Wisdom Teeth and Orthodontic Treatment

Dr. Lieblick: I always find it gratifying when we see a patient for their post-operative check after a wisdom tooth removal and they mention they’re heading right back to their orthodontist to continue with their treatment. It’s a great example of successful collaboration.

Dr. Rehrer: I agree completely, Russ. Those cases really highlight how different dental specialties work together. The communication and careful timing between our surgical practice and an orthodontist’s office are essential to making sure the patient’s overall treatment plan moves forward smoothly and successfully. It’s a true team approach.

Dr. Lieblick: And that specific intersection—between wisdom teeth and orthodontic treatment like braces—is a very common point of discussion for patients and parents. Welcome, everyone, to Oral Surgery Insights. I’m Dr. Russ Lieblick, and that’s Dr. Brandon Rehrer. Today, we want to explore that very relationship and answer the common questions surrounding it.

Dr. Rehrer: It's an important topic, because many people have questions about how their wisdom teeth might affect the beautiful, straight smile they’ve worked so hard to achieve with their orthodontist. Our goal is to clarify the connection and explain the rationale behind the recommendations we often make in coordination with our orthodontic colleagues.

Dr. Lieblick: A good place to start is with a very common belief, or perhaps misconception: that erupting wisdom teeth will push all the other teeth forward and cause them to become crowded again after braces have been removed. We hear this concern from patients and parents all the time.

Dr. Rehrer: We certainly do. It seems like a logical assumption—a big tooth erupting in the back could exert forward pressure. However, the modern scientific and clinical consensus is that wisdom teeth are generally not considered the primary cause of late-life dental crowding, particularly of the lower front teeth.

Dr. Lieblick: That’s a key point. While an erupting wisdom tooth can exert some localized force, the idea that it has enough power to create a domino effect and push an entire arch of teeth forward isn't well supported by research. It may be a small part of it, but it's more complex than that.

Dr. Rehrer: Exactly. Other factors are now understood to play a more significant role in that late incisor crowding. These include subtle, continued late mandibular growth, a natural lifelong tendency for teeth to drift slightly forward, and changes in the soft tissue pressures from our lips and tongue over time. These forces are present whether a person has wisdom teeth or not.

Dr. Lieblick: So, while we don't typically recommend removing wisdom teeth solely to prevent future crowding, their removal is still a very important part of many comprehensive orthodontic treatment plans, but for other, more clinically significant reasons.

Dr. Rehrer: One of the most common and clear-cut reasons for removing wisdom teeth in relation to orthodontics is the need to create space. An orthodontist's plan might involve moving the existing molars backward in the arch—a process we call distalization—to resolve crowding further forward or to correct a patient’s bite.

Dr. Lieblick: In those situations, the wisdom teeth, whether they are erupted or still impacted within the bone, are physically in the way. They occupy the very space the orthodontist needs to move the second molars into.

Dr. Rehrer: Correct. So, in these cases, the orthodontist will refer the patient to us for the removal of the wisdom teeth—often the upper ones first, or sometimes all four—to clear the path for that planned orthodontic movement. The surgery becomes a necessary enabling step for the orthodontic plan to succeed.

Dr. Lieblick: Another very important reason for removal is preventative care, aimed at protecting the long-term health and stability of the final orthodontic result. An orthodontist invests a year or two, sometimes more, carefully aligning a patient's teeth into a beautiful, healthy smile. The last thing anyone wants is for that result to be compromised by a preventable dental problem down the road.

Dr. Rehrer: And as we’ve discussed in previous episodes, impacted or poorly positioned wisdom teeth carry inherent risks. If an orthodontist looks at the patient’s X-rays and sees wisdom teeth that are deeply impacted, angled horizontally, or in a position that will make them impossible to clean, they recognize that these teeth are likely to cause future problems.

Dr. Lieblick: Those problems could include infection, decay, or damage to the adjacent, and very important, second molars. From a patient care perspective, it makes perfect sense to address this liability. Removing these high-risk wisdom teeth, often after the braces come off, is a proactive measure to protect the patient's investment in their orthodontic treatment and ensure their newly straightened smile remains healthy for years to come.

