Wisdom teeth: what they are, and whether they need removing

What wisdom teeth are

Wisdom teeth are the third molars, at the very back of each corner of the mouth. They usually erupt between 17 and 25.

Not everyone has them. Most people have four, but having two, one, or none at all is entirely normal and not a problem.

Most people can comfortably accommodate 28 teeth. A full complement including wisdom teeth is 32 — which is why, when wisdom teeth run out of room, they may come through at an angle, only partly emerge, or stay buried in the bone. That last situation is called impaction.

Do they need to be removed?

Often, no.

A wisdom tooth that has come through fully, sits in a functional position, is free of decay and gum problems and is causing no symptoms does not automatically need removing. Routine removal of healthy, symptom-free wisdom teeth is not supported by good evidence, and the surgery carries risks that leaving them alone does not.

What a healthy wisdom tooth does need is monitoring. They sit at the back where cleaning is hardest, so they can develop problems later even when fine now. We check them at your regular examinations and will tell you if anything changes.

If removal is recommended — by us or anyone else — these are fair questions: what specifically is wrong with this tooth, what happens if we leave it, and what are the risks of the surgery? You should get clear answers.

When removal is indicated

Wisdom teeth and crowding

Wisdom teeth are widely blamed for crowding of the front teeth. The evidence does not support this.

Removing wisdom teeth to prevent front-tooth crowding, or to stop teeth relapsing after braces, is not a sound reason on its own. Front teeth tend to drift with age whether or not wisdom teeth are present. Retainers are what prevent orthodontic relapse.

How they are assessed

A clinical examination plus an OPG — a panoramic X-ray, which we take on site. See dental X-rays and OPG.

That shows the position and angle of each tooth, its root shape, the state of the neighbouring molars, and — critically for lower wisdom teeth — how close the roots lie to the inferior alveolar nerve, which supplies sensation to the lower lip and chin.

That relationship largely determines both the difficulty of removal and the risk involved. Nobody should be recommending removal without imaging. Where the OPG suggests the roots are very close to the nerve, a 3D scan may be taken to see the relationship properly before deciding.

What removal involves

A simple extraction applies to a tooth that has erupted normally. It is loosened and lifted out under local anaesthetic, much like any other extraction, and usually takes a few minutes.

A surgical extraction applies to an impacted or partly erupted tooth. The gum is lifted, a small amount of bone may be removed, the tooth is often sectioned into pieces so it can come out through a smaller opening, and the gum is stitched. Sectioning sounds alarming and is actually the conservative approach, because it means removing less bone.

Most cases are done under local anaesthetic while you are awake. Sedation or general anaesthetic is available for anxious patients or difficult cases, and those are arranged through an oral and maxillofacial surgeon.

Allow around 20 minutes for a straightforward single tooth and up to an hour for a difficult impaction.

Who does it

Straightforward removals are carried out here by our general dentists. Victorian Dental Group is a general practice and none of our practitioners holds specialist registration.

We refer to a registered oral and maxillofacial surgeon where the tooth is deeply impacted, where the roots lie very close to the nerve, where general anaesthetic is preferred, or where your medical history makes surgery more complex. We will tell you which applies at the assessment, before you commit.

Risks of removal

Removal is a common procedure and usually straightforward, but it is surgery and it has risks:

Your practitioner will discuss the risks specific to your case before you consent to anything.

Recovery, day by day

First 24 hours. Bite firmly on the gauze for the first hour. Do not rinse, spit forcefully, use a straw or smoke — all of these dislodge the clot and invite dry socket. Cold compress on the outside of the face, twenty minutes on and twenty off. Soft, cool food. Rest with your head slightly raised.

Days two to three. Swelling usually peaks now, and so does jaw stiffness. Begin gentle warm salt-water rinses after meals. Keep brushing your other teeth normally, avoiding the socket. Bruising may appear along the jaw.

Days four to seven. Steady improvement. Swelling reduces, and you can usually open your mouth more comfortably. Any non-dissolving stitches come out around a week.

Week two onwards. Most people are back to normal eating. The socket takes several weeks to close over fully and a few months for the bone to fill in.

Most people take one to three days off work, depending on how difficult the removal was and what their job involves.

Pain relief. Paracetamol and ibuprofen taken as directed usually cover it, and together where your pharmacist or doctor confirms that suits you. Ibuprofen is not suitable for everyone, including people with asthma, stomach ulcers, kidney problems or on blood thinners.

Dry socket

This deserves its own mention because it is the complication people actually encounter.

It happens when the blood clot protecting the socket is lost, leaving bone exposed. Typically it appears three to five days after the extraction, as a deep throbbing ache that often radiates to the ear, sometimes with a bad taste. It is worse than the original pain and it does not respond well to ordinary pain relief.

It is treatable. We clean the socket and place a medicated dressing, and the relief is usually rapid. Call us rather than enduring it.

The things that raise the risk are smoking, rinsing or spitting too early, using a straw, and the contraceptive pill. Not smoking for at least 48 hours afterwards is the single most useful thing you can do.

Call us if

Spreading facial swelling with difficulty breathing or swallowing is an emergency — hospital, not a dental appointment. See dental emergency.

Cost

Fees depend on whether the removal is simple or surgical, how many teeth are involved, and whether sedation or referral is needed. A straightforward erupted tooth and a deeply impacted one are very different pieces of work. You receive a written plan with all costs before anything begins.

