A wisdom tooth needs removal when it is impacted and causing repeated infection, decaying, damaging the molar in front of it, or impossible to clean properly. A wisdom tooth that has erupted fully, bites against an opposing tooth and can be brushed does not need removing. Extraction is done under local anaesthesia in 20–45 minutes, with swelling peaking around day two and settling within four to five days.
Why wisdom teeth cause so much trouble
Wisdom teeth erupt between roughly 17 and 25, into a jaw that has usually stopped growing and often has no room left. When there is insufficient space, the tooth becomes impacted — stuck at an angle against the molar in front, or partly buried under gum and bone.
Signs it needs to come out
- Recurring pain or swelling at the back of the jaw, especially episodes that keep returning.
- A flap of gum over a partly erupted tooth that traps food and becomes infected (pericoronitis).
- Decay in the wisdom tooth, or worse, in the back surface of the molar in front of it.
- Difficulty opening the mouth fully, or a bad taste that keeps recurring.
- A cyst visible around the crown of an unerupted tooth on an X-ray.
Signs it can reasonably stay
- Fully erupted, upright, and biting against an opposing wisdom tooth.
- Reachable with a toothbrush, with healthy gum around it.
- No history of pain, swelling or food trapping.
- Completely buried in bone with no cyst, no symptoms and no contact with the molar in front.
What the X-ray is actually for
Before any wisdom tooth extraction we take an OPG. It shows the angulation of the tooth, the shape and number of roots, and critically, how close the roots sit to the inferior alveolar nerve in the lower jaw. That nerve supplies sensation to the lip and chin.
When the roots appear to overlap the nerve canal, a CBCT gives a three-dimensional view and the surgical approach is planned to protect it. This is the single most important reason not to have a lower wisdom tooth removed without proper imaging.
Recovery, realistically
- Day of surgeryBite firmly on gauze for an hour. Cold compress on and off. No rinsing, no spitting, no straws — all three can dislodge the clot.
- Days one to twoSwelling peaks around 48 hours. Soft cold food. Painkillers as prescribed, taken on schedule rather than waiting for pain to build.
- Days three to fiveSwelling subsides. Begin gentle warm salt-water rinses. Most people are back to normal eating by the end of this window.
- Day five to sevenReview appointment, sutures removed if non-dissolving, healing checked.
Severe pain appearing on day three to four, after an initial improvement, usually signals a dry socket — the clot has been lost. It is unpleasant but easily treated with a medicated dressing. Ring the clinic rather than waiting it out.
Questions we get asked
Do wisdom teeth cause front teeth to become crowded?
The evidence for this is weak. Lower front teeth tend to crowd with age whether or not wisdom teeth are present. Preventing crowding is not, on its own, a sound reason to remove them.
Can all four be removed at once?
Yes, and for patients who would rather have one recovery period than four it is often the preferred approach. It depends on the difficulty of each tooth and your general health.
How long should I take off work?
For a straightforward extraction, the same day and possibly the next. For a difficult impacted lower tooth, plan on two to three days.