My wisdom teeth don't hurt. Do they need to come out?

• Problems often don't hurt at first. Decay or gum disease behind a wisdom tooth, or damage to the molar in front, can start quietly.
• Hard to clean. Teeth that are partly through the gum, or tipped, trap food and bacteria.
• Usually easier when you're younger. In older adults, pain, discomfort, and complications after surgery are more likely. In the late teens and twenties, the roots are often not fully formed and the bone is more forgiving, so removal and healing tend to go more smoothly.
• Rarely, a cyst can form around a tooth stuck in the bone.

The American Association of Oral and Maxillofacial Surgeons points out that pain-free doesn't always mean disease-free.

• The evidence is unsettled. A 2020 Cochrane review found too little good evidence to say whether healthy, symptom-free wisdom teeth stuck in the jaw should be removed or kept.
• Surgery has its own risks, such as dry socket and, rarely, numbness from nerve injury.
• Some countries advise against routine removal. UK national guidance, for example, recommends removing wisdom teeth only when there's a specific problem.

Teeth that have come in fully, are in line with your other teeth, bite normally, have healthy gums around them, and can be cleaned well. These still need checkups and X-rays now and then.

• Decay in the wisdom tooth that can't be fixed, or decay or bone loss on the molar in front of it
• Repeated gum infections around a partly erupted tooth (pericoronitis)
• A cyst or other change around the tooth on an X-ray
• Damage to the neighboring tooth's root
• Planned braces or jaw surgery, where your orthodontist or surgeon asks for it

Crowding of the front teeth on its own isn't a strong reason. Most research hasn't found that wisdom teeth cause front teeth to crowd, and a review of the studies concluded that removing them only to prevent crowding isn't justified.

Ask to see the X-ray and have your dentist point to the problem, or explain the risk they're trying to prevent. If you keep them, ask how often they should be checked.