The Surgery

Assuming that wisdom teeth are erupted or unhealthy, they are commonly removed two at a time, the upper and lower on the same side of the mouth. A general dentist can do it using local anesthesia. Oral surgeons usually use general anesthesia, which is recommended for patients who are very anxious about the procedure.

Dr. Joy said that when the surgery is done between the ages of 17 and 20, complications are minimal and short-lived: primary swelling, pain and discoloration.

Postoperative complications increase with age, Dr. Joy said. Infection, painful sockets and prolonged healing are two to seven times more frequent in patients over 20, a study of 990 patients showed. By age 25 there is a 10 percent risk of damage to facial nerve.

And as age increases, so does the risk of nerve damage, which may cause numbness in parts of the face, drooling or speech impairments. Five times as many older patients as younger ones in the study suffered nerve damage. Increasing age also brings greater likelihood that bone surgery will be needed to pull the tooth.

Such findings prompt Dr. Joy and his surgical colleagues to recommend removal of wisdom teeth in people in their late teens. But the surgeons advised against removing wisdom tooth buds in children, since it is not possible to predict with certainty how the teeth will eventually be positioned.

Dr. Joy also noted that healthy, normally positioned wisdom teeth can be "very valuable additions to a person's mouth" and should not be removed. If nothing else, one might be used later as an implant to replace a molar that has been removed.

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