What can go wrong?

The potential complications associated with malpositioned wisdom teeth are not in question. The only argument is about how likely the complications are to occur, especially if the teeth have not erupted through the gum.

"If wisdom teeth are partially emerged, symptoms eventually occur in more than 80 or 90 percent of cases," said Dr. Edwin D. Joy Jr., professor of oral and maxillofacial surgery at the Medical College of Georgia in Augusta.

These are the most common complications of leaving malpositioned or impacted wisdom teeth in place:

• Infection of the surrounding gum tissue. This condition, pericoronitis, is most likely to occur if the tooth is partly erupted or very close to the surface.
• Fluid filled cysts. These can form from remnants of tissue around the crown of the tooth, becoming large and painful. Dr. Guralnick said that if panoramic X-rays are taken every three years, there will be an ample opportunity to detect such cysts while they are small and easy to be removed.
• Decay, or dental caries. The positioning of wisdom teeth makes them hard to clean and hard to repair.

Decay is most likely if the teeth have erupted, but even unerupted wisdom teeth sometimes develop caries. Damage to the adjacent teeth through infection or destruction of the supporting bone. Dr. Joy maintains that impacted wisdom teeth "invariably" cause periodontal pockets to form behind the adjacent teeth, which can jeopardize these teeth.

If any of these conditions occurs, there is no question that the tooth must be removed.Dr. Guralnick said, however, that there is no solid evidenced to show that impacted third molars cause other teeth to shift, so potential crowding of the other teeth is not justification for removing the wisdom teeth.

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