Does a Wisdom Tooth Always Need to Come Out? A Busan Guide

• Not every wisdom tooth has to come out. If it has grown in straight, is easy to clean and does its job, we may simply watch it.
• The trouble starts when it is half covered by gum or lying on its side. That leaves a spot you cannot clean.
• The outcome we most want to avoid is losing the molar in front because of a wisdom tooth.
• For a lower wisdom tooth, we first check how close it sits to the nerve canal. One X-ray is sometimes not enough.

At Reset Dental Clinic in Seomyeon, Busan, patients often ask whether a wisdom tooth has to come out, especially when it does not hurt. For patients living in or visiting Korea, we provide 1:1 English interpretation from your first consultation through the end of treatment.

The answer does not depend on whether you have a wisdom tooth. It depends on how it has grown in. An upright wisdom tooth and one lying on its side are completely different stories.

What is a wisdom tooth, and why does it grow in crooked?

A wisdom tooth is the third large molar at the very back of the row. Dentists call it the third molar.

It usually comes in between the late teens and early twenties. It is the last tooth to arrive, after all the others have settled into place.

That timing is where the problem begins. The teeth in front have already taken up the space, and if too little room is left, the wisdom tooth cannot stand upright.

Some people have all four wisdom teeth, some have a few, and some have none. Having none is not unusual either.

The KDCA National Health Information Portal describes a tooth that cannot come into place on time as an eruption disorder. The wisdom tooth is where this problem shows up most often.

Without enough space, a wisdom tooth may stop partway, tilt at an angle, or lie completely on its side. It may also stay buried in the gum or bone, which is called an impacted tooth.

Which of these you have is hard to tell from the outside. The small white part you see above the gum may not be the whole tooth, and a much larger body can be lying underneath.

Why is a half-erupted wisdom tooth so troublesome?

A tooth that is halfway out of the gum causes trouble more often than one that is fully buried.

When gum covers part of the crown, food and bacteria get into the gap, but a toothbrush cannot reach them. It becomes a pocket where things go in but do not come out.

The gum inflammation that develops here is called pericoronitis. Its signs include:

• swollen gum around the wisdom tooth
• pain in that area
• in severe cases, difficulty opening your mouth
• in severe cases, discomfort when swallowing

This inflammation tends to calm down and then flare up again, over and over. When it settles after medicine it may feel over, but the cause remains as long as the gap is still there.

It often flares when you are tired or run down. That is why it seems to show up during your busiest weeks.

Many people ask whether they can leave it once the swelling has gone down. What has settled is this round of inflammation, not its cause, so it may flare again if the covering gum and the gap remain. A good time to have it checked is right after it calms down.

How can a wisdom tooth damage the molar in front of it?

What we worry about more than the wisdom tooth itself is the tooth in front of it. That is the second molar, which comes in around age twelve and does the chewing for decades.

When a wisdom tooth tilts forward, it presses right up against the back of that molar. Neither a toothbrush nor floss can easily get into the spot where they touch.

As a result, decay can form on the back of the front molar, or the gum bone there can sink. A wisdom tooth lying on its side can also press on and damage the root of the tooth in front.

The problem is that this spot is hard to see even with a mirror. By the time you notice sensitivity or pain, the damage has often gone deep.

Harming a molar you rely on for decades in order to keep one wisdom tooth is not a good trade. That is why we look at the front tooth too when deciding whether to remove it.

If a wisdom tooth stays buried for a long time, a cyst can sometimes form around it. Because it grows without pain, it is often found on an X-ray alone.

People sometimes ask whether an implant goes in the wisdom tooth's place afterwards. Usually it does not, because it sits at the very end of the row and chewing works well without it. The situation is different if the front molar has been lost.

When should a wisdom tooth come out, and when can it stay?

Here is a summary. It is a general guide, and the actual decision is made after an examination.

Deciding to watch it does not mean you can forget about it. At every regular check-up, we look at that spot and the tooth in front together.

Some people hope that removing a wisdom tooth will slim the face. Removal is not a treatment to change facial shape, since the jawline is made by the jawbone and muscles. Right after removal, the face may even look more swollen.

You may also hear that wisdom teeth push the front teeth crooked. Many factors work together when a tooth row shifts, so we do not blame the wisdom tooth alone. If you have finished orthodontic treatment, wearing your retainer well is the more reliable step.

If you are pregnant or planning a pregnancy, timing depends on your stage and condition. It is wise to have your wisdom teeth checked in advance, and during pregnancy we decide together with your obstetrician.

Why do we check the nerve first for a lower wisdom tooth?

Inside the lower jawbone runs a canal for the nerve that gives feeling to the lower lip and chin. It is called the inferior alveolar nerve.

The roots of a lower wisdom tooth can lie close to this canal. Some roots almost touch it.

