Wisdom teeth, or third molars, appear (erupt) around the age of 16 to 25. They are commonly extracted when they affect other teeth, as they are generally considered expendable.

Most people have four wisdom teeth but it is common to find those that have fewer or even none (genetically absent). All teeth hurt to some degree as they erupt, but wisdom teeth are the final teeth to come out, and do so when we are adults. As a consequence, many find the pain to be above normal, but temporary. Upper & lower wisdom teeth erupt around the same time for most patients.

Possible problems

Problems with wisdom teeth usually occur as they erupt. Being the last teeth that come out, they often interfere with already erupted second molars and become misaligned. Using x-rays, it is common to see wisdom teeth positioned in every way imaginable, from horizontal to facing the second molar.

Poor alignment of wisdom teeth can crowd or damage adjacent teeth, the jawbone, or even nearby nerves. By leaning on second molars as they come out, wisdom teeth can make those teeth vulnerable to decay by trapping food debris and cultivating plaque.

Diagram illustrating possible scenarios with impacted wisdom teeth. Note the odd angles as they are errupting.

Additionally, wisdom teeth can be entrapped completely within the soft tissue and/or the jawbone or only partially break through or erupt through the gum. Teeth that remain partially or completely entrapped within the soft tissue and /or the jawbone are termed "impacted." Wisdom teeth that only partially erupt allows for an opening for bacteria to enter around the tooth and cause an infection, which results in pain, swelling, jaw stiffness, and general illness.

Furthermore, 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. While the above scenarios can occur with any teeth in the mouth, statistically, they are most common among wisdom teeth.

Treatment

Your dentist will rarely treat a wisdom tooth – extraction (removal of the tooth) is almost always the only treatment considered. If you are missing a large number of teeth, and keeping your wisdom teeth is essential, then your dentist may consider treating impaction, or decay of a wisdom tooth. Otherwise, most dentists are quick to recommend wisdom tooth extraction – as they should. People can live perfectly normal lives without the use of their third molars, as seen with those who are genetically missing them from birth.

The more debatable question is whether dentists should preemptively extract wisdom teeth before they have erupted and allowed for problems to develop. The theory is that early extraction helps avoid a more painful or more complicated extraction years later. The problem with this theory is that it assumes most wisdom teeth will cause problems as they erupt – this is simply not true. Another factor it ignores is that wisdom teeth extraction costs money and can have complications. Various studies that factored these into consideration have concluded that on average, preventive wisdom teeth extraction is not beneficial for the patient – the dentists behind this publication are in agreement. Nonetheless, many dentists still recommend extraction at an early age.

Extraction process

To begin, 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. 

In addition, the relative ease at which your dentist or oral surgeon can extract your wisdom teeth depends on the position of the impacted teeth. Wisdom teeth that are still under the gums, in the jawbone, or slightly protruding out, will require more of a surgical approach to extract. In comparison, wisdom teeth that have fully come out can be removed like any other teeth – relatively effortlessly.

In the later case, your dentist is likely to give you local anesthetic to numb any tissue and teeth in the region. Your dentist will likely take several x-rays, even if the tooth has fully come out, to see the teeth’s root configuration. If you are feeling anxious, ask about possible nitric oxide (“laughing gas”) treatment to help calm your mind. Next, your dentist will use a dental device that removes the tooth in seconds.

In the former case, where the tooth has not fully come out, your general dentist may refer you to a specialist in the field – an oral surgeon. In this scenario, you will either be under heavy local anesthesia, or even general anesthesia (put to sleep). Your oral surgeon will make incisions in your gums and “raise a flap” as to gain access to the tooth. If necessary, some bone may be cut during the removal process. Any tissue that is incised will be stitched together afterwards.

Post-treatment care

Following treatment, you are given time to regain sensation from the anesthesia. You will be prescribed pain killer drugs, and possibly antibiotics to prevent infection as the gums heal. Due to the anesthesia, it is often recommended that you have someone else drive you home.

Once home, the painkillers should be taken as advised by your surgeon. Any pain, swelling or stiffness is usually at its worst 2 or 3 days after the operation and then gradually improves.

Avoid vigorously rinsing or brushing in that part of your mouth for the first day because there are blood clots developing that may be disrupted. To clean the area, just rinse gently with warm salt water – such as after meals.

Most stitches will disappear between 7 to 10 days. At first, it may be possible to feel small fragments of bone with your tongue. These are the edges of the tooth socket and will soon disappear as well, as the gum heals.

To begin with, you should eat soft foods, gradually returning to a normal diet once your jaw feels less stiff. Do not drink alcohol or hot fluids such as tea or coffee, and avoid spicy foods and smoking. These can make the wound bleed and will delay healing.

Bleeding is likely to occur for several hours following an extraction. The first means of control is by placing a clean moist gauze over the space and biting firmly down upon it. Another common alternative is to bite down on a moistened tea bag (the acid actually helps blood clots form – speeding up the healing process). Apply pressure for 45 minutes until the bleeding has stopped. Anytime light bleeding occurs, pressure can just be re-applied. If bleeding is excessive and uncontrollable, then consult your dentist.

Avoid "sucking" actions (for example, don't drink beverages through straws or smoke). This can dislodge the clot, causing dry socket (discussed later) to develop.

Another typical symptom is facial swelling. To minimize swelling, place 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, although some swelling is unavoidable.

What can go wrong?

Most people undergo wisdom teeth extraction without having any complications. The most common complication following treatment is called “dry socket”. Dry socket occurs when a blood clot has failed to form or has been dislodged from the extracted tooth socket. Blood clotting is a required step of healing, and without this, healing will be delayed.

Dry socket typically occurs 3 or 4 days following the extraction and is accompanied by pain that ranges from dull 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 that needs to be replaced every 24 hours until symptoms subside. The most common reason for dry socket developing is that the patient drank fluids through a straw, making a “sucking” motion, or that they drank hot liquid. 

A far more rare event during teeth extraction is paresthesia. When bone needs to be removed to left out an impacted wisdom tooth, there is risk that local nerves may be damaged. The result is a numbness (called a paresthesia) of the tongue, lip or chin that can last a few days, weeks, months or may even be permanent.

Finally, during a difficult session, your dentist may damage the nearby second molar while trying to extract the third molar. Most damage is usually repairable – be sure to check that everything is right.

Cost

As you would expect, the cost of a wisdom tooth extraction correlates with the complexity of the case. If the tooth has come out fully, its extraction costs the same as any other tooth – roughly $100 per tooth.

The cost rises if the tooth is impacted. The cost can range anywhere from $250 to $350 per tooth for a general dentist, and more for a specialist such as an oral surgeon. Certain dental insurance policies cover the cost partially or in its entirety – check with your insurance company.