The last teeth in the permanent tooth line are called 20-year-old teeth (3rd big tooth). Although it begins to last between the ages of 17-21 on average, it may remain buried or semi-buried, mostly due to factors that prevent it from continuing. And these buried and semi-buried 20-year old teeth can remain without complaints and symptoms; however, sometimes pain, swelling, pericoronitis (inflammation of the surrounding gums), bad breath due to nutrient accumulation, resorption in the root and enamel of the neighboring teeth, bone resorption and a much lower rate of cyst and tumor formation.

If there are no symptoms and complaints in the presence of embedded 20 years old teeth, they can be left buried in the chin without pulling, but it is useful to follow them with 6-month controls.

In the presence of symptoms and complaints, the tooth can be removed using special surgical techniques or coronectomy (if there is a risk of tooth extraction causing nerve damage).

Also, even in individuals who pay attention to oral hygiene, they have difficulty in preventing plaque and nutrient accumulation because they travel in the most difficult parts of the toothbrush in the jaws. Shooting may be considered in cases where it does not close with the 20-year-old female in the opposite jaw and is not included in prosthetic treatment plans in the future, causing problems such as a bite. Although it is not possible to reach a consensus on the risk of causing interference with the pressure applied to the dental arch during or after orthodontic treatments during its application, its withdrawal can be considered (1).

Pathologies associated with 20-year-old teeth are as follows (2):

Clinical Signs and Symptoms: Caries, Pain (jaw, ear, head), Swelling, Paresthesia, Periodontal Pockets

Non-Inflammatory Radiological Symptoms: Perichoronitis, Root Resorption (External or Internal), Bone Resorption (Between the adjacent tooth), Mild Inflammatory Radiological Changes: Perichoronitis, Abscesses, Osteomyelitis

Other lesions that are rarely associated with 20-year-old teeth: Dentiginous cysts, Keratocysts, Odontomas, Ameloblastomas, Odontomas, Odontogenic Fibromas, Squamous Cell Carcinoma, Fibrosarcomas, Mucoepidermoid carcinomas

(1) Stanaitytė R1, Trakinienė G, Gervickas A. Do wisdom teeth induce lower anterior teeth crowding? A systematic literature review, Stomatologija. 2014; 16 (1): 15-8.

(2) P Santosh, Impacted Mandibular Third Molars: Review of Literature and a Proposal of a Combined Clinical and Radiological Classification, Ann Med Health Sci Res. 2015 Jul-Aug; 5 (4): 229–234