Wisdom teeth need to be removed when they are causing problems or are likely to, such as pain, infection, damage to nearby teeth, or being stuck under the gum. If your wisdom teeth have come in fully, are healthy and are easy to clean, you may be able to keep them. Your dentist decides based on an exam and X-rays, and it is often easiest to make that call in the late teens or early twenties.
What Are Wisdom Teeth?
Wisdom teeth are your third molars, the last teeth at the very back of your mouth. Most people have four, one in each corner, though some people have fewer or none at all. They usually start coming in between ages 17 and 25.
Many jaws don't have quite enough room for them. When a wisdom tooth can't come in fully, it is called impacted. An impacted tooth may stay completely under the gum and bone, come in partway, or grow in at an angle toward the tooth in front of it.
Reasons Wisdom Teeth Are Removed
Your dentist may recommend removal if a wisdom tooth is causing, or is likely to cause, any of these problems:
- Impaction. A tooth stuck under the gum or bone, or tilted against the next molar.
- Pain or pressure at the back of the jaw that keeps coming back.
- Infection of the gum around the tooth. This is called pericoronitis. Food and bacteria get trapped under a flap of gum over a partly erupted tooth, causing swelling, pain and a bad taste.
- Cysts. A fluid-filled sac can form around an impacted tooth and slowly damage bone or nearby roots.
- Decay or gum disease. Wisdom teeth are so far back that they are hard to brush and floss, so cavities and gum problems are common.
- Damage to the next tooth. A tilted wisdom tooth can push on the second molar and cause decay or bone loss there.
- Crowding concerns. Dentists don't all agree on how much wisdom teeth shift other teeth. Your dentist or orthodontist may still suggest removal as part of a larger treatment plan.
Wondering About Your Wisdom Teeth? Schedule an exam at our Sacramento office. Dr. Kathiriya will check your wisdom teeth with X-rays and give you an honest recommendation, whether that's removal or simply keeping an eye on them.
When Watching and Waiting Is Fine
Removal is not automatic. Keeping your wisdom teeth may be reasonable if they:
- Have come in fully and sit upright
- Meet the opposite teeth and help you chew
- Are free of decay and have healthy gums around them
- Can be brushed and flossed well
If you keep them, your dentist will check them at regular exams and take X-rays from time to time, because problems with wisdom teeth often cause no symptoms at first.
X-Rays and the Best Age to Decide
You can't see most of a wisdom tooth by looking in the mouth. A panoramic X-ray shows the whole jaw in one picture, including the position of each wisdom tooth, its roots and the nerve that runs through the lower jaw. Sometimes a 3D scan, called a cone beam CT (CBCT), is used to see exactly how close the roots are to that nerve. Digital X-rays use a very low dose of radiation.
Many dentists check wisdom teeth in the mid to late teens. At that age the roots are not fully formed and the bone is softer, so removal is usually simpler and healing is faster. Adults of any age can still have wisdom teeth removed safely, but recovery may take a little longer.
Depending on how deep and close to the nerve a tooth sits, your general dentist may remove it or refer you to an oral surgeon. Either way, you should get a clear explanation of why.
What Recovery Is Like
Wisdom tooth removal is usually a surgical extraction. The area is numbed, and sedation can help you stay relaxed. Most people take 2 to 3 days to rest, and feel mostly normal within about a week.
- Swelling and soreness usually peak around day 2 or 3, then fade
- Cold packs on the cheek help in the first 24 to 48 hours
- Soft foods for several days, chewing away from the surgery sites
- No straws, smoking or hard spitting for at least 72 hours to avoid dry socket
- Gentle warm salt-water rinses starting the day after surgery
Call your dentist if pain gets worse after day 3, or if you notice a bad taste or bleeding that won't stop. Go to the ER or call 911 for spreading swelling, a fever, or trouble swallowing or breathing. Our full guide to tooth extraction aftercare walks through healing day by day.
Frequently Asked Questions
Do all wisdom teeth need to be removed?
No. Wisdom teeth that are fully erupted, healthy, and easy to clean can often stay. They should be watched at regular checkups and X-rays, since problems can develop later without symptoms.
How do I know if my wisdom teeth are coming in?
You may feel pressure, soreness or swelling behind your last molars, or notice gum tissue that is tender or bleeds. Some people feel nothing at all. An X-ray is the only way to know where the teeth are and how they are growing.
Is it better to remove all four wisdom teeth at once?
Often, yes, if more than one needs to come out. Having them removed in one visit means one recovery instead of several. Your dentist will recommend what makes sense for your situation.
Can an infected wisdom tooth be an emergency?
It can. Mild gum swelling around a wisdom tooth should be seen within a day or two. Swelling that spreads into your face or neck, a fever, or trouble opening your mouth, swallowing or breathing needs the ER right away.
This article is general information, not a diagnosis or treatment plan. Every mouth is different. For advice about your own teeth, please schedule a visit or call (916) 929-3737.