Wisdom Teeth: Do They Always Need to Be Removed?

Having a wisdom tooth does not automatically mean that it needs to be removed. The decision should be based on the tooth’s position, whether it can be kept clean, whether disease or damage is present, and the individual benefits and risks of surgery.

When can impacted wisdom teeth be monitored?

A wisdom tooth can often be monitored if it has erupted into a healthy position, can be brushed and flossed properly, and is not causing pain, infection, decay, gum disease or damage to the tooth in front. An unerupted or impacted tooth does not necessarily require removal simply because it is present.

• It has erupted into a functional, cleansable position.
• There is no recurrent pain or infection.
• There is no significant decay or gum disease.
• It is not damaging the neighbouring second molar.
• There is no cyst or other concerning change around it.
• It does not interfere with other planned dental treatment.

Why might impacted wisdom teeth need to be removed?

Partly erupted wisdom teeth can be difficult to clean because food and bacteria accumulate beneath the gum around them. One common problem is pericoronitis—inflammation or infection of the gum surrounding a partly erupted tooth. Symptoms may include pain, swelling, an unpleasant taste, tenderness and difficulty opening the mouth.

Other potential reasons for removal include:

• decay in the wisdom tooth
• decay or erosion on the back surface of the second molar
• gum and bone loss around the neighbouring tooth
• recurrent infection or food trapping
• damage to the root of the neighbouring tooth
• a cyst or other pathology around an unerupted tooth
• persistent pain, swelling or difficulty maintaining oral hygiene.

Damage to the tooth in front can develop in an area that is difficult to see clinically. By the time symptoms appear, the second molar may already have significant decay or bone loss. This is why examination and appropriate imaging are important.

What investigations are needed?

For impacted wisdom teeth, the first step is a clinical examination. We assess how far the tooth has erupted, the health of the surrounding gum, whether the area can be cleaned, and whether there are signs of decay or infection. We also assess the condition of the tooth immediately in front.

OPG: the usual starting X-ray

An OPG, or panoramic dental X-ray, provides a two-dimensional overview of both jaws. It shows the angle and depth of the wisdom teeth, the surrounding bone and the approximate relationship to important anatomical structures. For many patients, an OPG provides all the information required.

When might a CBCT scan be recommended?

A CBCT creates a three-dimensional image. For lower wisdom teeth, we pay particular attention to the inferior alveolar nerve, which runs through the lower jaw and provides sensation to the lower lip and chin. If the OPG suggests that the tooth roots are very close to this nerve, a CBCT may help show the relationship in three dimensions and may alter the treatment plan. CBCT is not automatically required for every wisdom tooth.

How are impacted wisdom teeth removed?

Some fully erupted wisdom teeth can be removed in a similar way to other teeth. An impacted tooth may require a surgical approach. This can involve making a small opening in the gum, removing a limited amount of surrounding bone and dividing the tooth into smaller sections so that it can be removed with less force. The gum is then repositioned and dissolving stitches may be placed.

Local anaesthetic, sedation or general anaesthetic?

Local anaesthetic

Many wisdom teeth can be removed comfortably under local anaesthetic, similar to the anaesthetic used for a filling. You remain awake and the area is numb. Pressure and movement are normal sensations, but you should not feel sharp pain.

Sedation

For anxious patients or more involved procedures, sedation may sometimes be considered together with local anaesthetic.

General anaesthetic

Under a general anaesthetic you are unconscious during the procedure. It may be considered for more complex surgery, multiple teeth, or when individual circumstances make treatment under local anaesthetic unsuitable. General anaesthetic carries additional risks and normally requires an appropriately equipped hospital or surgical facility. The choice should be based on the patient and the procedure—not simply on the fact that the teeth are wisdom teeth.

What is a coronectomy?

Sometimes a lower wisdom tooth requires treatment but its roots lie extremely close to the inferior alveolar nerve. In selected cases, a coronectomy may be considered instead of removing the entire tooth. The crown is removed while healthy roots are intentionally left in the jaw, reducing the chance of disturbing a nerve that is intimately associated with the roots.

A coronectomy is not suitable for every tooth. Infected or unsuitable roots should not simply be left behind. Retained roots can occasionally migrate, become exposed or require treatment later.

What are the risks of surgery for impacted wisdom teeth?

The risks differ between patients and teeth. Possible complications include pain, swelling, bruising, bleeding, infection, delayed healing, dry socket, temporary jaw stiffness, damage to a nearby tooth or restoration, and retained root fragments.

Lower wisdom tooth surgery can affect the inferior alveolar nerve, causing numbness, tingling or altered sensation in the lower lip or chin. The lingual nerve, which supplies sensation to part of the tongue, can also potentially be affected. These changes are often temporary when they occur, but permanent altered sensation is possible. Upper wisdom teeth have different anatomy and may carry a risk of communication with the nearby maxillary sinus. Your dentist or surgeon should explain the risks specific to your tooth.

What are the alternatives to removal?

• Monitoring: periodic examination and X-rays when the tooth is healthy and not causing disease.
• Managing an acute infection: cleaning and local measures may settle inflammation, although recurrent infection may return if the underlying cause remains.
• Restoring the tooth: occasionally possible when access, position and long-term cleansability are favourable.
• Coronectomy: an option for selected lower wisdom teeth with a high risk of nerve injury.

What should I expect after wisdom tooth removal?

The first few days are usually the most noticeable. Some bleeding or oozing immediately after surgery is normal. Swelling commonly increases for 48 to 72 hours before gradually settling. Jaw stiffness, bruising and tenderness can also occur.

You will receive instructions specific to your procedure, including advice about pain relief, cleaning, diet and bleeding. Softer foods are usually more comfortable initially, and vigorous exercise should be avoided for the period advised. Smoking and vaping interfere with healing and increase the risk of post-operative problems.

Contact your dentist or surgeon if you have significant bleeding that will not stop, worsening pain or swelling after the initial recovery period, fever, difficulty swallowing or breathing, or new or persistent altered sensation.

Do impacted wisdom teeth always need removal?

There is no single answer for everybody. A healthy wisdom tooth in a good position may remain for life. A poorly positioned tooth causing recurrent infection or damage to its neighbour may be better removed.

At Burleigh Dentistry & Implants, we can assess your oral surgery needs, arrange appropriate imaging and discuss whether monitoring, removal, coronectomy or referral is most suitable for your circumstances.

Would you like your wisdom teeth assessed? Call Burleigh Dentistry & Implants on 07 5593 6461 or book online.

Reviewed by the Burleigh Dentistry & Implants clinical team. Last reviewed 20 September 2026. This information is general and does not replace an individual examination and treatment plan.