In short: Wisdom teeth do not have to be removed as a matter of course. It becomes necessary when they lack space, cause recurring inflammation, damage neighbouring teeth or cannot be cleaned properly. Symptom-free, fully erupted and well-maintained wisdom teeth can stay. The basis for the decision is always an X-ray, not your age.
Few procedures are recommended so routinely and judged so differently. The short answer: it depends on position and space, and both are only visible on an X-ray.
When removal is indicated
- Lack of space: the tooth does not come through fully, stays partly under mucosa or bone and therefore cannot be cleaned.
- Recurring inflammation: the mucosal pocket over a partly erupted tooth becomes inflamed again and again — painful and with swelling.
- Decay: on the wisdom tooth itself or, with worse consequences, on the hard-to-reach back surface of the neighbouring tooth.
- Pressure on neighbouring teeth or a cyst: a displaced tooth can damage roots or form a cyst that grows silently.
- Before orthodontic treatment, where the space is needed for the planned tooth movement.
When they can stay
If a wisdom tooth has erupted fully, stands in the row, has contact with the opposing tooth and can be brushed normally, there is no reason to remove it. Prophylactic removal without findings is not the rule today. What remains in such cases is observation: a check at the usual intervals so that beginning decay on the back surface is not missed.
How the procedure works
After local anaesthetic the tooth is exposed and removed, in sections for displaced teeth to spare surrounding tissue. The wound is sutured. The procedure itself usually takes considerably less time than patients expect. Discussed beforehand are the position of the nerve pathways in the lower jaw and the proximity to the sinus in the upper jaw — both are why planning happens on the X-ray and not in the chair.
With several teeth we often work one side at a time so that one side stays free for chewing. If you have pronounced anxiety or would like all four in one session, raise it at the preliminary consultation — there are solutions for both.
The days afterwards
- Cool from outside in intervals during the first 24 hours
- On the day of the procedure do not rinse, do not suck, use no straw — the blood clot in the wound must stay
- No sport, no sauna, no alcohol, no smoking for several days; nicotine markedly delays healing
- Soft, cool food. Dairy is unproblematic, very hot food is not
- Swelling and limited mouth opening are normal and peak around the second day
If pain and swelling increase again from the third day, if fever develops or a bad taste appears, call us. That is rare but treatable — and not something to wait out.
Frequently asked questions
All four at once or one at a time?
Both are possible. One side at a time preserves chewing ability and spreads the strain; all four in one session shortens the total downtime. The decision follows the findings and your situation.
How long am I affected?
In uncomplicated cases two to three days, somewhat longer for displaced teeth. Plan the appointment so that a quiet weekend or two free days follow.
Does German insurance cover removal?
With a medical indication, yes. Additional services such as sedation or three-dimensional imaging may be private and are discussed beforehand.
Do wisdom teeth push the front teeth out of line?
That was long assumed but is not clearly supported by evidence. It is not accepted today as a sole reason for removal.
This article provides general information and does not replace a dental examination. Medically reviewed by Dr. F. J. Rodríguez Ruíz, MSc., dentist at A+ Dental, Düsseldorf-Oberkassel.