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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 who will communicate with your primary care doctor and dentist about 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. And 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. The arguments for preventive treatment include the following:
- 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 that there isn't enough evidence to suggest that impacted wisdom teeth not causing problems in young adulthood will later cause problems. Therefore, they suggest that 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 an extraction if problems arise.
Surgical extraction
Surgical extraction of a wisdom tooth is almost always done as an outpatient procedure, which means that you will go home the same day. You may have local anesthesia that numbs the mouth or sedation anesthesia that makes you unaware of the surgical procedure.
During an extraction your dentist or oral surgeon makes an incision in the gums and removes any bone that blocks access to the impacted tooth. After the tooth is removed, the surgical wound is usually stitched closed and the empty space (socket) is packed with gauze.
You'll receive instructions for caring for the surgical wound after the procedure 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 when the post-surgical blood clot is dislodged from the socket — a complication that 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. 22, 2010.
- 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.
- Esposito M, et al. Impacted wisdom teeth. Clinical Evidence (Online). 2008. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19450307. Accessed Feb. 22, 2010.
- Gingivitis. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec08/ch095/ch095c.html. Accessed March 3, 2010.
- Caries. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec08/ch095/ch095b.html. Accessed March 3, 2010.
- Pogrel MA, et al. White paper on third molar data (2007). American Association of Oral and Maxillofacial Surgeons. http://www.aaoms.org/media.php. Accessed Feb. 27, 2010.
- 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. Accessed Feb. 22, 2010.
- Dental anxiety. American Dental Association. http://www.ada.org/public/topics/anxiety.asp. Accessed March 3, 2010.
- Carr AB (expert opinion). Mayo Clinic, Rochester, Minn. March 10, 2010.
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