So for a lower wisdom tooth, we first look at the whole area on a panoramic X-ray. If the root and canal overlap or the picture is unclear, we check again with a 3D image.

On a flat image, they may seem to overlap when in fact they sit apart, one in front of the other. A 3D image shows the real distance.

If the tooth is close to the nerve, we explain beforehand that a numb or tingling feeling may remain in the lower lip or chin after surgery. Most cases recover with time, but rarely it lasts longer.

In such cases, we may remove the tooth in sections rather than all at once, or plan a different approach. We choose the safer path over forcing it out in one piece.

For a lower wisdom tooth, planning usually follows these steps:

1. A panoramic X-ray shows the whole tooth and the nerve canal.
2. If they overlap or the picture is unclear, a 3D image is taken.
3. If the root is close to the nerve, we explain the chance of lasting numbness beforehand.
4. We choose the method, such as removing the tooth in sections.

Upper wisdom teeth are a different matter. Above the upper jaw lies an air space called the maxillary sinus, so we check the tooth's relationship with it.

What happens during and after wisdom tooth removal?

Removal is done under local anesthesia. According to the KDCA portal, dental local anesthesia blocks pain in that area alone, and you stay fully conscious.

Once the area is numb, you will still feel pressure and hear sounds, while the anesthetic works to block pain there. This is what surprises first-time patients most.

Some people have put off treatment because the dentist itself frightens them. In that case, we can discuss sedation, a method that helps you receive treatment in a calmer state.

Sedation is not something we recommend for everyone. We prepare it when it is judged necessary, after checking your general health and the medicines you take.

Protecting the socket

The space left after removal is called the socket. Blood collects there and forms a clot that acts like a scab, and healing starts from it.

If this clot comes loose, the bone can be left exposed and become very painful. So for a few days after removal, please follow these points:

• Keep biting on the gauze, but do not keep changing it or spitting.
• Do not spit hard or use a straw. The sucking force is the problem.
• Avoid smoking and alcohol for a while.
• Do not touch the socket with your tongue or fingers.
• Apply cold for the first day or two, then warmth after that, to help with swelling.

Swelling and discomfort are usually greatest on day two or three and ease after that. If pain gets worse after three or four days instead, do not wait it out; please contact us.

Recovery speed varies from person to person. It depends on how far the tooth was lying down, how much bone had to be shaped and your general health.

Some people ask whether all four wisdom teeth can come out at once. Sometimes they are removed together, sometimes in stages, depending on their position, your health, your meals and your schedule. Doing one side at a time lets you chew on the other side.

What should you ask at a wisdom tooth consultation in Busan?

Feel free to ask these questions word for word.

1. How has my wisdom tooth grown in? Ask to go through the X-ray together.
2. Should it come out now, or can we watch it? What is the reason?
3. Is the molar in front healthy right now?
4. If it is a lower tooth, how close is it to the nerve? Do I need a 3D image?
5. What discomfort might I have, and for how long?
6. If we watch it, how often will it be checked?

A clinic that answers while pointing to your images is explaining both why to remove it and why to keep it. That balance is what you are looking for.

If you already have X-rays from another clinic, bring them along. They help us compare any changes over time.

You do not need to decide anything at the first visit. Knowing how your wisdom tooth sits is already a useful result.

Frequently asked questions

Does my wisdom tooth need to come out if it does not hurt?

No pain does not mean no problem, because decay on the back of the front molar, or changes around a buried wisdom tooth, can progress without pain. So we do not decide on pain alone but check with imaging. We also will not push you to remove a wisdom tooth that does not hurt and is easy to keep clean.

Is an upper wisdom tooth easier to remove than a lower one?

Generally, the upper side tends to be easier. The lower jaw has harder bone and lies closer to the nerve canal, so we plan it more carefully. For upper teeth, we still check the relationship with the maxillary sinus.

Can I have my wisdom tooth checked in English in Busan?

Yes. We offer 1:1 English interpretation from the first consultation through the end of treatment. The clinic is near Seomyeon Station Exit 2 (5-min walk), opposite Lotte Hotel Busan, and you can call 010-8555-2854 (+82-10-8555-2854 from abroad).

References

• KDCA National Health Information Portal, "Wisdom Teeth" — where wisdom teeth sit and when they erupt, impaction and inflammation, when removal is considered and care after removal
• KDCA National Health Information Portal, "Tooth Eruption Disorders" — teeth that cannot come into place, and impacted teeth
• KDCA National Health Information Portal, "Gum Disease (Periodontal Disease)" — gum inflammation and bone damage starting in areas that are hard to clean
• KDCA National Health Information Portal, "Dental Local Anesthesia" — how local anesthesia works and why you stay conscious
• KDCA National Health Information Portal, "Dental Sedation" — how sedation lowers tension when dental treatment is difficult, and what is checked beforehand