Invisalign and Wisdom Teeth: Do They Need to Be Removed First?
You might wonder if you need to remove your wisdom teeth before starting Invisalign. This is a common question, and the answer isn’t the same for everyone.
Wisdom teeth, the third molars at the very back, often erupt in your late teens or early twenties, and they can sometimes cause crowding or other issues. Many people have them removed proactively, but is it necessary to take them out before Invisalign treatment? Stephen Forrest, DDS, at Des Moines Cosmetic Dentistry Center, breaks down how wisdom teeth can impact Invisalign and what dentists recommend in different situations.
Understanding Wisdom Teeth and Why They Matter
Wisdom teeth are the last set of molars to develop, usually appearing around age 17-25. Some people have all four, some have fewer, and a lucky few have none at all. Often there isn’t enough room in the jaw for these extra teeth, which can lead to them coming in at an angle or not fully emerging (impaction). When wisdom teeth only partially erupt or push against other teeth, they can cause problems like:
Crowding and Alignment Issues
A wisdom tooth might shove neighboring teeth out of position, leading to crowding or a crooked smile. This pressure from the back can undo some of the straightening that Invisalign or braces achieve if the wisdom teeth decide to move in later.
Pain, Infection, and Gum Problems
Wisdom teeth far back in the mouth are harder to clean. Partially erupted ones can trap bacteria, causing gum inflammation, tooth decay, or painful infections such as pericoronitis or abscesses. Impacted wisdom teeth can even lead to cysts or damage to the jaw if left unchecked.
Interference with Treatment
If a wisdom tooth starts coming in during orthodontic treatment, it might disrupt the movement of other teeth. For example, an emerging wisdom tooth could press on molars that Invisalign is trying to move, complicating the alignment process.
Not everyone experiences these issues. Some wisdom teeth come in straight and cause no trouble at all. The impact of wisdom teeth on your Invisalign treatment largely depends on whether those molars are healthy or problematic in your case.
Can You Get Invisalign If You Have Wisdom Teeth?
Yes, you can often get Invisalign even if you still have your wisdom teeth, but it depends on their condition. Having wisdom teeth by itself doesn’t automatically disqualify you from Invisalign treatment. Many people undergo successful Invisalign treatment without removing their wisdom teeth first. Here’s what to consider:
No Issues, No Extraction Needed
If your wisdom teeth have fully erupted in a normal position or they’re still under the gums but not causing any harm, they may not interfere with Invisalign. Wisdom teeth that are asymptomatic, meaning they aren’t causing pain, crowding, or infection, might not need removal at all. In these cases, an orthodontist can often plan your Invisalign around them. The clear aligners mostly work on your visible teeth toward the front, so wisdom teeth in the back may simply be left alone if they’re not a threat to your alignment goals.
Problematic Wisdom Teeth
If your wisdom teeth are impacted, coming in sideways, or already crowding your other teeth, your dentist or orthodontist will likely recommend taking them out before you begin Invisalign. Removing them creates space and prevents potential complications during treatment. For example, an impacted wisdom tooth pushing on its neighbors could hinder the movement of teeth into their correct positions. In such a scenario, extraction is the safe bet to avoid interrupting your Invisalign progress.
Invisalign with wisdom teeth is possible, but it’s evaluated on a case-by-case basis. Your dentist will examine your x-rays and mouth to see if those wisdom teeth pose a risk. If they’re sitting peacefully, you might get the green light to start Invisalign without extraction. If they’re ticking time bombs, it’s usually best to address them first.
Why Dentists Often Recommend Removing Wisdom Teeth First
Even though it’s not an absolute rule, many dental professionals advise removing troublesome wisdom teeth before Invisalign. Here are some reasons why taking them out first can be beneficial:
Prevent Treatment Disruptions
Emerging wisdom teeth can suddenly change the alignment of your teeth. Dentists know that if a wisdom tooth decides to move or erupt in the middle of Invisalign, it could derail the progress. Orthodontists often suggest getting wisdom teeth removed first because new wisdom teeth can disrupt the teeth-aligning process. Patients who skip removal sometimes end up pausing their Invisalign mid-course to extract a painful wisdom tooth, which delays treatment.
