Not every wisdom tooth has to come out. An impacted wisdom tooth that causes no pain, has no decay and is not damaging its neighbour can simply be monitored at regular check-ups. The UK’s national health guidance body, NICE, has advised against the preventive removal of healthy, disease-free impacted wisdom teeth since 2000. What decides the case is not your age or the fact that the tooth is impacted — it is what the examination and the radiograph actually show.
Below: which findings call for removal, how the procedure is done, how recovery progresses day by day, and which symptoms mean you should call the clinic.
What is a wisdom tooth, and why does it cause trouble?
Wisdom teeth are the third molars at the very back of each jaw, and they usually erupt between the ages of 17 and 25. The problem is rarely the tooth itself — it is the space available to it, because the modern jaw often has none left.
When space runs short, the tooth takes one of three paths:
- It erupts fully — if the jaw is wide enough, the tooth settles into position and functions like any other molar.
- It erupts partially — part of the crown stays under a flap of gum. Bacteria collect under that flap where no brush can reach, which leads to repeated gum infections (pericoronitis).
- It stays impacted — the tooth remains in the bone. It may sit upright, angled, horizontal or inverted; whether it presses on the neighbouring molar depends on that position.
None of these three states means “remove it” on its own. What matters is whether disease has actually started around the tooth.
Which wisdom teeth come out, and which are monitored?
This is the real question. The decision table:
| Finding | Decision | Why |
|---|---|---|
| Recurrent pericoronitis (infection under the gum flap) | Remove | The area under the flap cannot be cleaned, so the problem returns; NICE lists this explicitly as grounds for removal |
| Decay in the tooth itself that a filling or root canal cannot save | Remove | A tooth that cannot be restored stays a source of infection |
| Decay or root resorption in the adjacent second molar | Remove | The aim is not to save the wisdom tooth but to protect the healthy neighbour |
| A cyst or tumour forming around it | Remove | A surgical indication; waiting only costs more bone |
| A position that traumatises the opposing jaw or the cheek | Remove | Soft tissue that is injured continuously cannot heal |
| Cases required by an orthodontic or prosthetic plan | Planned removal | Depends on the treatment plan and is decided with your dentist |
| No symptoms, no decay, healthy neighbouring tooth | Monitor | Preventive removal is not recommended; a check-up every 6-12 months with a radiograph when indicated is enough |
That last row is the one most often skipped. Age alone is not grounds for removal. Roots do finish forming with age and can sit closer to the nerve canal in the lower jaw, which makes the procedure technically harder — but that is not considered sufficient reason to remove a healthy tooth today.
Before the extraction: examination and imaging
A panoramic radiograph is the standard. A single film shows the number and shape of the roots, the angle of impaction, the relationship to the neighbouring tooth and — most importantly — the distance to the inferior alveolar nerve canal.
A CBCT scan is not needed for every patient. Under the SEDENTEXCT guidelines, three-dimensional imaging comes into play when the panoramic film shows the roots lying close to the nerve canal. In that case the scan reveals whether the root passes in front of the canal, behind it, or wraps around it — information that directly changes the surgical plan.
Things you must mention at the examination: every medication you take (blood thinners in particular), any diagnosed systemic conditions, previous operations, and whether you are pregnant.
How is it done?
The extraction is performed under local anaesthesia. Once the area is fully numb you feel no pain — what you feel is pressure and movement.
- An erupted wisdom tooth is taken out like any other molar; it takes a few minutes.
- An impacted wisdom tooth requires surgical removal: a small incision in the gum, removal of the thin layer of bone over the tooth where necessary, sectioning the tooth so it can be lifted out in pieces, and closing the site with sutures. Depending on difficulty, this takes 20-45 minutes.
Sectioning the tooth is not a complication — it is the preferred technique. Removing a tooth in pieces puts far less strain on the surrounding bone and nerve than forcing it out whole.
Antibiotics are not needed for every extraction. The 2021 Cochrane review (Lodi et al.) found that prophylactic antibiotics reduce the risk of infection by about 66% and dry socket by about 34% — but that this benefit is not enough to recommend routine use. Because roughly one in 30 patients experiences a mild adverse effect and antibiotic resistance keeps rising, the decision is made patient by patient, based on individual risk.
Recovery: what to expect, day by day
- First 2 hours — Bite firmly on the gauze and resist checking it. Eat nothing until the numbness wears off; you can bite your lip or tongue without noticing.
- First 24 hours — Apply cold to the outside of the cheek (15 minutes on, 15 minutes off). Do not rinse, do not spit, do not drink through a straw and do not smoke. What those last three share is the suction they create in the mouth, which can pull the clot out of the socket. Swallowing normally, on the other hand, is entirely harmless.