Dr. Rehrer: A third, more specific reason, involves corrective jaw surgery, or orthognathic surgery. These procedures are often the ultimate expression of collaboration between an oral surgeon and an orthodontist to correct significant bite and facial skeletal discrepancies.

Dr. Lieblick: When we perform these surgeries, we need to make precise surgical cuts in the jawbones. The wisdom teeth are often located directly in the area where these cuts need to be made.

Dr. Rehrer: For that reason, it is standard practice to remove the wisdom teeth well in advance of the planned jaw surgery, typically six months to a year beforehand. This allows the bone in those areas to heal completely, providing solid, healthy bone for a clean surgical procedure and stable post-operative healing.

Dr. Lieblick: The timing of wisdom tooth removal in relation to orthodontic treatment can vary, and it's a key part of the collaborative planning. Sometimes, removal is best done before the braces are even placed.

Dr. Rehrer: This is often the case if the orthodontist identifies from the start that they will need the space occupied by the wisdom teeth for their planned tooth movements, as we discussed with distalization. Removing them upfront clears the path and allows the orthodontic treatment to proceed without delay.

Dr. Lieblick: Other times, the decision is made to remove them during the course of orthodontic treatment. As teeth are moved and the bite is aligned, it might become more apparent that the wisdom teeth are going to be problematic for the final alignment or long-term stability.

Dr. Rehrer: Performing the surgery while a patient is in braces is very common and perfectly safe. We simply coordinate with the orthodontist.

Dr. Lieblick: And finally, it's also very common to plan for removal after orthodontic treatment is complete. The patient gets their braces off, they're thrilled with their new smile, and then, as the final step in their comprehensive care, they are referred to us. This is often the case for those preventative removals we talked about, to address high-risk, asymptomatic teeth and protect the beautiful result they’ve just achieved.

Dr. Rehrer: The most important thing is that the timing is a deliberate part of the overall treatment plan, decided upon through communication between the orthodontist and the oral surgeon.

Dr. Lieblick: That collaborative process is something we really value. It ensures the best possible care for the patient, who is at the center of this team effort. It begins with the orthodontist making a referral to our practice.

Dr. Rehrer: We then conduct our own thorough evaluation, including reviewing the orthodontist’s records and our own diagnostic imaging. We communicate our findings and surgical plan back to the orthodontist, ensuring we are all aligned on the goals and the timing of the surgery within the broader orthodontic timeline.

Dr. Lieblick: This means the patient doesn't have to worry about coordinating between offices or translating clinical information. They can feel confident that their specialists are working together behind the scenes. Our goal is to make that experience as seamless as possible, so they can focus on their treatment.

Dr. Rehrer: This teamwork leverages the specific expertise of each provider. The orthodontist is the expert in aligning the teeth and bite, and we are the experts in performing the necessary surgery safely and effectively. By working together, we can achieve outcomes that neither of us could achieve alone.

Dr. Lieblick: So, Brandon, to bring it all together for our listeners, the relationship between wisdom teeth and orthodontic treatment is an important one, but maybe not for the reason many people think.

Dr. Rehrer: That’s a good summary, Russ. While wisdom teeth are not generally considered the primary cause of late-life dental crowding after braces, their removal is often a crucial and necessary step in a comprehensive orthodontic plan for other clear, clinical reasons.

Dr. Lieblick: That can be to create necessary space for orthodontic tooth movement, to prevent future dental health problems like infection or damage to adjacent teeth that could compromise the orthodontic result, or to prepare the jaw for corrective surgery.

Dr. Rehrer: The timing of the removal—before, during, or after orthodontic treatment—is a strategic decision made in close collaboration between the oral surgeon and the orthodontist, always based on the individual patient's specific anatomy and overall treatment goals.

Dr. Lieblick: It's a wonderful example of how different dental specialists partner together to provide the highest level of care. We hope this has clarified the connection and been helpful for any patients or parents currently navigating the world of orthodontics. Thank you for making Oral Surgery Insights part of your day.

Dr. Rehrer: We appreciate you listening, and we trust this discussion has provided some valuable insight.

Dr. Lieblick: Thanks for tuning in! We hope to see you at Beacon Oral Surgeons for care soon.