Wisdom Teeth Removal Surgery: Everything You Need to Know

Illustration of impacted wisdom tooth

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Wisdom teeth removal surgery is a procedure to remove the third set of molars, which typically appear between ages 17 and 25. Most people have at least one impacted wisdom tooth, meaning it doesn’t have enough room to grow naturally. By getting your wisdom teeth removed—either because an impaction has been identified or the potential for them to cause issues—you can ensure they don’t damage the surrounding teeth and bones.

wisdom teeth removal process
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What Is Wisdom Teeth Removal Surgery?

Wisdom teeth removal surgery is an outpatient procedure that is typically performed by a dentist or oral surgeon.

A dentist will recommend this surgery if an exam and X-rays reveal that your wisdom teeth are impacted or may cause dental problems for you in the future. (Not everyone has wisdom teeth, but most people have one to four.)

The surgeon will cut into the gums and remove the tooth, either as a whole tooth or in pieces. You’ll be under anesthesia, which could include nitrous oxide (laughing gas) or intravenous (IV) sedation. Your surgeon will decide which sedation to use based on your comfort level as well as the complexity and number of extractions required.

Contraindications

Wisdom tooth removal surgery before age 20 is typically easier than a procedure performed at a later age. While age doesn't preclude someone from getting their wisdom teeth removed, it can complicate matters.

Tooth roots aren’t fully formed in younger people, which makes them easier to remove and faster to heal. As you get older, roots become longer, curved, and more difficult to extract.

Potential Risks

Complications of wisdom teeth removal surgery can include:

  • Dry socket, a painful condition that can occur if a post-surgery blood clot gets dislodged from the extraction site, causing the bone and nerves underneath to become exposed
  • Irritated nerves
  • Sinus problems
  • Infection

Purpose of Wisdom Tooth Removal Surgery

Your dentist will monitor the development of your wisdom teeth during routine appointments and with dental X-rays. They may discuss removing them if they’ve become impacted or if they have the potential to cause problems, such as the following:

  • Infection
  • Tooth decay
  • Damage to surrounding teeth
  • Periodontal disease
  • Bone loss
  • Tooth loss

Your dentist may suggest having wisdom teeth removal surgery even if you aren’t experiencing any current symptoms in order to stop potential problems before they start. Since wisdom teeth are in an area that’s challenging to clean, it can be hard to maintain good oral hygiene with them in place.

You may be referred to an oral surgeon to perform the procedure. The surgeon will schedule a consultation before the surgery to go over your dental records and take additional X-rays to confirm the scope of your surgical needs.

Call your dentist or surgeon if you’re experiencing a dental emergency, such as severe pain, fever, or loose teeth. Do not wait for your surgery date.

How to Prepare

Ask your surgeon about any concerns you have before the procedure. They can tell you what to do in the days before surgery and how to plan for recovery time afterward. They can also talk to you about the type of anesthesia that will be used and how you’ll feel after the surgery.

The cost for wisdom teeth removal surgery will depend on the level of impaction and the number of teeth that are being removed. Check with your dentist, surgeon, and insurance provider on your benefits and what will be covered.

You can prepare for recovery by buying some soft or liquid-based foods that are easy to eat after surgery. These could include smoothies, applesauce, oatmeal, yogurt, and other foods that are easy to eat without chewing.

Location

Wisdom teeth removal surgery is performed in a dentist’s or oral surgeon’s office.

What to Wear

Wear loose, comfortable clothes for the procedure. If you’re getting intravenous anesthesia, wear a shirt with short sleeves or one that’s easy to roll the sleeves up. You won’t need to change into anything for the surgery.

Food and Drink

Follow your surgeon’s directions for eating and drinking before surgery. Instructions may vary depending on the sedation used.

If you are getting intravenous anesthesia, you won’t be able to eat or drink anything after midnight the night before the procedure so your stomach is empty.

Medications

The risk of bleeding problems can increase with medications such as aspirin, Coumadin (warfarin), and Advil (ibuprofen).

Let your doctor and dentist know if you're taking these or any other medications before dental surgery. They will let you know if you can keep taking your current medications or if (and when) you should stop taking them in preparation for surgery.

To avoid complications, let your doctor know about all of your medications, including prescription or over-the-counter drugs, vitamins, or other supplements.

What to Bring

Be sure to bring any necessary paperwork and your dental insurance card.

Your surgeon will probably advise you to make arrangements for someone to bring you home from the surgery, since you’ll be groggy after anesthesia. This person can wait for you in the waiting room, if desired.

Pre-Op Lifestyle Changes

Avoid tobacco and alcohol for at least eight hours before the surgery.

What to Expect on the Day of Surgery

Arrive on time for your appointment at the oral surgeon’s office. Your practitioner may perform dental X-rays again on the day of surgery if necessary.

During the Surgery

The surgery should take about 45 minutes. With anesthesia, you shouldn’t feel any pain or discomfort. Depending on what type of sedation is used, you may be asleep or conscious during the surgery.

