If you’ve been told you might need wisdom teeth removal, you’re not alone. It’s one of the most common questions we hear: “Do they really have to come out?” The honest answer is no, not always. But in many cases, removing wisdom teeth is the most predictable way to prevent pain, infection, damage to nearby teeth, and other long-term oral health issues.
In this guide, we’ll walk you through why wisdom teeth are often recommended for removal, when they can sometimes stay, and how our team at CRIOS makes a careful, patient-specific recommendation you can feel confident about.
What Are Wisdom Teeth, and Why Do They Cause Problems?
Wisdom teeth (also called third molars) are the last set of molars to develop. They typically start coming in during the late teens or early twenties, though timing varies.
The reason wisdom teeth cause trouble so often is simple: many mouths don’t have enough room for them. When there isn’t sufficient space, wisdom teeth may:
- Get stuck under the gums or in the jawbone (impacted)
- Partially break through the gums (partially erupted)
- Come in at an angle and press into the tooth in front of them
- Sit too far back to clean properly, increasing cavity and gum disease risk
Even when wisdom teeth don’t hurt right away, they can still create problems that show up later, sometimes suddenly.
Do Wisdom Teeth Always Need to Be Removed?
Not always. Some people have wisdom teeth that come in normally, sit in a healthy position, and can be cleaned like any other tooth. In those cases, we may recommend monitoring rather than removal.
But the reality is that wisdom teeth are often recommended for removal because the odds of future problems are high. And many of those problems are harder to treat once they begin, especially if they recur.
Our approach is straightforward: we recommend removal when keeping wisdom teeth creates a meaningful risk to your comfort, your neighboring teeth, or your long-term oral health.
Common Reasons We Recommend Wisdom Teeth Removal
1. Impaction (the tooth is trapped)
Impacted wisdom teeth are teeth that can’t fully erupt because they’re blocked by the jawbone, gum tissue, or another tooth. Impactions can be:
- Fully impacted (completely trapped under the gums/bone)
- Partially impacted (partly visible, but not fully erupted)
Impacted wisdom teeth are more likely to cause pain, swelling, infection, and problems for the tooth next to them. They can also be associated with changes in the surrounding tissue over time, which is one reason we often recommend a preventative approach.
2. Crowding and pressure on nearby teeth
Many patients worry about wisdom teeth “pushing” other teeth out of alignment. While every mouth is different, what we focus on clinically is this:
- Angled or impacted wisdom teeth can place pressure on the second molar
- That pressure can contribute to damage, decay, or gum/bone problems around that tooth
So even if crowding isn’t the main concern, protecting the neighboring molar often is.
3. Infection and gum irritation (especially with partial eruption)
Partially erupted wisdom teeth can create a pocket of gum tissue where bacteria and food get trapped. This can lead to a painful inflammation/infection around the tooth (often called pericoronitis).
Common symptoms include:
- Swollen, tender gum tissue in the back of the mouth
- Bad taste or bad breath that keeps returning
- Pain when chewing
- Jaw stiffness
These flare-ups often come and go, but repeated irritation is a strong sign that wisdom teeth removal may be the best long-term solution.
4. Pain, swelling, and recurring flare-ups
Wisdom teeth issues can be frustrating because they aren’t always consistent. You may feel fine for months, then suddenly have a painful episode.
If you’ve had recurring symptoms—especially infection-like flare-ups—we’ll often recommend removal to prevent the cycle from repeating and to reduce the risk of the problem worsening at an inconvenient time.
5. Cavities in the wisdom tooth or the tooth in front of it
Wisdom teeth are notoriously difficult to brush and floss because of their position so far back in the mouth. That makes them more prone to:
- Cavities in the wisdom tooth itself
- Cavities developing on the backside of the second molar
When decay begins on a wisdom tooth, it can be difficult to repair predictably due to access. In many cases, extraction is the most practical, preventative choice.
6. Long-term oral health concerns you can’t always feel
Some wisdom tooth problems don’t hurt at first. We may see signs on imaging that indicate a higher likelihood of future issues, such as:
- Early gum disease or inflammation behind the second molar
- Bone changes near the wisdom tooth area
- A wisdom tooth position that’s likely to cause ongoing hygiene problems
When we can see those risks developing early, proactive treatment can often prevent bigger problems later.
Signs Wisdom Teeth May Need to Come Out
If you’re experiencing any of these, it’s worth an evaluation:
- Pain or pressure in the back of the jaw
- Gum swelling, tenderness, or bleeding behind the last molar
- Bad breath or a bad taste that keeps returning
- Jaw stiffness or difficulty opening fully
- Food trapping behind the back molars
- Repeated “flare-ups” of soreness or swelling in the same area
Even if symptoms are mild, recurring patterns often tell us the tooth isn’t in a stable, healthy position.
When We May Recommend Keeping Wisdom Teeth
We’re always happy to give a balanced recommendation. Wisdom teeth may be left in place when they are:
- Fully erupted and in a functional, healthy position
- Not damaging the tooth in front
- Free of decay
- Surrounded by healthy gum tissue
- Easy for you to clean well at home
- Supported by a plan to monitor them during regular dental visits
A quick note about monitoring
Monitoring only works when we can reliably follow the tooth over time. If a wisdom tooth is hard to see, hard to clean, or already showing early warning signs, removal often becomes the safer long-term plan.
How Our Team Decides If Extraction Is Necessary
At CRIOS, we don’t make one-size-fits-all recommendations. We base guidance on what we can see clinically and what the evidence suggests about risk over time.
Step 1: We evaluate symptoms and your history
We’ll talk through what you’re feeling (or not feeling), how often symptoms occur, and whether you’ve had past infections or flare-ups.
Step 2: We use imaging to see what’s happening beneath the surface
Wisdom teeth are often a “below-the-gums” problem, so imaging is a key part of decision-making. We look at:
- Tooth position and angle
- Available space
- Signs of pressure or damage to the second molar
- Gum and bone health around the area
- Important anatomical structures near the roots
Step 3: We weigh risk vs. benefit
The core question we answer is:
Is keeping these teeth likely to create preventable problems—now or later?
When the risk of future complications is high, wisdom teeth removal is often the most appropriate preventative solution.
What to Expect If You Need Wisdom Teeth Removal at CRIOS
If removal is recommended, our goal is to make the process clear, comfortable, and predictable—no surprises.
In general, wisdom teeth removal is an outpatient procedure. We’ll review anesthesia options, what the procedure involves, and exactly what your recovery plan looks like. After the procedure, we provide straightforward aftercare instructions and clear guidance on what’s normal as you heal.
Most importantly: you’re not on your own. If you have questions during recovery, our team is here to help.
The Bottom Line: Not Always Necessary, But Often the Healthiest Preventative Option
So, do wisdom teeth always need to be removed? No. But many wisdom teeth are recommended for removal because they create a higher risk of impaction, infection, pain, damage to nearby teeth, and long-term oral health issues.
If you’ve been told you might need wisdom teeth removal, we’re happy to walk you through the reasoning, show you what we see on imaging, and help you make a confident decision.
If you’re experiencing symptoms—or you’re unsure what your wisdom teeth are doing—our team at CRIOS can evaluate them and recommend the right next step.
