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Wisdom teeth are the third and final set of molars to appear in the mouth, tending to erupt during the late teens or early twenties. Many people live their whole lives with healthy, fully erupted third molars and remain without pain or symptoms; however, symptoms can arise from the misalignment or impaction of third molars that lead to the recommendation of extraction.

Misaligned wisdom teeth may be positioned horizontally or angled toward or away from the other teeth. This misalignment may cause damage to the other teeth, and sometimes can cause jaw or nerve pain. In addition, poor positioning may make these teeth hard to clean, allowing plaque and other debris to accumulate which, in turn, can lead to decay or infection of the teeth and surrounding tissues.

Impacted wisdom teeth are those that either did not erupt or remain entrapped in the jawbone or surrounding soft tissue. A partially erupted wisdom tooth leaves direct access for bacteria to penetrate the area around the tooth and cause an infection. This can lead to painful swelling, stiffness in the jaw, and sometimes more generalized illness. Typically, partially erupted teeth are more prone to tooth decay and gum disease.

Due to surgical advances and anesthesia techniques, extraction of wisdom teeth can normally be performed safely on an outpatient basis under sedation. Patients should always give the oral surgeon a complete and comprehensive account of their medical history and current medications so that the doctor can provide an individualized procedure plan that best fits the patient's own medical needs.

Due to the complex and uncertain nature of third molar-related disease and complications, Massachusetts General Hospital’s Department of Oral and Maxillofacial Surgery (OMFS) recommend that everyone have a comprehensive third molar evaluation between ages 18 and 21. The purpose of this visit is to document third molar presence, position and development, chart baseline disease, and discuss treatment options, which may include early removal or longer-term management. If management is chosen over surgical removal, the oral surgeon will discuss appropriate hygienic measures, signs and symptoms of disease, and risk factors. Patients may choose "early removal" or they may choose management, which includes regular visits every two-five years with their oral surgeon.