- Not every impacted tooth is removed; those that cause no symptoms can be monitored with regular check-ups
- Planning with a panoramic X-ray and, when needed, three-dimensional CT
- The procedure is done under local anaesthesia; if needed the tooth is sectioned and removed in pieces
- Written aftercare instructions and a follow-up appointment are given after extraction
In short: A wisdom tooth is removed when it causes a problem such as recurrent gum infection, decay or bone loss in the neighbouring tooth, suspicion of a cyst, or a position that cannot be cleaned. A fully erupted tooth that can be cleaned and has no decay can stay in the mouth; impacted teeth that cause no symptoms can also be monitored with examinations and periodic X-rays. The decision is made for each patient after examination and imaging.
What is it?
Teeth normally break through the gum and come into the mouth at a certain age. If there is not enough room in the jaw, if the tooth has developed at the wrong angle, if the baby tooth was lost late, or if there is a formation such as a cyst around it, a tooth can remain trapped in bone or gum. This is called an impacted tooth. The most commonly affected are wisdom teeth (third molars) and the upper canines.
Depending on their position, impacted teeth are classified as fully impacted (within the bone, covered by gum) and partially impacted (partly open to the mouth). With partially impacted teeth, a space that is difficult to clean remains between the gum and the tooth; for this reason, this is usually the group that causes the most problems. The tooth may be tilted forwards, upright, horizontal or backwards. Many impacted teeth cause no symptoms for years.
In which cases is it removed, and in which is it monitored?
In the decision to extract, what matters is the problem the tooth causes or may cause, rather than the tooth itself. The main situations in which extraction is considered are:
- Recurrent gum infection (pericoronitis): Repeated swelling, pain and infection in the gum flap over a partially erupted tooth.
- Damage to the neighbouring tooth: An impacted tooth tilted forwards can cause decay, root resorption or bone loss in the second molar in front of it.
- Decay that cannot be cleaned: Decay progressing in the wisdom tooth or its neighbour in an area the toothbrush cannot reach.
- Suspicion of a cyst or pathology: A cyst can develop in the sac surrounding an impacted tooth; if imaging shows a suspicious area, removal and, if necessary, laboratory examination are planned.
- Trauma to the opposing tooth or the cheek: Teeth that, because of their position, wound the cheek or damage the opposing tooth.
- Orthodontic or prosthetic need: When the treatment plan requires it; for details, see our orthodontics page.
On the other hand, removal of a wisdom tooth that is fully erupted, fits the bite, can be cleaned and has no decay is not essential. For fully impacted teeth that cause no symptoms as well, clinical examination with periodic X-ray checks is often a sufficient option. Impacted canines, by contrast, are generally not extracted; when needed, the orthodontist exposes the tooth, bonds a bracket to it and brings it into position over months.
The surgical process
- Examination and history: General health, medicines used, allergies and any tendency to bleed are asked about; an intra-oral examination is carried out.
- Imaging: A panoramic X-ray shows the position of the tooth, its roots, its relationship with the neighbouring tooth and its closeness to the nerve canal in the lower jaw or to the sinus in the upper jaw. If the relationship is borderline, three-dimensional CT may be requested.
- Planning: The surgical approach is determined according to the position of the tooth, its root structure and its relationship with the bone; the patient is informed about the process and the possible risks.
- Anaesthesia: The procedure is done under local anaesthesia. Where a patient has dental fear or finds it hard to cooperate (children and adults alike), sedation or, if needed, general anaesthesia can be discussed with the dentist.
- Procedure: The gum is lifted, if needed some of the bone surrounding the tooth is removed, and the tooth is usually divided into pieces and taken out through a smaller space. The area is irrigated and stitched. The duration varies with the position of the tooth; it is often around half an hour.
- Follow-up: The stitches are removed after about 7–10 days and healing is checked.
If the tooth could be saved with root canal treatment, that option is considered first; see root canal treatment. If a missing-tooth solution is needed in place of the extracted tooth in future, implant planning is also discussed at the examination.
Aftercare and healing
On the first day, the most important step is for the blood to clot and close the wound. To protect this clot, the following rules are observed:
- Bite firmly on the gauze pad you were given for 30–45 minutes; do not spit, rinse or use a straw.
