Everything You Need to Know About Wisdom Teeth Removal

Do you have to get your wisdom teeth removed?

Getting your wisdom teeth out is a rite of passage up there with learning to drive and going to prom but decidedly less fun.

Because wisdom teeth are often removed when preparing for orthodontic treatment such as braces, says New York-based dentist Greg Gelfand, many teenagers have wisdom teeth surgery in high school.

Having your wisdom teeth out when you’re younger is seen as preferable, because the roots are not yet fully formed. But despite the practice being extremely common—an American Journal of Public Health study claimed that five million Americans had wisdom teeth extracted each year—it’s still stressful, and may even be unnecessary.

We spoke with dentists to uncover everything you need to know about wisdom tooth removal, from why we need to have them removed (or not) to ways to prepare to make your wisdom tooth removal a little less terrifying and a little more pleasant.

What are wisdom teeth?

“Wisdom teeth are the third set of molars that adults generally will get when they are between 18-26 years old. The nickname wisdom teeth comes from the fact that they erupt into the mouth during the college years in the majority of adults,” says Christopher Norman, a dentist in Englewood, Colorado.

The third molars are the last teeth in your jawbone, explains Dr. Gelfand. “Due to their positioning in the mouth, wisdom teeth are often difficult to access and properly clean, causing cavities and/or gum issues to readily develop.”

Three large molars make up the teeth in the back of the mouth for most adults, for a total of 12—six on top and six on the bottom. The four wisdom teeth are the last ones to come in.

Because they’re the last teeth to grow, due to the “current morphologic features of the modern human jaw, we simply do not have room for them,” says Los Angeles-based dentist Rhonda Kalasho, calling them “vestigial.”

When do you get wisdom teeth?

Wisdom teeth usually erupt when a person is between 16 and 20, explains Marc Sclafani, a dentist at One Dental in New York City.

As mentioned, there is often not enough room for them when they start to come in.

“This can lead to impacted wisdom teeth that are trapped beneath the gum tissue by other teeth or bone,” says Dr. Sclafani.

Wisdom teeth that only partially emerge or come in crooked can also lead to crowding and disease, Dr. Sclafani adds.

“Since teeth removed before age 20 have less developed roots and fewer complications, the American Dental Association recommends that people between 16 and 19 have their wisdom teeth evaluated to see if they need to be removed.”

Impacted vs. non-impacted wisdom teeth

There are two types of wisdom teeth: those that grow in normally and those that are impacted and can’t grow in properly.

“If they are impacted, but not causing issues for the adjacent teeth, then the wisdom teeth do not have to be removed, and are monitored for any significant changes,” Dr. Gelfand says.

“In some instances, there is sufficient room in the jawbone for wisdom teeth to function like other teeth, but in other cases, there is either inadequate space, or the positioning starts to cause issues with the adjacent molar.”

Why do we need to have them removed?

There are a variety of reasons wisdom teeth might need to be removed.

Pain

“The number one reason why wisdom teeth are removed is because they are impacted in our jaws and will cause pain/infection/or other issues,” says Dr. Norman, who adds that active cavities, a localized abscess, and cheek biting are also common reasons.

Overcrowding

Geoffrey R. Morris, a dentist from Boca Raton, Florida, also points to bone structure as a possible factor. “Not everyone needs them removed, but the most common reason for removal is a lack of bone structure to accommodate them comfortably. For some people, if they aren’t removed it may cause crowding of your teeth or jaw discomfort,” he says.

Dr. Kalasho agrees that crowding tends to be a factor, which can lead to health issues.

“Since most of us do not have room for our wisdom teeth, they grow in sideways, or they grow in so far back that it is hard to clean, thus leading to some localized gum disease, cavities, and swelling in the area,” she says. “Typically, if patients are unable to keep wisdom teeth clean, leading to cavities and gum disease of the wisdom teeth, then we highly suggest removal.”

Bone health

“Sometimes when the wisdom teeth health is compromised, it starts to negatively affect the neighboring teeth, like a rotten apple in a pile of good apples, it starts to break down the teeth we do use,” Dr. Kalasho says.

Luckily, much like your appendix, wisdom teeth are body parts you don’t need.

Wisdom tooth removal isn’t always necessary

While dentists almost always used to insist on removing wisdom teeth, attitudes have changed. Now some dentists no longer believe in automatically scheduling surgery.

“There are varying schools of thought in terms of the risk/reward benefit of removing wisdom teeth that are not hurting,” says Dr. Norman.

“My philosophy with patients is that if I see an indication that a wisdom tooth is going to cause them an issue in the future, I recommend getting it removed while they are still young and healthy and complications can be kept to a minimum.”

For Dr. Kalasho, wisdom tooth removal isn’t necessarily a given.

“If you can keep your wisdom teeth clean, and they are not causing issues to the surrounding dentition, occlusion, or your general oral health, then they can stay there for as long as they like. Many times the wisdom teeth or so impacted and stuck so deep near important structures, that it is safer to keep them in, think out of sight, and out of mind.”

Similarly, Dr. Gelfand prefers to monitor patients. “If they are impacted, but not causing issues for the adjacent teeth, then the wisdom teeth do not have to be removed, and are instead monitored for any significant changes.”

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Signs you may need your wisdom teeth removed

Whatever your age, you may be able to recognize signs in advance that it’s time to have your wisdom teeth removed.

