Short answer: Wisdom tooth extraction is the removal of the third molars at the very back of the mouth for reasons such as lack of space, impaction, recurrent gum inflammation, decay or damage to the neighboring tooth. Fully erupted teeth are removed with a simple extraction, while impacted or partially impacted teeth are removed with a minor surgical procedure. Routinely extracting wisdom teeth that cause no problems is not always necessary.
Wisdom teeth, also called third molars, usually start to erupt between the ages of 17 and 25 and are the last teeth in the mouth. In some people they settle into place without problems, while in many people they cannot fully erupt because of lack of space, come in at an angle or remain completely inside the bone. Frequently searched for as "wisdom tooth extraction", this procedure is one of the most common procedures in oral surgery. However, not every wisdom tooth needs to be extracted; the decision is made based on the tooth's position and the problems it causes.
In this guide we cover why wisdom teeth cause problems, when extraction is necessary, the difference between simple and surgical extraction, the steps of the procedure and what to pay attention to during healing.
What is a wisdom tooth, and why does it cause problems?
A wisdom tooth is the third molar at the very back of each half of the jaw, and most problems arise from there not being enough space in the jaw for it to erupt. The human jaw has become smaller over the course of evolution, but the number of teeth has stayed the same. As a result, wisdom teeth often try to erupt into a crowded space.
These teeth are classified into three groups according to how far they have erupted:
- Fully erupted: The tooth is fully visible in the mouth and contacts the opposing tooth.
- Partially impacted: Part of the tooth is visible in the mouth, while part is covered by gum or bone.
- Fully impacted: The tooth has remained completely inside the bone and is not visible in the mouth.
Impacted teeth can also be vertical, horizontal, or tilted forward or backward depending on their position. Teeth tilted forward and horizontal teeth in particular can cause problems by pressing on the second molar in front of them. In partially impacted teeth, the pocket between the tooth and the gum creates an environment where food debris and bacteria easily build up.
When is extraction necessary?
Wisdom tooth extraction is generally recommended when the tooth causes concrete problems such as pain, infection or damage to the neighboring teeth, or when the risk of this is seen to be high. Guidelines from national health authorities also generally do not recommend the routine extraction of impacted teeth that cause no symptoms and appear healthy.
Common reasons for extraction are:
- Pericoronitis: Recurrent inflammation of the gum over a partially impacted tooth; it can show up as pain, swelling, difficulty opening the mouth and a bad taste.
- Decay: Decay developing in the wisdom tooth, which is hard to clean because it is at the very back, or in the tooth in front of it
- Damage to the neighboring tooth: A tilted impacted tooth causing resorption or decay in the root of the second molar
- Cyst or tumor formation: Cystic structures can rarely develop around an impacted tooth.
- Gum disease: Deep pockets and bone loss around the wisdom tooth
- Prosthetic or orthodontic planning: When the dentist considers it necessary as part of certain treatments
It is a commonly heard belief that wisdom teeth cause crowding of the front teeth; however, scientific studies do not clearly support this relationship. Crowding of the front teeth depends on many different factors. For this reason, deciding on extraction solely to prevent crowding is generally not recommended.
What is the difference between simple and surgical extraction?
A simple extraction is the removal of a fully erupted tooth from its socket with special instruments; a surgical extraction is the removal of an impacted or partially impacted tooth by opening the gum and, if necessary, removing some bone. Which method is used is determined by the position of the tooth and the shape of its roots.
- Simple extraction: Generally takes less time and may not require stitches.
- Surgical extraction: The gum is lifted, some of the bone over the tooth is removed and, if necessary, the tooth is divided into pieces and removed. At the end of the procedure, the area is stitched.
A panoramic X-ray is taken before the extraction. In the lower jaw, if the roots of the tooth are very close to the canal carrying the nerve that provides sensation to the lower lip and chin, a three-dimensional CT scan may be requested. This examination is important for assessing the risk of nerve injury and planning the extraction accordingly.
How is the procedure done?
