Wisdom Teeth: Signs of Problems, Removal and Recovery

Wisdom teeth are the third molars at the very back of the mouth. For some people they come in without trouble and work like any other tooth. For others, there is not enough room, and they become trapped, crooked or partly erupted. This guide explains how dentists decide whether wisdom teeth should be removed, what the procedure generally involves, and how to recover comfortably.

Table of Contents

When wisdom teeth appear

According to the ADA’s MouthHealthy page on wisdom teeth, third molars usually appear between the ages of 17 and 21. When they come in correctly, healthy wisdom teeth can help with chewing. Some discomfort as they come through is normal, but the ADA advises seeing a dentist promptly if you have pain.

What can go wrong

Problems usually come down to space and position. A wisdom tooth is called impacted when it is trapped in the jaw or under the gums. MouthHealthy describes several issues dentists watch for:

Teeth in the wrong position can trap food, giving cavity-causing bacteria a place to grow.
Teeth that have not come in properly can make it hard to floss between the wisdom tooth and the molar next to it.
Partly erupted teeth can let bacteria into the gums, leading to infection, pain, swelling and jaw stiffness.
Impacted teeth can sometimes form a cyst that may damage nearby roots or bone.
Some believe wisdom teeth without room can crowd or damage neighboring teeth.

How dentists decide on removal

Every patient is different. The ADA lists changes that may mean wisdom teeth should be removed: pain, infection, cysts, tumors, damage to neighboring teeth, gum disease, and tooth decay that cannot reasonably be restored. Removal may also be recommended as part of orthodontic or other dental treatment. Before deciding, your dentist will examine your mouth and take X-rays.

Not everyone needs their wisdom teeth out. The ADA notes that wisdom teeth that stay should continue to be monitored, because problems can still develop later. If you are told to remove teeth that are not causing symptoms, it is reasonable to ask what specific findings support the recommendation, and what the risks are of waiting and watching instead.

Who performs the procedure

Many general dentists remove wisdom teeth that are fully erupted and straightforward. Impacted or complicated cases are commonly referred to an oral and maxillofacial surgeon, a specialty defined by the ADA National Commission as covering surgical treatment of the hard and soft tissues of the mouth and jaws. Our guide to dental specialists explains the roles.

What the surgery generally involves

Consultation. Review of X-rays (sometimes a 3D scan), your medical history and your anesthesia options.
Anesthesia. Options can range from local anesthetic alone to nitrous oxide, IV sedation or general anesthesia, depending on complexity, your anxiety level and the provider. If you are sedated, you will need someone to drive you home.
Removal. Erupted teeth may be removed much like any extraction. Impacted teeth may require an incision in the gum, removal of some bone, or sectioning the tooth into pieces.
Closing and gauze. Stitches may be placed, and you will bite on gauze to control bleeding.

Cost factors

We do not list prices, because they vary with region and complexity. The main variables are the number of teeth, whether they are erupted or impacted (and how deeply), the type of anesthesia, imaging, and whether a specialist performs the surgery. Dental insurance often covers part of medically necessary removal; check your plan and request a pre-treatment estimate. The FAIR Health Consumer dental cost tool can give a reference for local charges. Our tooth extraction guide covers cost factors in more detail.

Recovery tips

Your surgeon’s written instructions come first. The ADA’s general advice for extractions (MouthHealthy) includes:

Do not smoke, and avoid vigorous rinsing.
Avoid drinking through a straw for 24 hours.
Follow the suggested diet; cool, soft foods are typical at first.
Rinse gently if you need to during the first few days.
Use a cold cloth or ice bag for swelling, and ask your dentist about pain medication.
Keep brushing your other teeth, but be gentle near the surgical sites.

Plan a few quiet days after surgery, especially if several impacted teeth are removed. Have soft foods and any prescribed medications ready before the appointment.

Warning signs after surgery

Watch for dry socket, a painful condition that can occur when the blood clot over the socket is dislodged and bone and nerves are exposed (MouthHealthy). Pain that gets worse instead of better after a few days is a typical clue. Also call your dentist for bleeding that does not slow with pressure, increasing swelling, fever, pus or persistent numbness. Trouble breathing or swallowing is a reason to call 911. See our dental emergency guide.

Finding a provider

Browse general dentists and oral surgeons near you in our directory. Our guide on how to choose a dentist includes questions to ask at a consultation.

Frequently asked questions

At what age do wisdom teeth come in?

According to the ADA, wisdom teeth usually appear between ages 17 and 21.

Do all wisdom teeth need to be removed?

No. Healthy, well-positioned wisdom teeth can stay, but they should be monitored. Removal is usually recommended when there is pain, infection, cysts, damage to nearby teeth, gum disease or unrestorable decay.

Who removes impacted wisdom teeth?

Impacted or complex wisdom teeth are commonly referred to an oral and maxillofacial surgeon, although many general dentists remove straightforward ones.

What is dry socket?

Dry socket is a painful condition after an extraction in which the blood clot is dislodged, leaving bone and nerves exposed. Contact your dentist if you suspect it.

Photo: Nadezhda Moryak / Pexels

Sources

By the Dentists Reviews Editorial Team.

This is general information, not medical advice. Talk to a licensed dentist about your own situation. See our disclaimer.

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