Wisdom teeth and orthodontic treatment

How do wisdom teeth affect straight teeth? Should I be worried about my wisdom teeth coming through and moving my teeth? Should I have my wisdom teeth removed, and when should I do this?

Orthodontists are often asked these questions by new patients and those that have finished their orthodontic treatment. In this blog post, we discuss the common questions and concerns associated with wisdom teeth, their effect on the other teeth in the mouth, and encourage you to consult a specialist orthodontist before you go stocking up on supplies for your recovery… because you might not need your wisdom teeth removed after all!

What are wisdom teeth?

Most adults will naturally have four wisdom teeth, but about 15-20% of people never develop at least one of these four teeth. They are the third and last molars, found at the very back on each side of the upper and lower jaws, and are the final teeth to grow through the gums (erupt). They usually appear in the mouth when a person is in their late teens or early twenties. Wisdom teeth often erupt without problems; however, sometimes, the wisdom tooth has insufficient space to erupt properly and becomes “impacted”.

The fact that they come through when you’re older is one of the reasons they’re known as wisdom teeth: you only get them when you have matured and are ‘wiser’!

What are wisdom teeth for?

Anthropologists believe that our wisdom teeth originally evolved to help our ancestors get the most from their diets, which involved a lot of coarse and rough food such as leaves, roots, nuts and meats. Historically, our ancestors needed large and powerful jaws to be able to chew this food. The jaws of modern humans have evolved to be much smaller than our Neanderthal ancestors, which means for many of us, the wisdom teeth simply don’t fit in anymore.

As our diet has changed dramatically over the millennia to include more soft foods that don’t wear down our teeth as much, our wisdom teeth are no longer necessary for our survival. In fact, wisdom teeth are now so redundant that evolutionary biologists consider them to be ‘vestigial organs’, meaning they are now entirely functionless thanks to evolution.

Wisdom teeth to remove?

Do wisdom teeth always hurt when they come through?

The short answer is no, not always! For some people, their wisdom teeth will come through properly aligned, and while it’s likely they’ll experience some tenderness and ‘teething’ around their gums as the teeth erupt into the mouth, it won’t necessarily be painful. In this instance, it’s unlikely any action will need to be taken.

However, as you’re no doubt aware, some people have a very different experience!

Why can it hurt when wisdom teeth come through?

There are a number of reasons why wisdom teeth can be painful or uncomfortable when they come through. It could be that there’s not enough room in your mouth for them, so they are putting pressure on the other adjacent teeth possibly shifting their positions. It could also be because the tooth is trying to come in sideways or has become jammed or “impacted” behind the last tooth in the mouth. In this instance, the gum covering the wisdom tooth can become swollen and infected, which might make your jaw or the area around your ear sore.

How long can wisdom tooth discomfort last?

Wisdom tooth discomfort can last for one to two weeks, but this will vary between individuals because each case is unique. The pain is rarely static, and might increase and decrease at certain times of day. As wisdom teeth grow in stages rather than all at once, it’s likely you’ll experience a few rounds of discomfort before your wisdom tooth has fully come through.

How can I reduce the discomfort from wisdom teeth coming through?

If you experience pain while your wisdom teeth are coming through, one of the most effective remedies is taking over-the-counter pain relief such as Ibuprofen. Alternatively, you might find it helpful to use a teething gel such as Bonjela, which can be applied directly to the area around your wisdom tooth to manage your discomfort.

Heat and ice can also help to relieve pain. Try wrapping an ice-pack or a bag of frozen vegetables in a tea towel and placing on the inflamed side of your face, or eat an ice cube and hold it over the painful area inside your mouth. Swishing your mouth with warm, salty water , or drinking a cup of warm herbal or black tea can also relieve some of the discomfort.

If the pain from erupting wisdom teeth is severe or if you notice swelling around your face or jaw, you should make an emergency appointment to visit your general dentist as this is a sign that the area around the erupting tooth has become infected.

Should I have my wisdom teeth removed?

Although this is a common question, there is no one-size-fits-all answer, as it will depend on the severity and frequency of your symptoms, as well as the impact the wisdom teeth are having on the rest of your mouth.

The main reasons for wisdom teeth removal are:

– Recurrent infections caused from the teeth only partially erupted and impossible to clean properly

– The potential damage to the adjacent healthy molars from the erupting wisdom tooth.

One of the best ways for your orthodontist to tell how your wisdom teeth are coming through will be to take an x-ray of your mouth.

Are wisdom teeth hard to remove?

Again, there’s no one-size-fits-all answer to this, as it depends on how the teeth are growing, the length of their roots and the proximity of the wisdom tooth to other structures in the jaw such as nerves and blood vessels.