Wisdom tooth extraction is mostly done under local anesthesia; the patient may feel pressure during the procedure, but the aim is that they do not feel sharp pain. For patients with high anxiety, or when several teeth are to be extracted at once, the option of sedation may also be considered.
- Evaluation: The position of the tooth is examined with an examination, X-rays and, if needed, a CT scan; general health and medications being used are asked about.
- Anesthesia: The area is numbed with local anesthesia.
- Reaching the tooth: For impacted teeth, the gum is opened and, if necessary, bone is removed.
- Removing the tooth: The tooth is removed whole or in pieces.
- Cleaning and closure: The extraction socket is cleaned and stitched if necessary.
- Instructions: The patient is given written and verbal information about the healing period.
The duration of the procedure varies with the position of the tooth; a simple extraction may take a few minutes, while extracting a deeply impacted tooth may take longer.
What is healing like after the extraction?
Swelling, tenderness and slight bleeding in the first few days after extraction are expected; swelling usually peaks on the second or third day and decreases afterward. Healing of the soft tissues is usually complete within a few weeks.
Recommendations that support healing are:
- Keep biting on the gauze pad placed after the extraction for as long as your dentist tells you.
- On the first day, apply cold to the outside of your cheek at intervals.
- For the first 24 hours, don't rinse, spit or drink through a straw; these actions can dislodge the blood clot.
- Don't smoke; smoking delays healing and increases the risk of dry socket.
- In the first days, eat lukewarm or cold, soft foods; avoid chewing on the extraction side.
- Take the medications your dentist recommends as directed.
- From the next day on, keep brushing your other teeth; be careful around the extraction site.
If 2–4 days after the extraction the pain increases instead of decreasing, with severe pain radiating to the ear and a bad taste, this may be a sign of a condition called dry socket, which is associated with early loss of the blood clot. This condition is treatable; when you notice it, you should see your dentist. Fever, steadily increasing swelling, bleeding that won't stop or numbness lasting more than a few days are also symptoms that should be reported to your dentist.
Frequently asked questions about wisdom tooth extraction
Can upper and lower wisdom teeth be extracted at the same time?
Depending on the dentist's evaluation, the teeth on the same side or on both sides can be extracted in a single session. This decision is made based on the difficulty of the teeth, the patient's general condition and their preference.
Can a wisdom tooth be extracted during pregnancy?
Non-urgent extractions are generally postponed until after delivery. In necessary situations such as an acute infection, treatment can be planned for the most suitable period in consultation with the obstetrician. For other general questions, you can also take a look at our frequently asked questions page.
Wisdom tooth evaluation in Ankara
If you notice recurring pain at the very back of your mouth, swelling of the gum or difficulty opening your mouth, evaluating the condition of your wisdom tooth with an X-ray is the right start. At our clinic in Park Oran Ofis in Çankaya, we explain, based on the examination findings, whether the tooth needs to be extracted, and plan the procedure if necessary.
Frequently asked questions
Does an impacted wisdom tooth that doesn't hurt need to be extracted?
Routine extraction of impacted teeth that cause no symptoms and do not damage neighboring teeth is generally not recommended. These teeth can be monitored with regular check-ups. The decision to extract is made by evaluating the X-ray findings and possible risks.
How long does swelling last after wisdom tooth extraction?
Swelling usually peaks on the second or third day after extraction and decreases noticeably within a week. Swelling may be more pronounced after surgical extractions. Applying cold on the first day helps limit swelling.
What is dry socket, and how can you tell?
Dry socket is a healing problem caused by early loss of the blood clot in the extraction socket. It usually shows up 2–4 days after the extraction as increasing, severe pain that may radiate to the ear, together with a bad taste. When you notice it, you should see your dentist.
When can I return to a normal diet after the extraction?
Soft, lukewarm foods are recommended for the first days. Most people can switch to firmer foods within a few days, but it is necessary to avoid chewing hard foods on the extraction site for a while. If you have stitches, follow your dentist's recommendations.