Extractions usually fall under general or major dental depending on complexity; ask for the item numbers and check your annual limit. HICAPS on-the-spot claiming; Afterpay and Zip accepted. See payment options.

Questions we are asked

Should I have all four out at once? Where all four need removing, doing them together means one recovery instead of several. Where only one is a problem, there is no need to remove healthy ones alongside it.

What age is best? If removal is genuinely indicated, roots are less developed and healing is faster in the late teens and early twenties. That is an argument about timing, not a reason to remove healthy teeth.

Will I be swollen for a wedding next week? Possibly. Allow at least two weeks before any event that matters.

Can I drive home? Yes after local anaesthetic. No after sedation or general anaesthetic, and you will need someone to take you.

Do I need antibiotics? Usually not. They are prescribed where there is active spreading infection or a specific medical reason, not routinely.

What if I just leave it? For a healthy, symptom-free tooth that is often the right answer, with monitoring. For one causing recurrent infection or decaying the molar in front, leaving it usually costs you more later.

Victorian Dental Group — 291 Wattletree Road, Malvern East VIC 3145

Phone (03) 9088 5808 · Monday to Friday, 8:00am–5:00pm · closed weekends and public holidays

Book online at any hour.

This page is general information and does not replace advice from a registered dental practitioner about your own circumstances. Any surgical procedure carries risks; outcomes vary between individuals. Please see our Disclaimer.

What are wisdom teeth?

The third molars, at the very back of each corner of the mouth, which usually appear between about 17 and 25. Most people have four, but it is perfectly normal to have fewer or none at all. Some erupt fully and function well; others are impacted, meaning there is not enough room and the tooth stays partly or completely buried, often at an angle.

Do wisdom teeth always need removing?

No, and this is worth being clear about. A wisdom tooth that has come through cleanly, can be cleaned, and is causing no symptoms or disease generally does not need to be removed. Impacted teeth that are causing no problems are often monitored with periodic examination and X-rays rather than taken out. Removing a tooth simply because it is impacted is not a given — there should be a reason.

When is removal recommended?

Repeated infection of the gum over a partly erupted tooth, decay in the wisdom tooth or in the molar in front that cannot be restored, gum disease around it, a cyst or other pathology on X-ray, damage to the adjacent tooth, or persistent pain traceable to it. Removal is also sometimes advised before orthodontic treatment, before some medical treatments, or where access for cleaning makes future problems near-certain.

What is pericoronitis?

Infection of the gum flap covering a partly erupted wisdom tooth — the usual reason a wisdom tooth suddenly becomes painful. The area is swollen, tender, often with a bad taste, and it can be hard to open the mouth fully. It is managed by cleaning the area and sometimes antibiotics, then deciding whether the tooth should come out, since it tends to recur. Spreading facial swelling, fever, or difficulty swallowing or breathing means a hospital emergency department or 000, not a dental appointment.

What is assessed before removal?

The position and shape of the roots, and their relationship to nearby structures — for lower teeth, the nerve that supplies sensation to the lip and chin, and for upper teeth, the maxillary sinus. An OPG X-ray is taken on site; where the roots appear closely related to the nerve, a cone beam CT scan may be arranged to see it in three dimensions. That assessment determines both the risk and whether the case should be referred.

What are the risks?

Pain, swelling and limited mouth opening for several days are expected rather than complications. Beyond that: dry socket, where the clot is lost and pain increases sharply around day three to five; infection; prolonged bleeding; bruising; damage to an adjacent tooth or restoration. For lower wisdom teeth, the important one is nerve injury — numbness, tingling or altered sensation of the lip, chin or tongue, which is usually temporary but in a small number of cases is permanent. For upper teeth, an opening into the sinus is possible. These are discussed against your own X-rays before you consent, not in the abstract.

Are there alternatives to taking the whole tooth out?

Yes, in some cases. Monitoring is an option where there is no disease. Where a lower root lies very close to the nerve, a coronectomy — removing the crown and deliberately leaving the root tips undisturbed — can substantially reduce the risk of nerve injury, though it is not suitable in every case and the roots occasionally need attention later. Treating an infection and keeping the area clean may be enough where the tooth is otherwise sound.

Is it done here or referred?

Straightforward wisdom tooth removal under local anaesthetic is carried out at the practice. Victorian Dental Group is a general dental practice and holds no specialist registration. Deeply impacted teeth, roots closely related to the nerve, cases needing sedation or a general anaesthetic, and anyone whose medical history makes surgery more complex are referred to a registered oral and maxillofacial surgeon. You will be told plainly which category your case falls into.

What is recovery like?

Swelling peaks around day two or three and then settles; most people take a few days off strenuous activity and eat soft food for several days. Bite on the gauze as instructed, use cold packs for the first day, do not rinse vigorously, and do not smoke or use a straw for at least 24 hours, as both are strongly associated with dry socket. Keep the area clean with gentle warm salt water rinses from the day after. Ring us if pain worsens rather than eases after two to three days, if bleeding will not settle, or if numbness persists beyond the day of surgery.

How do I arrange an assessment?

Victorian Dental Group, 291 Wattletree Road, Malvern East VIC 3145. Phone (03) 9088 5808 or email info@victoriandentalgroup.com.au, Monday to Friday 8:00am to 5:00pm, or book online. An assessment with an X-ray comes first, and you receive a written plan with costs and the risks specific to your case before anything is booked.

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