is there an optimal time to remove wisdom teeth?

Does the age that wisdom teeth are removed affect the outcome? Many studies show that as we get older, wisdom teeth become more difficult to remove, and often results in an increase in complications. 

Wisdom teeth become more difficult to remove with increasing age. The jaws become harder, the periodontal ligament (microscopic ligament which hold the teeth in the socket) around the tooth thins with age, and the roots form more completely with time.

Many publications have studied this and tried to identify risks with time of removal. Here are a number of journal publications with summaries showing higher risk with delayed wisdom tooth removal.

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JOMS 2012 What is the Effect of Timing of Removal on the Incidence and Severity of Complications, Pogrel

This study reviewed articles related to wisdom teeth and complications. The aim was to see if younger (< 25yo) patients have a decreased risk of complications and a more rapid recovery.

*One paper examined 958 patients on recovery of wisdom tooth surgery. Patients older than 21 years old had a more prolonged recovery than < 21yo—> this is for all parameters including pain, number of days til no pain medication was needed, and number of days until the patient reported few to no problems.

*One study of 8,748 third molars removed in 4,004 patients showed increasing age was correlated with decreased recovery.

*Mandible fracture is an uncommon problem in general with tooth removal, but “the incidence may increase with age.” One study cited in this paper suggested that increased age may be a factor in mandibular fracture. 

Infection: position infection rates were noted to increase after 25 yo. And even worse, so does the severity of infection. One study the paper cited included 388 lower third molars removed, patients over 25yo had a 2.7X greater risk of infection.

Another paper cited reviewed 1500 third molar removals and showed an increasing rate of dry socket and infection with age.

*It was noted over the age of 35 yo that extractions become more difficult.

*The paper touched on a popular topic of periodontal healing behind the 2nd molar after 3rd molar (wisdom tooth) removal. Studies showed that the distal 2nd molar/wisdom tooth site had better healing in patients under the age of 25yo. It tends to be worse healing after 25yo.

*Concluded that with increasing age, third molars become more difficult to remove, may take longer to remove, and may result in an increased risk for complications. 25 years is the critical age after which complications become more common, recover takes longer, and the healing is less complete. Because of this, many recommend removal of third molars in young adults.

It specifically mentions there are zero studies indicating a decrease in complications with increasing age. And that those who suggest that patients retain and watch their wisdom teeth shoudl carefully review the risks of delaying third molar removal with these patients.

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JOMS 2007 Age as a Risk Factor for Third Molar Surgery Complications, Chuang

Study looked at age and how it affected the rate of complications after third molar removal. 4,004 patients with 8,748 wisdom teeth removed. Grouped patients as under 25yo, then by decades (26-35, 36-45, etc) 

Cites study by Chapasco showing patients over 25 for M3 removal (868 patients) had a 3X greater complication rate compared to those under 25 yo.

Concluded that patients over 25 yo were 46% more likely to have a complication than patients < 25yo (after controlling for other variables). It was noted that out of 4000 patients there were no deaths associated with M3 (third molar) extraction, no unplanned transfusions, and just 1 jaw fracture. The rate of a nerve injury was less than 2% of all extractions.

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JOMS A Prospective Study of Complications Related to Mandibular Third Molar Surgery (Osborn)

A study on over 9500 patients with over 16,000 mandibular wisdom teeth removed.

Patients were grouped into under 24yo, 25 to 34 yo, and over 35 yo.

This study focused on patient age upon wisdom tooth removal and the complication rate. 

Some stats worth citing:

*After 25 years of age, patients had 1.6X increased rate of dry socket (where half of the patients in this study required 4 or more post-op visits), and an 6.5X overall increased rate of nerve injury for patients over 25 yo.

*If the patient had an infection as a reason to remove the wisdom teeth, there was 2X the rate of dry socket. If there was a cyst or tumor present, dry socket risk was 3X greater. 
The study showed there is an increased rate of complications with wisdom tooth removal in older patients. On this basis it is suggested to focus on preventative care and when indicated remove wisdom teeth during the teenage years to decrease the rate incidence of postoperative morbidity.

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JOMS 2003 Types, Frequencies, and Risk Factors for Complications After Third Molar Extraction

Efforts to limit complications can improve patient experience. 

Factors associated with complications of wisdom tooth removal include age, previous infection, periodontitis, surgeon experience, difficulty of extraction, length of extraction, and others. In the study “increased age was found to be significantly associated with complications.”

Changes with increased age include higher bone density, completely formed roots, diminished wound healing capacity. These can increase complications.