A birthday is an easy thing to put on the calendar. Deciding when wisdom teeth need attention is less tidy. Dr. Alan Hecht, an oral surgeon at Somerset Oral Surgery, says there is no single age when every patient should have them removed. The more useful decision is when to evaluate the teeth and what that evaluation shows.
I interviewed Dr. Hecht on Oct. 8 about the questions parents bring to his office. They want to know whether their son or daughter needs the teeth removed, what happens if they stay and whether all of them need attention at once. Those questions sound as though they should have one straightforward answer. Dr. Hecht says the teeth themselves determine much of the conversation.
The calendar and the teeth are on different schedules
Dr. Hecht says, “there’s no set age as far as when wisdom teeth need to come out.” He makes a distinction between two kinds of development: “there’s sort of your skeletal age and then there’s your dental age.” In other words, the number on a birthday cake does not tell him how developed the wisdom teeth are. That is something he needs to look at.
Dr. Hecht says 16, 17 and 18 are typical ages to start looking, but he emphasizes that those numbers are not absolute. He has removed fully formed wisdom teeth in 13- and 14-year-olds. He also sees 25-year-olds whose wisdom teeth are still undeveloped. His examples show how different dental development can be at the same stage of life.
Some wisdom teeth come in and work fine, Dr. Hecht says. He does not see that situation often in his office because a patient’s dentist has usually been watching the teeth before recommending removal. That explains the group of patients arriving for a consultation. It does not mean every wisdom tooth in every mouth needs to come out.
An evaluation and a decision to remove are therefore different steps. Looking at the teeth can lead to a recommendation to wait. It can also reveal why waiting longer deserves a closer discussion. The point is to make that decision with information about the teeth rather than assume a particular birthday settles it.
Waiting becomes a question about anatomy
Dr. Hecht says leaving problematic wisdom teeth can mean cavities, infections or cyst formation. He also describes less developed teeth as less likely to involve complications. In the lower jaw, the relationship to the nerve is an important consideration. He discusses the teeth, lip, chin, tongue and taste when explaining why nerve-related questions matter.
As patients get older, Dr. Hecht says the complication concern rises and healing declines. He describes about 25 as a rough cutoff, then immediately qualifies it. There is “no real absolute cut off,” he says. It could be sooner or later, which brings the discussion back to the individual teeth rather than a rule for everyone of the same age.
The upper jaw presents a different issue. Dr. Hecht looks at the sinus above the upper back teeth. He says less developed roots carry less chance of sinus infection or sinus exposure. The lower-jaw nerve question and upper-jaw sinus question are reasons he wants the evaluation to happen before a patient assumes there is plenty of time.
His advice captures that distinction: “It’s always better to say, ‘Oh gosh, let’s wait a little bit.’ than to say, ‘Oh no, we waited too long and now there’s a higher complication for the nerve.’” The recommendation is to get the teeth evaluated early. It is not a recommendation to schedule the same procedure for every teenager. An early look leaves room for a conversation about whether waiting makes sense.
A quiet tooth can still belong in the conversation
Dr. Hecht hears the assumption that pain will simply go away. About the problematic teeth he is discussing, he says, “In most cases, it might get better for a little while, but ultimately it will cause a problem.” He wants that pattern considered when deciding what to do with a problematic tooth. Temporary improvement is something he wants considered during the evaluation rather than used to end the discussion.
He also hears that only the tooth causing trouble needs attention. If the lower right is bothering a patient, Dr. Hecht says the lower left typically follows, then the upper right and upper left. He describes that as the pattern behind his recommendation to be proactive. “Typically” matters here because he is explaining his view, not predicting a fixed sequence for every patient.
Somerset Oral Surgery has three doctors: Dr. Hecht, Dr. Tyler Jacobs and Dr. Maya Ramachandran, an oral medicine specialist. For Dr. Hecht, the wisdom teeth discussion includes which teeth deserve attention and why. That can be a broader question than identifying today’s painful corner of the mouth. The evaluation gives the recommendation its context.
Dr. Hecht starts screening with a panoramic X-ray, a two-dimensional picture of a three-dimensional head, and usually recommends a CT scan if a question remains. He says a tooth often looks closer to the nerve on the panoramic image than on the three-dimensional scan. If the nerve is very close, he may leave the tooth or remove only its crown and leave the roots, which he says typically fill back in with bone; he does not use that approach in the upper jaw. The imaging helps him consider the anatomy before choosing a plan.
This article shares information from the interview, not medical advice. It does not decide whether any particular wisdom tooth needs removal. That decision belongs in an individual evaluation with the surgeon.
The question to take away is when the teeth should be looked at, not which birthday automatically means surgery. Dr. Hecht’s examples show why age alone cannot make the decision. The findings can support waiting or explain why waiting deserves more thought. His advice is to get them evaluated early.
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