Ensure Invisalign Has Room to Work
Invisalign aligners need space to gradually shift your teeth. A large or improperly angled wisdom tooth at the very back can act like a roadblock. By removing it, the aligners can fit and work more effectively without that obstruction. It’s a bit like starting with a clean slate. Once the wisdom teeth are out, your clear aligners can move all your teeth freely into alignment without unexpected resistance.
Avoid Undoing Your Results Later
One big worry is that you’ll finish Invisalign, enjoy your straight new smile, and then a year later a wisdom tooth starts pushing through and messing up that beautiful alignment. Removing wisdom teeth beforehand means there’s no lurking molar that might push your teeth out of place after your Invisalign is done.
Better Oral Health During Invisalign
Having an impacted wisdom tooth with swollen gums or trapped food can make oral care tougher. Taking out a problematic wisdom tooth can improve overall oral hygiene and comfort. You reduce the risk of infections or cavities developing in that area while you’re focusing on straightening your smile. Simply put, it removes a potential source of pain and germs.
Remember, most people will end up needing their wisdom teeth removed at some point in their life. Given that odds are high, many dentists say it’s better to do it on your terms rather than being forced into an emergency extraction later. It’s often a better safe than sorry approach. By handling wisdom teeth first, you’re potentially saving yourself from an unexpected toothache or extended treatment time.
When Wisdom Teeth Removal May Not Be Necessary
In some scenarios, you and your dentist might decide to keep your wisdom teeth in during Invisalign. Removal isn’t automatically required for everyone. Here are instances where you might not need to have them out first:
- Wisdom Teeth Fully Erupted and Healthy: If your wisdom teeth came in normally, are aligned well, and aren’t causing any crowding, a dentist might say there’s no need to extract them solely for Invisalign. They’ll still keep an eye on them, but if X-rays show they’re positioned harmlessly, you can proceed. Some wisdom teeth erupt with ease, fit fine in the mouth, and do not require extraction. In this case, your Invisalign plan may simply include those teeth as-is or just ignore them if they don’t need moving.
- Wisdom Teeth that Won’t Interfere: Occasionally, a wisdom tooth might be angled in a way that it isn’t affecting the rest of your teeth at all (for example, it might never erupt or it’s situated far enough away from the action). Dentists have tools like 3D scans and X-rays to judge this. If they determine your wisdom teeth won’t interfere with alignment, they may leave them. Wisdom teeth don’t always need removal, if they aren’t going to impact the treatment, you can keep them.
- Monitoring Through Treatment: When extraction is not done upfront, it’s usually paired with close monitoring. Your dentist will likely schedule regular check-ups or extra X-rays during your Invisalign journey to ensure those wisdom teeth stay quiet. If any changes arise, say a wisdom tooth starts to shift or cause discomfort, the plan might change (you would then discuss pulling it out).
It’s important to note that choosing not to remove wisdom teeth before Invisalign is something to decide with your dentist or orthodontist. They will weigh the risks and benefits based on your specific case. Every patient is different; some people truly might never have an issue with their wisdom teeth, and extracting healthy teeth unnecessarily isn’t done without cause. If your provider believes you can straighten your teeth without touching the wisdom teeth, they’ll explain why and how they’ll manage it.
What If a Wisdom Tooth Comes In During Invisalign?
Life (and teeth) don’t always stick to our schedule. If you start Invisalign while your wisdom teeth are still in your jaw, there’s a chance one could begin to erupt during the course of treatment. So what happens if a wisdom tooth decides to make an appearance in the middle of your Invisalign plan?
- Dental Team Will Assess Quickly: First, don’t panic. Let your dentist/orthodontist know right away if you feel a wisdom tooth pushing through or any new pain in the back of your mouth. They’ll take a look. In many cases, they may take an X-ray to see the wisdom tooth’s position and decide if it needs to come out immediately.
- Possible Pause for Extraction: If the wisdom tooth is causing pain or is likely to disturb your alignment, the dentist might recommend pausing your Invisalign and getting that tooth removed. This is not uncommon, some patients do have to interrupt their Invisalign treatment to extract wisdom teeth, then resume after healing. It’s better to address it than to continue treatment in discomfort or risk ineffective results.
