A wisdom tooth coming in doesn’t always need to be removed. The decision is based on specific clinical criteria — not a one-size-fits-all rule.
Here’s how Dr Zerguine assesses the situation at Dental Swiss Clinics in Montreux.
What a wisdom tooth is
Wisdom teeth — or third molars — are the last teeth to erupt, usually between ages 17 and 25. Their development can be straightforward or problematic depending on the space available in the jaw and their position.
Contrary to popular belief — an asymptomatic, well-positioned wisdom tooth can absolutely be left in place and monitored. Extraction is not automatic.
When to monitor without extracting
A wisdom tooth can be kept when it is correctly positioned, functional, and accessible for hygiene. Regular radiographic monitoring is sufficient in these cases.
The absence of symptoms alone does not justify extraction — the decision is guided by clinical and radiographic assessment.
When extraction is necessary
Several clinical situations justify extraction — not always urgently, but with a clear medical indication.
Eruption-related inflammation
When the wisdom tooth is breaking through bone and gum — this process can cause pain, recurrent inflammation, or a localized infection called pericoronitis. If these episodes recur, extraction is indicated.
Orthodontic treatment
As part of orthodontic treatment, wisdom teeth can compromise the result or long-term stability. Their extraction is often planned in advance or during treatment.
Recurrent infection
Recurring infectious episodes around the wisdom tooth — pain, swelling, trismus — indicate a situation that will not resolve on its own. Extraction ends the cycle of infection.
Decay of the wisdom tooth or the adjacent tooth
A wisdom tooth that is hard to clean often develops cavities. Worse — it can cause decay on the second molar, the tooth just in front. This is a serious complication that justifies preventive extraction as soon as the risk is identified.
A poorly positioned tooth
A wisdom tooth in a horizontal position or partially impacted can chronically injure the cheek or surrounding tissues. If the situation is worsening — extraction is recommended before complications set in.
The most serious complication — resorption of the adjacent tooth
This is the most concerning clinical situation related to wisdom teeth. A poorly positioned wisdom tooth can put pressure on the roots of the second molar and cause resorption — that is, progressive destruction of the neighboring tooth’s roots.
This complication often progresses silently — without pain or visible symptoms. It is detected on X-rays. That’s why regular radiographic follow-up is essential, even when there are no symptoms.
Advanced resorption can lead to the loss of the second molar — a functional and valuable tooth. When identified early, it warrants prompt extraction of the wisdom tooth.
Extraction at the clinic — when Dr Zerguine refers
The vast majority of wisdom tooth extractions are performed directly at the clinic under local anesthesia.
The only situation in which Dr Zerguine refers you to an oral and maxillofacial surgeon — when the lower wisdom tooth is in close contact with the inferior alveolar nerve (formerly called the inferior dental nerve). This nerve runs through the lower jaw and supplies sensation to the lip and chin. Extracting under these conditions without specialized equipment carries a risk of nerve injury — paresthesia or permanent numbness of the lower lip.
This risk is assessed on a panoramic X-ray or cone beam scan before any decision is made.
What the assessment includes
Before any extraction decision — a complete clinical and radiographic assessment is essential.
It determines the exact position of the tooth, its relationship to nearby anatomical structures, the risk of complications, and the optimal timing for intervention if extraction is indicated.
Frequently Asked Questions
Do all wisdom teeth need to be removed? No — a well-positioned, asymptomatic wisdom tooth that can be cleaned properly can be kept under regular radiographic monitoring.
Is extraction painful? It is performed under local anesthesia — the procedure itself is painless. Mild post-operative effects are possible in the first few days — swelling, tenderness — and are generally well managed with appropriate treatment.
At what age should wisdom teeth be removed? The earlier extraction is performed — when the roots are not yet fully formed — the easier the recovery. But age alone is not an indication. The clinical situation determines the decision.
My wisdom tooth doesn’t hurt — should it still be monitored? Yes — some complications, such as resorption of the adjacent tooth, can progress without pain. Regular radiographic follow-up helps detect them before they worsen.
Can extraction be done at the clinic, or do I need to go to the hospital? In the vast majority of cases — at the clinic, under local anesthesia. Referral to an oral and maxillofacial surgeon is only necessary when the tooth is in close contact with the inferior alveolar nerve.
For an assessment of your situation — contact Dental Swiss Clinics in Montreux, Monday to Friday, 8:00 AM to 8:00 PM.