If your child currently has one or more wisdom teeth that has yet to erupt, you face a choice if those teeth do not appear impacted on x-rays. Wisdom teeth do tend to eventually erupt through the gums -- they generally don't stay hidden -- but they can cause a number of issues if they don't erupt normally, or if you have only one or two left after removing other impacted teeth. So, you have to figure out what to do with the teeth to prevent those problems later on. It is possible that the wisdom teeth will erupt with no problems, but thinking ahead is always best. 

The Case for Waiting and Seeing

If the teeth aren't impacted, and your child has all four wisdom teeth, there's no reason to immediately undergo surgery to remove the teeth. Unerupted teeth have to be removed by surgery that usually requires general anesthesia, and going through that when there's no immediately obvious problem isn't a good idea because of the increased risk of complications from the surgery. These can include bad reactions to the anesthesia, nerve damage, jaw damage, and infection. Children and teens may have a difficult time caring for the suture sites properly.

But let's say the child has two OK wisdom teeth and two impacted teeth. He or she should certainly have the two impacted teeth removed. But you still have the option to wait to see what the other two do. He or she can always have the teeth pulled later on if they start causing a problem once they erupt (and pulling wisdom teeth requires only local anesthesia instead of general, so the risk of possible side effects dwindles rapidly right there).

The Case for Removing the Teeth

If the child is already undergoing surgery to remove an impacted tooth, removing all of the wisdom teeth can be an efficient use of time. Once they're out, you no longer have to worry about them.

If you remove one tooth and leave the other tooth -- for example, removing a bottom tooth but leaving the corresponding top tooth -- you risk supraeruption, a condition in which the top tooth grows out and then keeps growing, eventually hitting the space in the bottom jaw where the other tooth should have been. Supraerupted teeth can damage the gum sections they hit.

If all four wisdom teeth seem OK, you still may want to remove them, however. It's possible the teeth will erupt crookedly, with the points on the molars' surfaces digging into the child's tongue or cheek. Wisdom teeth are also difficult to take care of properly because they're so far back in your mouth. Cavities in those teeth are common, and your child would end up having to either pull the teeth or undergo drilling that far back in his or her mouth.

Talk to your dentist about the options for your child's teeth, and if your child is older, definitely get him or her involved in the decision-making process. A dentist, such as Russell Pollina, DDS, will be able to give you a specific recommendation.