Wisdom tooth extraction is a surgical procedure to remove one or more wisdom teeth — the four permanent adult teeth located at the back corners of your mouth on the top and bottom.

If a wisdom tooth doesn’t have room to grow (impacted wisdom tooth), resulting in pain, infection or other dental problems, you’ll likely need to have it pulled. Wisdom tooth extraction may be done by a dentist or an oral surgeon. Some dentists and oral surgeons recommend wisdom tooth extraction even if impacted teeth aren’t causing problems, as a preventive measure against potential future problems.

Why it’s done

Problems with impacted wisdom teeth

Wisdom teeth are the last of your teeth to come in, or erupt, through the gums. Sometimes a wisdom tooth becomes impacted, or stuck below the surface of your gums, and grows at an odd angle, possibly causing complications.

Wisdom teeth, or third molars, are the last permanent teeth to appear (erupt) in the mouth. These teeth usually appear between the ages of 17 and 25. Some people never develop wisdom teeth. For others, wisdom teeth erupt normally — just as their other molars did — and cause no problems.

Many people, however, develop impacted wisdom teeth — teeth that don’t have enough room to erupt into the mouth or grow normally. Impacted wisdom teeth may erupt only partially or not at all.

An impacted wisdom tooth may:

• Grow at an angle toward the next tooth (second molar)
• Grow at an angle toward the back of the mouth
• Grow at a right angle to the other teeth, as if the wisdom tooth is “lying down” within the jawbone
• Grow straight up or down like other teeth but stay trapped within the jawbone

You’ll likely need your impacted wisdom tooth pulled if it results in problems such as:

• Pain
• Infection
• Damage to an adjacent tooth
• Development of a fluid-filled sac (cyst) around the wisdom tooth
• Damage to surrounding bone
• Complications with orthodontic treatments to straighten other teeth

What you can expect

During the procedure
Your doctor or oral surgeon may use one of three types of anesthesia. The appropriate anesthesia for you depends on the expected complexity of the wisdom tooth extraction and your own comfort level. Your options include:

• Local anesthesia. Your doctor or oral surgeon administers local anesthesia with one or more injections near the site of each extraction. Before you receive an injection, your dentist or surgeon will likely apply a substance to the gums that numbs the site. You’re awake during the tooth extraction. Although you’ll feel some pressure and movement, you shouldn’t experience pain.
• Sedation anesthesia. Your doctor or oral surgeon gives you sedation anesthesia through an intravenous line in your arm. Sedation anesthesia suppresses your consciousness during the procedure and you don’t feel any pain. You will also receive local anesthesia to numb your gums.
• General anesthesia. In special situations, you may be offered general anesthesia. For general anesthesia, you inhale medication through your nose. This type of anesthesia makes you lose consciousness, and you don’t feel any pain during the procedure. Your surgical team closely monitors your medication, breathing, temperature, fluids and blood pressure during general anesthesia.

During wisdom tooth extraction, your dentist or oral surgeon:

• Makes an incision in the gum, creating flaps to expose the tooth and bone
• Removes any bone that blocks access to the tooth
• Divides the tooth into sections if it’s easier to remove in pieces
• Removes the tooth
• Cleans the site of the removed tooth of any debris from the tooth or bone
• Stitches the wound closed to promote healing, though this isn’t always necessary
• Places gauze over the extraction site to control bleeding and to help a blood clot form

After the procedure
If you receive sedation anesthesia or general anesthesia, you’re taken to a recovery room after the procedure. If you have local anesthesia, your brief recovery time is likely in the dental chair.

As you heal from your surgery, follow your doctor’s instructions on:

• Activity. After your surgery, plan to rest for the remainder of the day. Resume normal activities the next day, but for at least a week, avoid strenuous activity that might result in dislodging the blood clot from the socket.
• Beverages. Drink lots of water after the surgery. Don’t drink alcoholic, caffeinated, carbonated or hot beverages in the first 24 hours. Don’t drink with a straw for at least a week because the sucking action can dislodge the blood clot from the socket.
• Food. Eat only soft foods, such as yogurt or applesauce, for the first 24 hours. Start eating semisoft foods when you can tolerate them. Avoid hard, chewy, hot or spicy foods that might get stuck in the socket or irritate the wound.
• Pain management. You may be able to manage pain with a prescription pain medication — given by your doctor or oral surgeon — or an over-the-counter pain reliever, such as acetaminophen (Tylenol, others). Holding a cold pack against your jaw also may relieve pain.
• Bleeding. Some oozing of blood may occur the first day after wisdom tooth removal. Try to avoid excessive spitting so that you don’t dislodge the blood clot from the socket. Replace gauze over the extraction site as directed by your dentist or oral surgeon.
• Swelling and bruising. Swelling and bruising of your cheeks usually improves in two or three days. Use an ice pack as directed by your dentist or surgeon.
• Cleaning your mouth. Don’t brush your teeth, rinse your mouth, spit or use a mouthwash during the first 24 hours after the surgery. After that time, gently rinse your mouth with warm salt water every two hours and after meals for a week after your surgery. Mix 1/2 teaspoon (2.5 milliliters) of table salt in 8 ounces (237 milliliters) of water. After the first 24 hours, resume brushing your teeth, being particularly gentle near the surgical wound to avoid disrupting any stitches.
• Tobacco use. If you smoke, don’t do so for at least 24 hours after surgery — and wait longer than that if possible. If you chew tobacco, don’t use it for at least a week. Using tobacco products after oral surgery can delay healing and increase the risk of complications.
• Stitches. You may have stitches that dissolve within a few weeks or no stitches at all. If your stitches need to be removed, schedule an appointment to have them taken out.

When to call your dentist or surgeon
Call your dentist or oral surgeon if you experience any of the following signs or symptoms, which could indicate an infection, nerve damage or other serious complication:

• Swelling that worsens after two or three days
• Fever
• Severe pain not relieved by prescribed pain medications
• A bad taste in your mouth not removed with saltwater rinsing
• Pus in or oozing from the socket
• Blood in nasal discharge
• Persistent numbness or loss of feeling

Results

You probably won’t need a follow-up appointment after a wisdom tooth extraction if:

• You don’t need stitches removed
• No complications arose during the procedure
• You don’t experience persistent problems, such as pain, swelling, numbness or bleeding — complications that might indicate infection, nerve damage or other problems

If complications develop, your dentist or oral surgeon will discuss appropriate treatment options with you.