These are the steps for a typical procedure:

  • Sedation: If you are receiving nitrous oxide (laughing gas), you will be fitted with a small mask to fit over your nose to inhale the sedative, allowing you to be awake but remain relaxed. If intravenous (IV) sedation is chosen, the assistant will place a needle in the vein in your arm to administer a sedative throughout the surgery. This is generally considered the most comfortable option since you drift in an out of consciousness and are unlikely to remember the procedure afterward.
  • Numbing: After sedation, your surgeon starts by numbing the wisdom teeth and their surrounding tissues with a local anesthetic.
  • Tissue removal: The surgeon removes any gum tissue covering the area where the wisdom tooth is located to access the tooth.
  • Bone removal: An impacted wisdom tooth could be fully or partially covered with bone. If this is the case, a high-speed handpiece is used to drill through and remove the bone covering the tooth.
  • Loosening and sectioning of the tooth: When the impacted wisdom teeth are visible to the dentist, various surgical instruments are used to gently loosen them from any connective tissue in the tooth's socket. The surgeon may also cut the tooth into sections to allow for easier removal.
  • Tooth removal: Once the wisdom tooth is loose or has been completely sectioned, it is ready to be removed. The surgeon will use surgical instruments specially designed to fully remove the tooth.
  • Stitches: Now that the wisdom teeth are gone, the surgeon may add stitches to close up the area. This is sometimes necessary when impacted wisdom teeth are removed or when the practitioner feels the patient will better heal with stitches in place.

After the Surgery

After the procedure is complete, the nitrous oxide gas or IV drip is stopped and you'll be brought slowly out of sedation.

The dentist will provide gauze for you to bite down on to help blood clot in the area. Immediately after surgery, you may feel mild effects of the anesthesia, including nausea, dizziness, and shivering.

You'll be brought to a recovery room where you will be monitored. Once a specialist has determined that you are stable and breathing normally, you'll be cleared to go home. Usually you'll spend less than an hour in the recovery room.

After surgery, you will feel groggy and swollen. You may not feel much pain immediately, but it will probably increase as the local anesthetic wears off in the hours after surgery.

Recovery

For the first 24 hours after the surgery:

  • Avoid rinsing your mouth vigorously or drinking through a straw.
  • Don’t drink alcohol or use mouthwash with alcohol.
  • Avoid brushing your teeth next to the extraction site. Use a soft manual toothbrush, which is gentler than an electric one.

Some pain, bleeding, and swelling in your mouth and cheeks are likely to persist for up to several days after the surgery. You may not be able to open your mouth all of the way during this time.

The extraction site can take up to six weeks to heal, but most people can resume normal activities the next day. That said, avoid strenuous activity for a week after the surgery to avoid breaking off the blood clot.

Avoid smoking during the healing process.

Healing

Your dentist or surgeon will give you extra gauze to use on the extraction site at home.

If you have bleeding after this gauze is removed, fold another piece of clean gauze into a pad. Dampen the pad with warm water and gently hold it between your teeth in the area of the extraction. Avoid chewing on the gauze. Keep it in place for about 30 minutes and replace it if it becomes soaked with blood.

Your dentist may also suggest moistening a tea bag and gently biting down on it for 30 minutes to control bleeding. Tea contains tannins, compounds that can constrict blood vessels to help stop bleeding.

In a 2014 study, researchers gave patients regular gauze or gauze moistened with green tea extract to use on their gums after tooth extraction. They found that the gauze with green tea extract was more effective at stopping bleeding than the regular gauze.

As you heal, be on the lookout for symptoms of dry socket, which include:

  • Severe pain radiating out from the socket toward the neck or side of the face
  • Visible bone in the extraction site
  • Foul smell or bad taste in the mouth

Contact your surgeon immediately if you have any symptoms of dry socket, heavy bleeding, or significant pain.

Pain Relief

Over-the-counter pain medicine such as Tylenol (acetaminophen) and Advil (ibuprofen) are usually effective for pain after wisdom tooth extraction. You might also try putting a bag of ice or a cold damp washcloth on your face to help with swelling and pain.

In some cases, your surgeon may prescribe pain medicine, which can include opioids such as hydrocodone and oxycodone. These medications can be safe if used as directed for a short amount of time. It's important to follow your surgeon's instructions because misuse can lead to overdose, addiction, or death.

Eating and Drinking

Your dentist will give you suggestions for what and when you can eat after surgery. The soft tissues in your mouth will likely be sensitive for several weeks. Usually you can start eating soft or liquid-based foods and slowly start adding more solid foods when you feel ready. Avoid foods that are spicy, acidic, chewy, or small and hard (e.g., nuts, seeds, and granola), which can irritate the site.

Your dentist may suggest gently rinsing your mouth with warm salt water (1/2 teaspoon of salt in 8 ounces of warm water) after meals, being careful not to dislodge any blood clots.

A Word From Verywell

Wisdom tooth removal is a common dental procedure and complications are rare. For a successful recovery, it's important to closely follow the post-operative instructions you receive, particularly during the first seven to 10 days following your procedure. Take time to ask any questions you have so you fully understand how to care for yourself during this time.

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Article Sources
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  8. Institute for Quality and Efficiency in Health Care. Should You Have Your Wisdom Teeth Removed?

  9. Soltani R, Haghighat A, Fanaei M, Asghari G. Evaluation of the Effect of Green Tea Extract on the Prevention of Gingival Bleeding after Posterior Mandibular Teeth Extraction: A Randomized Controlled TrialEvidence-Based Complementary and Alternative Medicine. 2014;2014:1-4. doi:10.1155/2014/857651

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