Wisdom teeth: remove them or not? Advice in Luxembourg

Wisdom teeth are the third molars, the last teeth to come through, usually between the ages of 17 and 25. Despite what many people believe, they do not automatically need to be removed: it all depends on how much room your jaw has and whether the teeth are actually causing trouble. In Luxembourg, a dentist assesses the situation and, for difficult extractions, refers you to a maxillofacial surgeon. The decision is made case by case, after an examination and a panoramic X-ray.

Why do these teeth cause so much trouble?

Human jaws have become smaller over time, but the number of teeth has stayed the same. Wisdom teeth arrive last, when most of the space is already taken. Three things can then happen.

Sometimes the tooth erupts normally and lines up with the others — no problem at all. Sometimes it stays trapped in the bone or under the gum, which is called an impacted tooth, or it grows at an angle and pushes against its neighbour. And sometimes it only comes through halfway: a flap of gum still covers part of the tooth, and bacteria slip underneath it easily. That pocket is almost impossible to clean with a toothbrush and can become infected. This is pericoronitis, a painful inflammation of the gum around the tooth, with swelling, difficulty opening the mouth and sometimes fever. It is the most common wisdom tooth problem in young adults.

When can you keep them?

Removing all four wisdom teeth as a matter of routine is no longer standard practice. A wisdom tooth is worth keeping when it has fully erupted, sits in line with the other teeth, can be cleaned properly and has no decay — or when it is completely impacted, lies deep in the bone, touches no neighbouring tooth and shows no abnormality on the X-ray. In that case the dentist simply keeps an eye on it at your regular check-ups, with an occasional X-ray to confirm that nothing has changed.

A healthy wisdom tooth even has its uses: it contributes to chewing and can occasionally serve as an anchor for future dental work.

When does extraction become necessary?

Some situations clearly tip the balance towards removal:

• repeated episodes of pericoronitis, despite good oral hygiene;
• decay in the wisdom tooth or in the molar next to it that cannot be treated properly because of the tooth’s position;
• a tooth growing at an angle that is damaging or loosening its neighbour;
• a cyst or another lesion around an impacted tooth, visible on the X-ray;
• recurring pain or infections, or an extraction required as part of orthodontic or surgical treatment.

When removal is indicated, it is better not to put it off for years: in young adults the roots are not yet fully formed and the bone is more flexible, which makes the procedure simpler and recovery quicker.

What does the extraction involve?

Most extractions are done at the dental practice under local anaesthetic: you stay awake, the area is completely numb, and you feel pressure at most — never pain. The procedure usually takes between a few minutes and half an hour per tooth.

When a tooth is deeply impacted, lies close to a nerve, or several teeth need to come out in one session, the dentist refers you to a maxillofacial surgeon. Depending on the case, the operation is then done under reinforced local anaesthetic, under sedation or, more rarely, under general anaesthetic in hospital. It is a very common, well-mastered procedure, and the practitioner explains each step beforehand — which takes away much of the apprehension.

Recovery: what to realistically expect

The days after an extraction are rarely pleasant, but they follow a predictable course. Your cheek swells, peaks around the second or third day, then settles. Limited mouth opening, slight bleeding on the first day and some bruising on the cheek are normal. The pain responds well to the painkillers prescribed, and the aftercare instructions are simple: cold packs, lukewarm soft food, no vigorous rinsing on the first day, no smoking.

Some warning signs, however, mean you should call the practice without delay: pain that gets sharply worse after three or four days of improvement, persistent fever, swelling that keeps growing, a bad taste or discharge, bleeding that will not stop, or difficulty swallowing or breathing — in that last case, outside opening hours, call 112.

How it works in Luxembourg

In Luxembourg you can see a dentist directly, without a referral. The dentist establishes whether removal is needed, performs straightforward extractions and refers complex cases to a maxillofacial surgeon. Consultations, X-rays and wisdom tooth extractions are covered by the National Health Fund (CNS) under the usual reimbursement conditions; if the operation takes place in hospital, cover follows the rules that apply to hospital procedures. You can find a dentist or a maxillofacial surgeon near you and book an appointment directly on Doctipro.