- Aligners Can Adjust: Interestingly, minor wisdom tooth eruptions can sometimes be managed without a full stop. Orthodontists can adapt your clear aligners even if a wisdom tooth comes out or is extracted mid-treatment. Often, they will trim the back of the aligner or design the next set of trays to accommodate the new space. In other words, even if a wisdom tooth is removed during Invisalign, it usually doesn’t hinder your progress, the aligner can be modified to leave room for the healing area. You might get a short break to heal, but once that’s done, treatment continues.
- Keep Everything Clean: If you do have a wisdom tooth extraction during Invisalign, you’ll get specific instructions to keep the area clean without disturbing it. The removable nature of Invisalign is actually helpful here, you can take out the trays to gently clean your mouth and the extraction site. Make sure to follow all care instructions so you heal up without complications and can get back to straightening your teeth.
The point is that an emerging wisdom tooth during Invisalign is a hurdle, not a roadblock. It shouldn’t ruin your treatment; at most it may extend the timeline a bit. This is one more reason why regular check-ups during Invisalign are important, so any surprise like a pesky wisdom tooth can be caught and managed promptly.
If You Keep Wisdom Teeth Through Invisalign (Or Delay Extraction)
Maybe you and your dentist decide to do Invisalign first and deal with wisdom teeth later, or maybe your wisdom teeth never caused issues during treatment but you still have them afterward. In these cases, how do you protect your newly straight smile and oral health going forward?
- Regular Monitoring: As mentioned earlier, if you choose to hold off on wisdom tooth removal, your dental provider will want to keep a close eye. You should get regular monitoring from your dentist to ensure your teeth stay healthy and aligned if wisdom teeth remain after Invisalign. Usually this means periodic check-ups and X-rays. If those wisdom teeth start to shift or show signs of causing crowding, your dentist will advise promptly scheduling an extraction before real misalignment occurs.
- Retainers Are Your Friend: After Invisalign, you’ll be given retainers to wear (typically at night) to keep your teeth in their new positions. These are especially crucial if wisdom teeth are still in the picture. The retainers help counter any small pressures or movements, essentially preventing your teeth from shifting back. Consistent retainer use can often hold your teeth in place even if wisdom teeth try to nudge them. (In fact, orthodontists say retainer wear has a much bigger role in maintaining alignment than whether or not you removed wisdom teeth.)
- Future Extraction if Needed: Don’t be surprised if a dentist eventually says, “It’s time to take those wisdom teeth out.” Maybe you got through Invisalign fine, but a year or two later one wisdom tooth starts acting up. Since straightening is done, you can remove a wisdom tooth later without orthodontic consequences, you’ll just want to be sure to keep wearing your retainer during healing. Many orthodontists ultimately recommend removing wisdom teeth at the first sign of trouble to preserve that straight smile you worked hard for. It’s much easier to address it than to risk your teeth shifting and needing braces or aligners all over again.
- Listen to Your Body (and Your Dentist): If you experience jaw pain, gum swelling behind your molars, or crowding sensation at any point, get it checked. These could be signs a wisdom tooth is on the move. Likewise, continue to follow your dentist’s advice on caring for your smile. They’ll let you know if and when those wisdom teeth have to go.
The Importance of a Professional Dental Consultation
The decision to remove wisdom teeth before Invisalign comes down to personal dental circumstances. It’s not a one-size-fits-all rule. That’s why the most important step is a thorough consultation with your dentist or orthodontist. They will examine your teeth, take X-rays, and evaluate the position of your wisdom teeth.
A dentist will consider questions like: Are the wisdom teeth likely to erupt soon? Are they angled in a problematic way? Are they causing any decay or gum issues already? Your dentist will use their findings to give you personalized advice on whether to take them out before starting Invisalign.
Don’t be shy about discussing your concerns during this exam. If you’re worried about surgery, mention it. If you prefer to avoid extra procedures, ask if it’s safe to keep the wisdom teeth for now. Dr. Forrest at Des Moines Cosmetic Dentistry Center will explain the pros and cons. Remember, his goal aligns with yours, a healthy, straight smile that lasts a long time. He’ll help choose the path (Invisalign with or without prior wisdom tooth extraction) that best sets you up for success.
