaw, sometimes even horizontally. Some wisdom teeth only partially emerge through the gums. Other times, they remain completely hidden. Wisdom teeth that aren't able to emerge normally become impacted, or trapped, within your jaw.To prevent an impacted tooth, dentists often recommend removing the wisdom teeth before they emerge or grow too large. Many dentists believe it's better to remove the teeth when someone is younger and more likely to recover faster from surgery. This is why many teenagers or young adults have their wisdom teeth extracted before the teeth cause problems and become more firmly rooted in the jaw.Wisdom teeth removal may be necessary —  if:

• Wisdom teeth partially emerge through the gums. This increases the chance of a bacterial infection called pericoronitis.
  
• Unerupted wisdom teeth are expected to grow crooked and damage other teeth.
  
• A fluid-filled sac (cyst) develops around an unerupted wisdom tooth, which can damage surrounding tissue or bone.
  
•    It is always better to see your dentist early . He can often refer you to amazing people that make wisdom teeth removal a breeze ! ( instead of an ordeal ) Pick wisely when you choose who takes your wisdom teeth out 
  

The only person who can advise you on this is your family dentist. They will need to look in your child's mouth and in conjunction with xrays, determine if the wisdom teeth:

1) Have enough room to emerge witout any problems to the tooth in front.
2) If the tooth does not have enough room to erupt will it develop too close to the nerve trunk supplying sensation to the lip. This can prove difficult when the tooth needs to be removed later without increasing the risk of nerve damage.
3) Will the presence of the wisdom tooth create other problems like infection in the gum when it is partially erupted.
4) have other problems associated with the tooth itself in the jaw bone ie, cyst.

These issues can only be determined after a thorough dental examination in conjunction with good xrays. 

As my colleague has suggested in this thread, it is better to have this assesed earlier than later.

Most teenagers don't have their wisdom teeth come through until late in teen years or later. Often an orthodontist will recommend removal of wisdom teeth after a course of treatment to straighten crooked teeth. It is common to see young people develop crooked teeth when the wisdom teeth start to come into the mouth. It is common practice to take an OPG x-ray every two years for patients over 12 years and by age 16 it is often possible to predict that there may not be enough  space to fit the wisdom teeth in the mouth. If the wisdom teeh are going to come through straight then the best time to remove them is often just after they come through, but if the teeth are crooked in the bone (impacted) then a specialist oral surgeon should be consulted to work out the best time to remove them at minimal cost while still keeping the teeth straight. A major consideration with teenagers is timing the removal of wisdom teeth so it does not conflict with trail exam or end of year examintions at school.  

I regularly see people who are worried about their wisdom teeth or have been advised to have them removed, but times have changed.The philosophy of the removal of wisdom teeth has changed over the years, the general opinion now of dentists and surgeons is; there needs to a diagnosable condition or issue present to necessitate the removal of wisdom teeth.  These include but are not limited too;

1. Periodontal conditions (severe gum disease) affecting the wisdom teeth that may be acting to seed of localised gum issues.

2. Recurring infection of the tissues surrounding the wisdom teeth when they are partially up in the mouth (called pericoronitis).  I classify recurring as more than twice a year that has necessitated the prescription of antibiotics to resolve the infection.

3. Decay or a hole in the wisdom tooth requiring filling. I generally will not restore or fill a wisdom tooth unless fully erupted, well positioned and is easy to clean and reach to do the filling properly.  I feel any other situation is a waste of money and you may as well spend the money removing it rather than filling the wisdom tooth.  As a few years down the track the filling will need replacing and you will be faced with the same problem remove or keep, you will just be poorer the money you originally spent.

4. If the position of the wisdom tooth is causing damage to the tooth in front and looks as though it is causing dental decay (a hole) in the tooth next door or in front of it.

WISDOM TEETH WILL NOT CAUSE YOUR OTHER TEETH TO MOVE, WITH OR WITHOUT WISDOM TEETH THE TEETH  WILL MOVE FORWARDS AND CROWD, THIS IS NATURE AT WORK. 

Wisdom teeth do not need to be removed post orthodontics.

Upper wisdom teeth are generally very straight forward to remove.  Lower wisdom teeth can be a little more complicated.There are very few times I would recommend removal of all four (or all, not everybody has four wisdom teeth) wisdom teeth at once.  If you follow the modern philosophies then the tooth in question needs to be removed.  If it happens to be a lower wisdom tooth I will encourage the patient to remove the upper wisdom tooth on the same side, this is because over time it will keep growing down and become a problem.  This is not reversed though if removing an upper wisdom tooth only as the lower wisdom teeth are maintained in the bite by the upper tooth in front of the upper wisdom tooth.Only maybe if you are going through the cost of general anaesthetic and a hospital stay and all wisdom teeth can be deemed to eventually cause a problem would I recommend contemplating all four wisdom teeth be removed at once.If somebody has recommended removing all four wisdom teeth, ask;  WHY, WHAT IS THE PROBLEM?

Remember removing Wisdom Teeth is a surgical process even if simple and there are side effects and possible risks to surrounding anatomical features inculding nerves in surrounding tissues that can be permanently damaged in the process of removing wisdom teeth and perforation of the air sinuses in the upper jaw.  There is always a balance in any medical field which is what is the benfit verse the risk.  This means unless there is a greater benefit by removing the wisdom teeth compared to the surgical risks then the process should not be undertaken.

Dr Adam Alford graduated from the University of Sydney, Australia, in 2000 with honours. Dr Alford has worked extensively in Cosmetic and Implant Dental practices in Australia and the UK. He has a special interest in, general dentistry, orthodontics, preventative dentistry, children’s dentistry, cosmetic dentistry, dental implants and tooth whitening. Dr Alford is the author of the article and he maintains a General Dental, Cosmetic, Orthodontic and Implant Dental Surgery in Brisbane and the BrisbaneCBD,  http://www.adamalford.com.auWebmasters are free to reprint this article provided that it is not edited, the authors information is included, and the links are included as live links. .