Wisdom teeth are the third and final set of molars that most people get in their late teens or early twenties. Sometimes these teeth can be a valuable asset to the mouth when healthy and properly aligned, but more often, they require removal. Wisdom teeth present potential problems when they are misaligned—they can position themselves horizontally, be angled toward or away from the second molars, or be angled inward or outward. In addition, they can be entrapped completely within the soft tissue and/or the jawbone or only partially break through (erupt) through the gum. Teeth that remain partially or completely entrapped within the soft tissue and /or the jawbone are called "impacted."
The removal, or extraction, of wisdom teeth is generally recommended when:
- The jaw isn't large enough to allow all the wisdom teeth to fully erupt in an alignment that is useful for chewing and crushing food.
- Wisdom teeth only partially erupt. This allows an opening for bacteria to enter around the tooth and cause an infection, which results in pain, swelling, jaw stiffness, and general illness. Partially erupted teeth are also more prone to tooth decay and gum disease because their hard-to-reach location and awkward positioning makes brushing and flossing difficult.
- Poor alignment of wisdom teeth crowds or damages adjacent teeth, the jawbone, or nerves. Wisdom teeth that lean toward the second molars make those teeth more vulnerable to decay by entrapping plaque and debris.
- Cysts (fluid-filled sacs) form, or to minimize their potential for forming. Cysts destroy surrounding teeth, jawbone, and nerves. If untreated, a tumor could develop from the walls of the cysts, requiring a more complicated surgical procedure for removal.
How do I know if I have wisdom teeth?
Ask your dentist about the positioning of your wisdom teeth. He or she may take an X-ray periodically to evaluate for the presence and alignment of your wisdom teeth. Your dentist may also decide to send you to an oral surgeon for further evaluation.
Your dentist or oral surgeon may recommend that your wisdom teeth be extracted even before problems develop. This is done to avoid a more painful or more complicated extraction that might have to be done a few years later. Removal is easier in young people, when the wisdom teeth roots are not yet fully developed and the bone is less dense. In older people, recovery and healing time tend to be longer.
How is a wisdom tooth removed?
The relative ease at which your dentist or oral surgeon can extract your wisdom teeth depends on the position of the impacted teeth. Your oral health care provider will be able to give you an idea of what to expect during your pre-extraction examination. A wisdom tooth that is fully erupted through the gum can be extracted as easily as any other tooth. However, a wisdom tooth that is underneath the gums and embedded in the jawbone requires an incision into the gums and then removal of the portion of bone that lies over the tooth. Often, the tooth will be extracted in small sections rather than in one piece to minimize the amount of bone that needs to be removed to get the tooth out.
What medications might be needed during the extraction process?
Before your wisdom tooth is extracted, the tooth and the surrounding tissue will be numbed with a local anesthetic—the same injection with the same medication you receive to numb a tooth before having a cavity filled. In addition to the local anesthetic to numb the pain, you and your dentist or oral surgeon may decide that a sedative is desired to control your anxiety. Sedating medications that could be selected include: nitrous oxide (otherwise known as "laughing gas"), an oral sedative (for example, Valium®), or an intravenous sedative (administered via an injection into your veins). If nitrous oxide is given, you will be able to drive yourself home. If any of the other medications is selected, you will need someone to drive you to and from the appointment.
What does recovery involve?
How quickly you heal depends on the degree of difficulty of the extraction (a simple extraction of a fully erupted tooth versus a tooth impacted into the jawbone). Your dentist will explain what to expect in your specific case. In general, here’s what to expect.
During the first 24 hours
Bleeding may occur for several hours after tooth extraction. To control it, position a piece of clean moist gauze over the empty tooth socket and bite down firmly. Apply constant pressure for about 45 minutes. A moistened tea bag is an effective alternative. The tannic acid in tea helps healing blood clots to form (blood clots function similarly to a scab on an open wound). Repeat this process if a small degree of bleeding continues; if heavy bleeding continues to occur, contact your dentist or oral surgeon. Avoid rinsing or spitting for 24 hours after tooth extraction, avoid "sucking" actions (for example, don’t drink beverages through straws or smoke) and avoid hot liquids (such as coffee or soup). These activities can dislodge the clot, causing dry socket (see below for description) to develop.
Facial swelling in the area where the tooth was extracted typically occurs. To minimize swelling, placed a piece of ice, wrapped in a cloth, on that area of your face on a schedule of 10 minutes on, followed by 20 minutes off. Repeat as necessary during this first 24-hour period.
Pain medications , such as acetaminophen (Tylenol®) or ibuprofen (Motrin® or Advil®) can be taken for minor pain. Your dentist or oral surgeon may prescribe more potent pain relievers, such as narcotics, if necessary.
Antibiotics that may have been prescribed prior to tooth extraction (to treat any active infection around the wisdom tooth to be extracted) should continue to be taken until the full prescription has been taken
Foods should be chewed on the side of the mouth opposite the extraction. Avoid hot liquids and alcoholic beverages for at least 24 hours. In the case of difficult extractions, consume a soft or liquid diet for the first 24 hours.
Continue to brush your teeth , but avoid the teeth directly neighboring the extracted tooth during the first 24 hours. On day two, resume the gentle brushing of your teeth. Do not use commercial mouth rinses—these can irritate the extraction site.
After 24 hours
Facial swelling in the area of the tooth extraction should be treated with heat after the first 24 hours of ice. Apply a moist warm towel to the area on a 20 minute on, 20 minute off schedule. Repeat as necessary.
Rinse your mouth with warm salt water (1/2 teaspoon of salt in a cup of warm water) after meals and before bed. Do not use commercial mouth rinses.
Stitches (if used and if not self-dissolving) need to be removed by your oral health care provider in about 1 week. If you do require stitches, ask what type you have been given.
Watch for signs of dry socket (described below). This condition requires treatment by your oral health care provider.
Complete healing doesn’t occur for a few weeks to a few months following the extraction. However, within the first two weeks, there should be enough healing in the area of the extraction to be able to use your mouth comfortably.
What are the potential complications associated with wisdom teeth removal?
Two of the more important complications are dry socket and paresthesia.
- Dry socket: Dry socket is a common complication that occurs when either a blood clot has failed to form in the extracted tooth socket or else the blood clot that did form has been dislodged. Without clot formation, healing will be delayed. When it happens, dry socket typically occurs 3 or 4 days after the extraction and is accompanied by pain (ranging from "dull" to moderate to severe) and a foul mouth odor. Your dentist or oral surgeon will treat the dry socket by placing a medicated dressing in the socket. The dressing will need to be removed and replaced every 24 hours until symptoms subside.
- Paresthesia: Paresthesia is a complication that occurs less frequently. Wisdom teeth entrapped in the jawbone are often close to nerves. Sometimes these nerves can be bruised or damaged during the tooth removal process. The result is a numbness (called a paresthesia) of the tongue, lip, or chin that can last a few days, weeks, or months, or may even be permanent.
How much does wisdom teeth extraction cost?
Simple extraction of a wisdom tooth will cost less than the cost of extraction of an impacted wisdom tooth. Because costs vary in different areas of the country, you should contact your dentist or oral surgeon for their charges. Also check with both your dental insurance carrier and medical insurance provider. One or the other type of insurance may cover a portion of the cost of wisdom teeth removal, but plans do vary widely in their coverage.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 5/14/2007
