Wisdom Teeth Removal: The Complete Guide

Medically reviewed by Dr. Sam Wood

Wisdom teeth removal is the surgical extraction of the third molars, the last teeth to come in, usually between ages 17 and 25. They are removed when there is no room for them, when they are impacted (stuck in the bone or gum), or when they cause pain, infection, or damage to neighboring teeth. In the US the procedure costs roughly $200 to $600 per tooth for a simple extraction and $300 to $1,100 per tooth for an impacted one, with most people recovering in three to seven days.

Why wisdom teeth cause trouble

Modern jaws are frequently too small for a third set of molars. When a wisdom tooth cannot erupt fully, it does one of several things: it stays buried in the bone, comes in at an angle pressing on the second molar, or breaks partway through the gum and leaves a flap of tissue that traps food and bacteria.

Each situation carries its own problems:

• Partial eruption leads to pericoronitis, a painful gum infection around the tooth that tends to come back.
• Angled or horizontal impaction can damage the root of the tooth in front of it and makes both teeth hard to clean, so decay develops where you cannot see it.
• Fully buried teeth can develop cysts in the sac around the crown, which slowly hollow out the jawbone.
• Erupted but crowded teeth are often simply unreachable with a toothbrush and decay early.

Some people have wisdom teeth that come in straight, with room to spare, and never cause a problem. Those do not need to come out. Others never develop wisdom teeth at all.

Do they always need to be removed?

No. The American Dental Association and the American Association of Oral and Maxillofacial Surgeons both recommend removal when wisdom teeth are causing, or are likely to cause, problems: pain, repeated infection, cysts, damage to adjacent teeth, decay that cannot be restored, or gum disease around the tooth. A healthy, fully erupted, cleanable wisdom tooth can be kept and monitored.

The reason removal is often recommended in the late teens, before symptoms, is practical: roots are not fully formed yet, the bone is softer, and recovery is faster. The same tooth removed at 40 tends to be a harder surgery with a slower recovery. Your dentist will usually take a panoramic X-ray in your mid-to-late teens to see how the teeth are positioned and make a recommendation.

How much wisdom teeth removal costs

Add to that a consultation and panoramic X-ray ($100 – $300) and the sedation fee if you choose it: nitrous oxide is often $50 – $150, IV sedation $300 – $800. Oral surgeons charge more than general dentists but handle the difficult impactions.

Dental insurance usually covers extractions as a basic or major service at 50 to 80 percent, and impacted wisdom teeth are sometimes covered under medical insurance when they are classed as a surgical procedure. Check both policies. Dental schools remove wisdom teeth at a substantial discount under faculty supervision.

The procedure

Removal of all four wisdom teeth typically takes 45 to 90 minutes. The steps:

1. Anesthesia. Options are local anesthetic alone (you are awake and numb), local plus nitrous oxide, oral sedation, or IV sedation, where you are drowsy and unlikely to remember the procedure. General anesthesia is used less often. Most people having all four impacted teeth out choose IV sedation. 2. Access. For an impacted tooth, the surgeon makes an incision in the gum and removes a small amount of bone covering the tooth. 3. Removal. The tooth is loosened and lifted out. Larger teeth are often sectioned into pieces so they can be removed through a smaller opening. 4. Cleaning and closure. The socket is cleaned of debris, and the gum is stitched, usually with dissolvable sutures. 5. Gauze. You bite on gauze to form a clot, and you are monitored briefly before going home.

If you had anything more than local anesthetic, you need someone to drive you home and stay with you for a few hours.

Recovery day by day

• Day 1: Bite on gauze for the first hour and change it as needed. Expect oozing, numbness for several hours, and swelling starting to build. Rest with your head elevated. Cold packs on the cheek, 20 minutes on and 20 off. Liquids and very soft food only.
• Days 2-3: Swelling and bruising peak. Soreness is at its worst but should be controlled by prescribed or over-the-counter pain relief. Start gentle warm salt-water rinses after 24 hours. Soft foods: yogurt, eggs, mashed potatoes, smoothies eaten with a spoon.
• Days 4-7: Swelling recedes, jaw stiffness eases, most people are back to work or school. Gradually return to normal foods.
• Weeks 2-4: Sockets close over. Small food traps are normal and can be rinsed out with a syringe if your surgeon gives you one.

Three rules for the first week: no smoking, no straws, no vigorous rinsing or spitting. All three can dislodge the blood clot and cause dry socket.

Dry socket and other complications

Dry socket (alveolar osteitis) happens when the clot in the socket is lost before the wound heals, exposing bone. It shows up as a sharp, radiating pain starting two to four days after surgery, often with a bad taste. It is not dangerous but it is intensely painful; your surgeon treats it with a medicated dressing that gives fast relief. It affects roughly 2 to 5 percent of extractions and is far more common in smokers and in lower wisdom teeth.

Other complications are uncommon: infection (treated with antibiotics), prolonged bleeding, and, for lower wisdom teeth close to the nerve, temporary or rarely permanent numbness of the lip, chin, or tongue. Your surgeon assesses nerve proximity on the X-ray beforehand and will tell you if your risk is elevated.

When to see a dentist

See a dentist if you have pain, swelling, or repeated gum infection at the back of your jaw, if food constantly packs behind your last molar, or if you are 16 to 25 and have never had a panoramic X-ray to check your wisdom teeth. After surgery, contact your surgeon the same day if you have bleeding that soaks through gauze for more than a few hours, pain that gets worse after day three instead of better, a fever, pus, or numbness that persists beyond the first day. Difficulty swallowing or breathing with swelling is an emergency.

Frequently asked questions

Sources

• American Dental Association (MouthHealthy) – Wisdom teeth
• Mayo Clinic – Wisdom tooth extraction
• American Association of Oral and Maxillofacial Surgeons – Wisdom teeth management
• Cleveland Clinic – Wisdom teeth

This article is for general information only and is not a substitute for professional dental advice, diagnosis, or treatment. Always consult a licensed dentist about your specific situation.