Impacted Wisdom Teeth: When Is Removal Considered?

Pain alone does not determine whether an impacted wisdom tooth needs removal. Disease, effects on neighbouring teeth, nerve or sinus relationships and monitoring options are assessed. The same surgical plan does not suit every symptom-free impacted tooth.

What Is a Wisdom Tooth?

Wisdom teeth, also known as third molars, are usually four in number — two upper and two lower — in most people. However, in some individuals these teeth never develop at all, or only some of them come through.

Impacted wisdom teeth can sit in different positions. Some remain completely encased in bone, while others emerge only partially through the gum. In some cases the tooth lies horizontally and presses against the neighbouring tooth; in others it stays impacted at an angle.

Why Do Impacted Wisdom Teeth Cause Problems?

The most common issue with impacted teeth is pain and a feeling of pressure. This is especially noticeable while the tooth is trying to erupt, as it presses on the surrounding tissue. The pain can sometimes radiate to the ear, jaw, or temple area.

In partially erupted impacted teeth, bacteria can build up more easily beneath the gum. This can lead to a gum infection known as “pericoronitis.” Symptoms may include swelling, redness, difficulty opening the mouth, bad breath, and sometimes fever.

Wisdom teeth that sit horizontally or at an angle can press against the healthy tooth in front of them, leading to decay or root damage. In some cases, the sac surrounding the impacted tooth can develop into a cyst over time. Left untreated, cysts can progress to the point of eroding the jawbone.

Does an Impacted Wisdom Tooth Always Need to Be Removed?

No. Not every impacted wisdom tooth requires extraction. If the tooth is completely trouble-free, isn’t damaging the surrounding tissue, and can be monitored regularly, removal may not be necessary.

However, extraction may be recommended in the following situations:

• Recurring infection
• Pain and swelling
• Damage to the neighbouring tooth
• Decay has developed
• A cyst has formed
• Space is needed for orthodontic treatment
• The tooth cannot be cleaned properly

How Is an Impacted Wisdom Tooth Extracted?

For partially erupted teeth, a procedure similar to a standard tooth extraction may be used. However, teeth that are completely impacted or in a difficult position require surgical extraction.

During the surgical procedure, local anaesthesia is administered, so the patient does not feel pain. The gum is opened to reach the tooth. When necessary, the tooth is divided into smaller pieces for removal, and the area is closed with stitches at the end of the procedure.

Duration depends on position, root anatomy and procedure extent. A personal timetable cannot be given before assessment.

What to Watch For After Extraction

Certain guidelines should be followed after the removal of an impacted tooth to support a healthy recovery.

The dressing should be used as recommended for the first 24 hours. Hot, hard, and spicy foods should be avoided on the same day. Smoking and alcohol consumption can delay healing. Using a straw is not recommended, as it may disturb the blood clot.

Applying ice externally can help reduce swelling. Taking the medication prescribed by the dentist as directed supports the healing process.

Frequently Asked Questions

Is impacted wisdom tooth extraction painful?

Anaesthesia is planned for the procedure. Pressure may be felt; report pain during treatment. Individual instructions address afterwards pain and swelling, and worsening symptoms need assessment.

How long does impacted tooth extraction take?

Duration depends on position, root anatomy and procedure extent. A personal timetable cannot be given before assessment.

Can more than one wisdom tooth be extracted at the same time?

In some cases, the upper and lower teeth on the same side can be extracted in the same session. However, separate sessions are sometimes preferred for a more comfortable recovery.

What happens if an impacted tooth is not removed?

Impacted teeth that cause problems can lead to serious issues over time, such as infection, decay, bone loss, and damage to neighbouring teeth.

Related treatment and assessment

• Wisdom Teeth: Monitoring and Removal
• Impacted Tooth Surgery

This information does not replace an individual assessment. At your appointment, explain when symptoms began and share details of medicines and previous treatment.

Source and further reading

• NHS: Wisdom tooth removal