- Days 2-3 — Swelling peaks at 48-72 hours, and this is when your mouth opens least easily. That is the expected course of healing, not a sign that something has gone wrong.
- After day 3 — You can start rinsing gently with warm salt water (half a teaspoon of salt in a glass of warm water). Cold packs now give way to warm compresses.
- Days 5-7 — Swelling and jaw stiffness improve markedly. Sutures, if placed, come out in this window.
- ~2 weeks — The gum closes over. The bone underneath remodels over several months, a process you will not notice.
Eating: warm and soft on the first day (soup, yoghurt, purée), then build the texture back gradually. Hot, hard, crunchy and seeded foods can wait out the first week.
Warning signs: when to call the clinic
- Pain that increases rather than fades on days 3-5, together with a bad odour. This is the classic picture of dry socket: the clot has broken down and bone is exposed. After surgical removal of impacted lower wisdom teeth it is reported in 5-30% of cases — well above the 1-4% seen after simple extractions. It does not resolve on its own; a dressing placed at the clinic usually settles the pain the same day.
- Swelling that grows after 48 hours or spreads towards the neck or under the eye; fever; difficulty swallowing or breathing. These indicate spreading infection and should not wait.
- Bleeding that does not stop with firm pressure.
- Numbness in the lip, chin or tongue lasting beyond 24 hours. Involvement of the lower jaw nerve is uncommon: in a systematic review covering 44,171 extractions, temporary loss of sensation occurred in 1.2% of cases and permanent involvement in 0.28%. Even so, tell us as soon as you notice it — it is something that needs to be followed up.
Common misconceptions
“All wisdom teeth come out sooner or later.” They do not. The NICE guidance says the opposite: impacted teeth showing no sign of disease are monitored, not removed.
“Wisdom teeth crowd your front teeth.” This is the most widespread belief that the evidence does not support. Systematic reviews of the question have found no clear association between wisdom teeth and lower incisor crowding, which is why preventive removal is not recommended as a way of preventing relapse after orthodontic treatment either.
“Rinsing often after an extraction keeps it clean.” For the first 24 hours the opposite is true. At that stage the clot over the wound is the healing; vigorous rinsing and spitting dislodge it.
“Smoking only affects the lungs — it has nothing to do with an extraction.” Smoking roughly triples the risk of dry socket (around 13% versus 4%).
“You must always take antibiotics after an extraction.” The Cochrane review concludes otherwise: routine use is not recommended, and the decision is made case by case.
The decision comes after the examination
Nothing in this article replaces someone looking at your radiograph. Whether a given wisdom tooth should or should not be removed can only be said after an intraoral examination and a panoramic film — and that assessment usually fits into a single appointment.
Our clinic is in Davultepe, on GMK Bulvarı, a few minutes from Tece and Mezitli. After the examination you receive a written treatment plan. You can browse our services for other treatments, or check the frequently asked questions for anything else on your mind.
Frequently asked questions
Does wisdom tooth removal hurt?
The procedure itself is done under local anaesthesia, so you feel no pain — most patients describe pressure and pushing. Discomfort begins in the first hours as the anaesthetic wears off and is comfortably controlled with the painkillers you are prescribed. Expect more soreness in the first two days after the surgical removal of an impacted tooth than after a simple extraction.
How long does recovery take after wisdom tooth removal?
Swelling peaks at 48-72 hours and then subsides over the following 5-7 days, and difficulty opening your mouth eases over the same period. Most patients are back to their normal routine after 2-3 days. The gum closes in about two weeks, while the bone underneath remodels over several months.
Can both sides be removed in the same appointment?
Yes — the upper and lower teeth on one side, or in suitable cases both sides, can be removed together. Doing it in one session shortens the total recovery, though chewing is harder in the first few days. The decision depends on how impacted the teeth are, the expected length of the procedure and your general health.
When can I smoke after an extraction?
Smoking roughly triples the risk of dry socket, the condition that follows loss of the blood clot; systematic reviews put the rate at around 13% in smokers versus about 4% in non-smokers. Wait at least 72 hours, and a full week if you can. Both the hot smoke and the sucking action needed to draw on a cigarette act directly on the clot.
Can a wisdom tooth be removed during pregnancy?
Non-urgent extractions can wait until after the birth. If there is an infection or persistent pain, however, postponing treatment is the greater risk — the second trimester is generally preferred and the choice of medication is planned together with your obstetrician. Always tell us at the examination if you are pregnant or think you might be.
How much does wisdom tooth removal cost?
We can only give an exact figure after an examination and a panoramic radiograph, because extracting an erupted tooth and surgically removing an impacted one are not the same procedure. After the examination you receive a written treatment plan with the full price, and no surprise items appear mid-treatment.