- Stay away from smoking and alcohol; the first 48–72 hours are especially important for smoking.
- On the first day avoid hot and hard foods, eat soft and lukewarm food, and apply cold intermittently to the cheek from the outside.
- From the second day you can rinse gently with lukewarm salt water; continue brushing the other teeth, but do not touch the wound with the brush.
- Take the prescribed medicines as recommended and rest.
Swelling and tenderness generally peak in the first 2–3 days and then decrease; temporary limitation in mouth opening is normal. Most of it passes within a week; it can take a few weeks for the tissue to settle fully.
Risks
As with any surgical procedure, swelling, pain, bleeding, infection and temporary jaw stiffness can occur with impacted tooth extraction. Dry socket (alveolar osteitis), which develops when the clot is lost, usually shows itself 2–4 days after extraction as severe pain spreading to the ear and a bad smell; when you contact the clinic, the area is cleaned and treated. If lower wisdom teeth are close to the nerve canal, temporary numbness of the lip and chin can occur; it is uncommon for it to be permanent, but it should not be disregarded. Closeness to the sinus in the upper jaw is also assessed during planning. These risks are discussed in detail beforehand.
Contact the clinic without waiting if you notice any of the following: steadily increasing pain, fever, growing swelling, difficulty swallowing or breathing, bleeding that does not stop, and lip or chin numbness that continues days later.
Visit plan for patients from abroad
Impacted tooth or wisdom tooth surgery can usually be planned in a single visit: examination and imaging on the first day, surgery if it is considered suitable, and you need to be at the clinic about a week after the procedure for the stitch check. A panoramic X-ray may be enough for a remote preliminary assessment; the final decision is made by the examination at the clinic. Details: process for international patients.
Points to consider
- In the first days after extraction, swelling, tenderness, bleeding in the form of slight oozing and limited mouth opening can occur.
- Smoking, using a straw and rinsing on the first day disturb the clot and increase the risk of dry socket; the instructions must be followed.
- With teeth close to the nerve canal in the lower jaw, temporary lip and chin numbness can occur; if it lasts long, it should be reported to your dentist.
- During pregnancy, non-urgent surgical procedures are generally postponed; be sure to mention that you are or may be pregnant.
- Regularly used medicines, blood thinners and systemic diseases affect the treatment plan; they should be shared at the examination.
Frequently asked questions
Does every wisdom tooth have to be removed?
No. Teeth that are fully erupted, can be cleaned, have no decay and fit the bite can stay in the mouth. Impacted teeth that cause no symptoms can also be monitored with periodic examinations and X-rays. Extraction comes into question for a reason such as recurrent infection, decay, damage to a neighbouring tooth or a cyst.
How is an impacted tooth extracted, and how long does it take?
The procedure is done under local anaesthesia; the gum is opened, the tooth is divided into pieces if needed and removed, and then stitches are placed. The duration varies with the position of the tooth; it is often around half an hour, and can be longer for difficult positions.
Is pain felt during and after the procedure?
Local anaesthesia numbs the area; you may feel a sensation of pressure during the procedure. Pain and swelling are expected in the first 2–3 days once the anaesthesia wears off; they are managed with prescribed medicines and cold application, and generally decrease considerably within a week.
When can I return to a normal diet after extraction?
On the first day, lukewarm and soft foods are preferred. As swelling goes down, most people return to a normal diet in about a week; the wound area should not be strained while chewing.
Is lip numbness after extraction permanent?
Temporary numbness can occur with teeth close to the nerve canal in the lower jaw; it is uncommon for it to be permanent. For this reason, the closeness of the tooth to the nerve is assessed beforehand with imaging. If numbness lasts longer than a week, you should contact the clinic for a check.
What happens if I do not have an impacted tooth removed?
A tooth that causes no symptoms often does not cause problems and can be monitored. In teeth that do cause symptoms, infection episodes can become more frequent, and decay and bone loss can progress in an area in front of the tooth that cannot be cleaned; this can lead to loss of that tooth as well.
The information on this site is for general guidance only; diagnosis and treatment require an examination by a dentist.