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Treatments and drugs
By Mayo Clinic staffImpacted wisdom teeth that are causing pain or other dental problems are usually surgically removed, or extracted.
If you have medical conditions that may increase surgical risks, your dentist will likely ask you to see an oral surgeon to discuss the best course of action.
Managing asymptomatic wisdom teeth
If impacted wisdom teeth aren't causing symptoms or apparent dental problems, they're called asymptomatic. Some disagreement exists in the dental community about how to manage asymptomatic impacted wisdom teeth. Research on this topic doesn't strongly favor one strategy over the other.
Some dentists and oral surgeons recommend removing asymptomatic wisdom teeth to prevent future potential problems. They argue:
- An asymptomatic tooth may not be free of disease and may be a particularly vulnerable site for gum disease and tooth cavities.
- The procedure rarely results in serious complications in younger adults.
- The procedure is more difficult and more likely to cause complications later in life, particularly among older adults.
Other dentists and oral surgeons recommend a more conservative approach. They note:
- There isn't enough evidence to suggest that impacted wisdom teeth not causing problems in young adulthood will later cause problems.
- The expense and risks of the procedure don't justify the expected benefit.
With a conservative approach, your dentist will monitor your teeth for decay, gum disease or other complications. He or she may recommend removing a tooth if problems arise.
Surgical removal
Surgical removal (extraction) of a wisdom tooth is almost always done as an outpatient procedure, meaning you'll go home the same day. You may have local anesthesia, which numbs your mouth; sedation that depresses your consciousness; or general anesthesia, which makes you lose consciousness.
During an extraction your dentist or oral surgeon makes an incision in your gums and removes any bone that blocks access to the impacted tooth. After removing the tooth, the dentist or oral surgeon typically closes the wound with stitches and packs the empty space (socket) with gauze.
You'll receive instructions for caring for wounds and for managing pain and swelling.
Most wisdom tooth extractions don't result in long-term complications. Problems that can occur include:
- Dry socket, or exposure of bone if the post-surgical blood clot gets dislodged from the socket, which can be painful and delay healing
- Infection in the socket from bacteria or trapped food particles
- Damage to sinuses near the upper wisdom teeth
- Weakening of the lower jawbone
- Damage to nerves that results in altered sensation in the lower lip, tongue or chin
- Wisdom teeth. American Association of Oral and Maxillofacial Surgeons. http://www.aaoms.org/wisdom_teeth.php. Accessed Feb. 21, 2012.
- Marciani RD. Third molar removal: An overview of indications, imaging, evaluation, and assessment of risk. Oral and Maxillofacial Surgery Clinics of North America. 2007;19:1.
- Bagheri SC, et al. Extraction versus nonextraction management of third molars. Oral and Maxillofacial Surgery Clinics of North America. 2007;19:15.
- Haug RH, et al. Evidenced-based decision making: The third molar. Dental Clinics of North America. 2009;53:77.
- Gingivitis. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/dental_disorders/periodontal_disorders/gingivitis.html. Accessed Feb. 22, 2012.
- Caries. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/dental_disorders/common_dental_disorders/caries.html. Accessed Feb. 22, 2012.
- Kandasamy S, et al. The wisdom behind third molar extractions. Australian Dental Journal. 2009;54:284.
- Farish SE, et al. General technique of third molar removal. Oral and Maxillofacial Surgery Clinics of North America. 2007;19:23.
- Postextraction problems. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/dental_disorders/dental_emergencies/postextraction_problems.html. Accessed Feb. 23, 2012.
- Dental anxiety. American Dental Association. http://www.ada.org/3102.aspx. Accessed Feb. 23, 2012.
- White RP Jr., et al. Evaluation and management of asymptomatic third molars: Lack of symptoms does not equate to lack of pathology. American Journal of Orthodontics and Dentofacial Orthopedics. 2011;140:10.
- Kandasamy S. Evaluation and management of asymptomatic third molars: Watchful monitoring is a low-risk alternative to extraction. American Journal of Orthodontics and Dentofacial Orthopedics. 2011;140:11.
- Carr AB (expert opinion). Mayo Clinic, Rochester, Minn. March 22, 2012.
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