Why do wisdom teeth cause problems?
“They say I have a wisdom tooth—does it have to come out? It doesn't hurt.” This is one of the questions we hear most often in the clinic. Wisdom teeth are the third large molars at the very back of the mouth. They usually come in between the late teens and the twenties, but because there's not enough room in the jaw, they often lie tilted or come only partly through the gums.
The problem is less the wisdom tooth itself than its surroundings. Food and bacteria get under the gum that half-covers it and cause inflammation (pericoronitis), and the back of the molar in front (the second molar) decays in the gap the toothbrush can't reach. The molar in front is a tooth you use for chewing your whole life, so losing it while trying to keep the wisdom tooth is a big loss.
When should it be extracted, and when can it be watched?
| Condition | Decision |
|---|---|
| Gums swell and hurt repeatedly | Extract |
| A cavity forms on the wisdom tooth or the back of the molar in front | Extract |
| Lies tilted and pushes against the root of the molar in front | Extract |
| A cyst is seen around the wisdom tooth | Extract |
| Came in straight, meets the opposing tooth, and is easy to clean | Watch |
| Completely buried deep in the bone with no changes around it | Monitor with regular X-rays |
Sometimes we extract even when it doesn't hurt, and we don't extract every one that comes in. A cavity on the back of the molar in front shows up on X-rays first, and by the time it hurts it's often already deep. On the other hand, we don't extract a wisdom tooth that meets the opposing tooth well and is used for chewing just as a matter of routine.
If you're about to start orthodontics, whether to extract depends on the orthodontic plan. If only an upper wisdom tooth comes in and there's no lower tooth to meet it, the upper wisdom tooth often drops down and makes you bite your cheek or traps food, so it's often extracted.
What are the steps of wisdom tooth extraction?
- We check the position with X-rays. A panoramic X-ray shows the tilt and root shape, and if the root of a lower wisdom tooth looks close to the nerve canal, we check the distance again with CT.
- We give anesthesia. For lower wisdom teeth, anesthesia is given near the nerve trunk inside the jaw, so half of your lip and tongue goes numb.
- If it's covered by gum, we open the gum; if it's buried in bone, we reshape a little of the surrounding bone.
- A tooth that won't come out in one piece is divided into a few sections and removed. This causes less damage to the surrounding bone and gums than opening wide and pulling it out all at once.
- We rinse the site, stitch it if needed, and have you bite on gauze.
During extraction you'll feel pressure and vibration, but sharp pain is blocked by anesthesia. If it hurts, raise your hand and let us know. We'll add more anesthesia.
How long does wisdom tooth extraction take?
| Wisdom tooth condition | Time to extract |
|---|---|
| Upper wisdom tooth that came in fully and straight | Around 10 minutes after anesthesia |
| Lower wisdom tooth that came in only partly | Around 20–30 minutes |
| Impacted wisdom tooth lying in the bone | Around 30 minutes to 1 hour |
Including X-rays, anesthesia, explanations, and post-extraction instructions, your time at the clinic is longer than this. Teeth with curved roots or that are firmly fused to bone can take longer. Not injuring the nerve and the molar in front comes before speed.
How many can be extracted at once?
Usually we extract the upper and lower ones on the same side at once, and the other side after it heals. You need to be able to chew on one side so eating is comfortable while you recover. All four can be extracted at once, but both sides swell and hurt together, making eating quite uncomfortable for a few days. We decide based on your schedule and the condition of the wisdom teeth.
How we do it at Wonjin Dental
First we look on X-rays at how the wisdom tooth sits relative to the molar in front and the nerve, and we start by telling you whether there is a reason to extract it. For impacted wisdom teeth whose roots are close to the nerve, Dr. Rayeon Kim (oral and maxillofacial surgery) also examines them. Extraction and panoramic X-rays are covered by Korean National Health Insurance. Pain and recovery in the days after extraction are covered separately in pain and recovery time after wisdom tooth extraction, and eating, brushing, and exercise in brushing, eating, and exercise after wisdom tooth extraction.
Frequently asked questions
What happens if I don't have my wisdom tooth removed?
A wisdom tooth that came in without problems and is easy to clean is sometimes kept for life. If a half-covered wisdom tooth is left as it is, inflammation keeps recurring and it can lead to a cavity on the back of the molar in front or damage to its root, so we monitor it with regular X-rays.
Do wisdom teeth push the front teeth and make them crooked?
The evidence that wisdom teeth push the front teeth out of alignment is rather weak. Age-related changes and whether you wore a retainer after orthodontics play a bigger role in front teeth shifting. We don't extract wisdom teeth just because of the front teeth.
What if my lip stays numb after extraction?
If your lip or tongue still feels dull the day after the anesthesia wears off, let us know right away. This rarely happens when the root of a lower wisdom tooth is close to the nerve, and in most cases sensation returns over a few weeks to a few months, but we monitor the progress and provide any treatment needed.
Can a wisdom tooth be extracted during pregnancy?
Unless there is urgent inflammation, we tend to postpone it until after delivery. If you're planning a pregnancy, it's a good idea to have your wisdom teeth checked before then.