“Some of the most common signs that a wisdom tooth will need to be removed are: pain or pressure in the areas behind the last visible tooth, swelling or tenderness in the gums and or jaws around the wisdom teeth, and chronic cheek biting from wisdom teeth that come in at odd angles,” says Dr. Norman.

Dr. Kalasho also warns about paying attention to factors like swelling and pervasive odors.

“Gum swelling around your wisdom tooth, a bad smell coming from the area of the wisdom tooth, pain in the region, immediate neighboring teeth having dental pain due to impaction of the wisdoms, and most commonly seen facial swelling limiting the range of opening the mouth.”

Dr. Morris points to other signs, including the shifting of the teeth, as well as joint and jaw pain or eruption of the teeth at unusual angles.

Notice people backing away when you talk? Bad breath can also be a sign, says Dr. Gelfand.

“Since proper cleaning of wisdom teeth is often difficult—for patients and dentists alike—food particles and buildup can accumulate in this far-reaching area of your mouth, which may lead to bad breath, cavities, and gum disease.”

How to prepare for wisdom tooth removal

Your dentist should give you pre-operative instructions; make sure you follow them closely, says Dr. Norman.

“These instructions can be unique to each doctor based on how they perform your surgery and should not be deviated from,” he says.

Avoid smoking—both before and after surgery—to limit the chances of dry socket. Dry socket, or alveolar osteitis, is a painful condition in which the blood clot that’s supposed to form in the spot where a tooth was removed doesn’t form or is dislodged, exposing the bone or nerves.

“Make sure you are not taking any medications that can lead to thinning of the blood like ibuprofen before surgery, you will want to stick to Tylenol. Keep a healthy and clean diet, and minimize your anxiety levels,” says Dr. Kalasho.

Dr. Morris recommends vitamins and a healthy diet, as well as proper hygiene, to give patients the best chance of a good surgery and easy recovery.

“The best recommendation is to make sure you are brushing and cleaning your mouth to the best of your abilities to decrease bacterial contact, as well as eating properly and taking vitamins to promote healing.”

Tips for a successful (and pain-free) recovery

After your wisdom tooth removal, you can expect recovery lasting between one to five days, says Dr. Kalasho, with days two and three usually being the worst for pain and swelling.

Here are some tips and tricks to make your recovery easier.

Pain relievers

“We always recommend staying ahead of the pain and taking the pain reliever prescribed to you by your doctor as soon as you get home, even if you do not feel pain yet,” says Dr. Kalasho, who says that bleeding, throbbing, and pressure is normal.

Use gauze to stop the bleeding

During the day, Dr. Kalasho advises rolling up a piece of gauze, placing it on the extraction site, and biting down to tamper bleeding. If bleeding before bed, try elevating the head with pillows covered by a towel. Be mindful that certain behaviors can exacerbate bleeding.

Brush gently

“Do not do anything that would cause you to lose the clot, like rinsing too vigorously, drinking through a straw, smoking, or eating something too sharp,” says Dr. Kalasho.

Dr. Sclafani agrees that you should go gentle on your mouth.

“Do not clean the teeth next to the healing tooth socket for the rest of the day,” he says. “You should, however, brush and floss your other teeth well and begin cleaning the teeth next to the healing tooth socket the next day.”

It’s also a good idea to brush your tongue. That will help get rid of bad breath and any lingering unpleasant tastes that can be common after teeth are pulled.

Rinse with salt

Dr. Sclafani recommends that after surgery his patients rinse with a solution of half a teaspoon of salt in an 8-ounce glass of warm water after meals. That will help keep food particles out of the extraction site.

“Try not to rinse your mouth vigorously, as this may loosen the blood clot,” he says. “Avoid using a mouthwash during this early healing period unless your dentist advises you to do so.”

Ice it

Swelling and discomfort are normal, Dr. Sclafani says. “To help reduce swelling and pain, try applying an ice bag or cold, moist cloth to your face. Your dentist may give you specific instructions on how long and how often to use a cold compress.”

Take it slow

Dr. Norman cautions his patients to follow post-operative instructions carefully, which involves easing back into normal behavior.

“Don’t rush back into things too quickly,” Dr. Norman says. “This can lead to some uncomfortable post-operative complications such as dry sockets and prolonged soreness in the surgical areas. Other than that, use the removal of your wisdom teeth as an opportunity to lay on the couch, relax, and catch up on some Netflix while your body is healing.”

What to eat after wisdom tooth removal

“This is my favorite part to go over with my patients!” says Dr. Norman. He recommends soft foods that don’t require heavy chewing.

“Examples of foods I suggest to my patients are: scrambled eggs, mashed potatoes, yogurt, ice cream, fruit smoothies, protein drinks, and lots and lots of water. Your calorie content needs to stay the same while you are recovering, so high-calorie soft foods are the way to go!”

Dr. Sclafani also recommends soft foods such as scrambled eggs, as well as liquids. Equally important: what not to eat. “It is best to avoid hot foods and alcoholic beverages.”

Dr. Norman cautions his patients away from things like bagels, steak, and sandwiches that require lots of chewing. “I also tell my patients to stay away from anything that has small pieces that could get stuck in your surgery site: granola, potato chips, nuts, etc.”

Finally, stay away from hot or spicy foods, warns Dr. Gelfand. He also recommends avoiding small seeds and alcohol, which might impede wound healing. “Generally, food that requires a lot of chewing should be avoided since post-surgical swelling can make chewing especially difficult.”

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