Wisdom teeth generally arrive between seventeen and twenty-five, into a jaw that often has no room left for them. Some erupt cleanly and cause no trouble for life. Others cause recurring problems, and a proportion cause damage to the tooth in front while producing very little in the way of symptoms.
The routine removal of all four regardless of symptoms is no longer the standard approach. The decision is made tooth by tooth.
Signs a wisdom tooth needs attention
- Recurring pain or swelling at the back of the jaw, often flaring and settling over months.
- Pericoronitis: inflammation of the gum flap over a partly erupted tooth, with swelling, bad taste, difficulty opening and pain on biting. It tends to recur once it has happened.
- Decay in the wisdom tooth or the molar in front. The contact point between a tilted wisdom tooth and the second molar is almost impossible to clean, and decay there often damages the second molar, which is the more valuable tooth.
- Food persistently trapping behind the last molar.
- Gum disease localised to the area, with deep pockets behind the second molar.
- Cysts or bone changes around an unerupted tooth, usually found on an x-ray.
- Pressure or crowding sensations, though evidence that wisdom teeth cause crowding of the front teeth is weak.
When leaving them alone is right
A wisdom tooth that has erupted fully, is in a functional position, can be cleaned properly and is causing no problems is generally left in place and monitored. An unerupted tooth that is fully covered by bone, causing no symptoms and showing no pathology is also commonly monitored rather than removed. Monitoring means periodic examination and x-rays, not ignoring it.
The assessment
An OPG x-ray shows the position and angle of each wisdom tooth, the state of the surrounding bone and its proximity to the inferior alveolar nerve in the lower jaw and the sinus in the upper. Where a lower wisdom tooth sits close to that nerve, a CBCT scan gives a three-dimensional view, because the relationship between root and nerve determines the risk and sometimes the technique. That assessment is what allows a proper discussion of risks before you consent.
The procedure
Removal is usually done under local anaesthetic. Where the teeth are deeply impacted, where several are being removed at once, or where anxiety makes it appropriate, sleep dentistry is available.
A simple extraction of a fully erupted wisdom tooth is much like any other extraction. A surgical extraction of an impacted tooth involves raising the gum, sometimes removing a small amount of bone, and often sectioning the tooth so it can be removed in pieces through a smaller opening. Stitches may be placed. A single tooth commonly takes twenty to forty minutes.
Recovery, realistically
- First 24 hours. Bite on gauze to control bleeding. Ice on the outside of the face in intervals. Rest, keep your head elevated, avoid rinsing, spitting, straws and smoking, all of which can dislodge the clot. Soft, cool food.
- Days two and three. Peak swelling and stiffness, usually worse on day two or three than on day one. Start gentle warm salt water rinses after twenty-four hours. Continue soft food and keep the area clean.
- Days four to seven. Swelling subsides, opening improves, most people return to normal food gradually. Many return to work or study within two to three days for a simple extraction, and take a few days more after a surgical one.
- Week two onward. Stitches dissolve or are removed. The socket continues filling in over several weeks.
Contact the practice if bleeding will not settle, if pain increases sharply around days three to five rather than improving, if swelling worsens after day three, if you develop a fever, or if numbness persists beyond the expected duration of the anaesthetic. Pain that spikes later in the week is the classic pattern of a dry socket, which is treatable and worth attending to promptly.
Risks worth discussing
Every surgical procedure carries risk. For lower wisdom teeth, temporary or in rare cases lasting altered sensation in the lip, chin or tongue is the risk that matters most, and it relates to nerve proximity. For upper wisdom teeth, communication with the sinus is possible. Dry socket, infection and prolonged swelling are the more common complications. Your dentist should explain which of these apply to your specific case based on the imaging before you consent.
Timing
Removal is generally more straightforward in younger patients, where roots are less fully formed and bone is more elastic, and recovery tends to be quicker. That is a consideration rather than a reason to remove teeth that are causing no problems. Many people choose to schedule removal during a break from study or work, which is worth planning a few weeks ahead.
What it costs
Tooth extraction at Civic Gentle Dental Care, including wisdom teeth, ranges from $275 to $600 depending on complexity. An emergency examination starts from $70 to $110 with x-rays at $52 each as needed. Where treatment is carried out under general anaesthesia, anaesthetist fees vary case by case and are discussed after consultation. Most health funds contribute under extras cover. Current fees are on our price list, with more on our wisdom teeth removal page and tooth extraction page.
Common questions
Do all four have to come out at once?
No. Removing all four in one session suits some people because it means a single recovery. Others prefer one side at a time so they can still chew comfortably. Both are reasonable.
How long will I be swollen?
Swelling typically peaks around day two or three and settles over the following days. Ice in the first twenty-four hours and keeping your head elevated both help.
Can I go to work the next day?
After a simple extraction, often yes. After a surgical removal of impacted teeth, plan for two to three days and avoid strenuous activity for about a week.
What is a dry socket?
It occurs when the blood clot in the socket is lost or breaks down before healing, exposing bone. It typically presents as worsening pain three to five days after the extraction and is treated by cleaning and dressing the socket.
Booking an appointment in Canberra City
Civic Gentle Dental Care is a dentist in Canberra City at Suite 8, Level 3/161 London Circuit, a short walk from the Canberra Centre. To arrange an appointment, call (02) 6247 0224 or send us a message through our contact page.
This article is general information only and is not a substitute for individual dental advice. Whether a treatment is suitable for you, and what it will involve, can only be determined after an examination by a dentist. Any prices mentioned are estimates drawn from our current price guide and are not a quote.