In general, wisdom teeth in your lower jaw are more likely to be ‘impacted’ and tend to be harder to remove than wisdom teeth in your top jaw. Your orthodontist may refer you to a specialist oral and maxillofacial surgeon, or back to your general dentist to assess this further. Your surgeon will discuss risks associated with wisdom tooth removal. In general, the risks and complications of wisdom tooth removal are very low, but post-operative infection, delayed healing, and nerve damage can occur.

The removal of wisdom teeth can be done under a local or general anaesthetic, depending on the number of teeth that need to be removed, the level of difficulty involved in their removal and your personal preference. Your surgeon will explain all options of sedation available to suit your individual needs. If the removal is via a local anaesthetic, then the immediate area which surrounds your tooth will be numbed, similar to when you are having a filling. Removal of wisdom teeth under a general anaesthetic would involve the procedure being conducted by a specialist oral and maxillofacial surgeon in a day surgery hospital setting.

After your wisdom teeth are removed, it is common to experience some swelling and discomfort for a few days. It’s possible that you’ll have couple of stitches to help keep the wound closed and aid with its healing. Your surgeon will give you personal instructions on how best to care for your mouth following the procedure, for example whether you should be using any particular mouthwashes to help with your recovery.

If you are still using retainers provided by your orthodontist, they may be too uncomfortable to wear for the first few days after the procedure. But it is important to go back to wearing your retainers again as soon as your mouth feels comfortable enough to do so.

There are not usually any dietary restrictions after you’ve had your wisdom teeth out, but it’s likely you’ll want to avoid hard foods such as nuts and seeds, or crunchy foods like chips until your mouth heals. You should also avoid alcohol and smoking for at least 24-hours following your procedure, or in line with your surgeon’s guidance. wisdom teeth hard to remove

What happens if I ignore painful wisdom teeth?

If you ignore painful wisdom teeth, it may turn into a more serious infection. Soreness around your wisdom tooth, and pain in your jaw, ear or the side of your face can all be symptoms of infection. If that infection isn’t treated, it can spread to the surrounding areas. In severe, untreated cases, the spreading infection may cause facial swelling and compromise your airway, restricting your ability to breathe and swallow, which is a true medical emergency.

It can also be difficult to clean wisdom teeth that have not properly come through. Thanks to their location at the back of your mouth, they’re much more prone to a build-up of food particles and plaque that can cause infection around your tooth, leading to decay and the possibility of developing cysts. As well as having a negative effect on the wisdom tooth itself, this can also impact on the health of the surrounding gums, teeth and bone.

Having painful wisdom teeth removed means you can avoid these potential complications.

Should I be worried about my wisdom teeth coming through and moving my teeth if I’ve had orthodontic treatment?

There is no clear answer because each case is different. When you start to feel your wisdom teeth coming through, you should visit your orthodontist to discuss orthodontic treatment options if necessary. He or she will be able to take a closer look at how the wisdom teeth are impacting on the rest of your teeth, arrange an x-ray of the teeth and jaws, and advise on whether you’ll need to take further action.

Your orthodontist can advise the best way to ensure your newly straight teeth remain in place well after your braces come off. Some patients are recommended a fixed orthodontic retainer (this is placed behind the front teeth, so it is generally invisible), others may be encouraged to wear their removable orthodontic retainers long term.

What else can affect my straight teeth?  

There are a number of other factors that can cause teeth to become crooked over time. Even people without wisdom teeth will notice changes to the alignment of their teeth after many years, so clearly the wisdom teeth are not the only culprits for these long term changes in tooth position.

We now know that as we age our body continues to change – we get grey hair, more wrinkles and our teeth also slowly move with time. Retainers help teeth to maintain their alignment following orthodontic treatment, so because of these natural changes most orthodontists now advise the long term or life time wear of orthodontic retainers after treatment with braces or aligners.

Your orthodontist can advise the best way to ensure your newly straight teeth remain in place well after your braces come off.

When in doubt, ask your orthodontist

While wisdom teeth typically will not harm a straight smile achieved through orthodontic work, removing them may still be recommended to ensure the overall health of your mouth.

Because every person and every case is different, it’s always best to consult with a specialist orthodontist for further advice about whether you should have your wisdom teeth removed and how this might affect your orthodontic treatment in the long term.

The best person to offer you advice and guidance on how wisdom teeth may affect your teeth after orthodontic treatment is your specialist orthodontist. If you are unsure of where to find a registered orthodontist, check the Find An Orthodontist tool on the ASO website to find your nearest practice. 


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