Wisdom teeth: when they need to go, and when they don't.

Wisdom teeth are the third molars — the last four teeth at the back of the mouth, arriving long after the others, when the jaw is often already full. Some people never develop all four; some never develop any.

Plenty of people keep their wisdom teeth for life without a single problem. Removal is only worth it when a tooth causes trouble, or is clearly on its way to causing it. The useful question is not whether to remove them by default, but whether this tooth, in this mouth, is actually a problem.

There are clear, honest reasons to remove a wisdom tooth:

• Impaction — the tooth is stuck under gum or bone and cannot come through properly;
• Recurrent pain or infection around a partly-erupted tooth (pericoronitis);
• Damage to the neighbouring molar — pressing on it or causing decay where they meet;
• Cysts or significant decay that cannot be restored.

And a reason not to: a wisdom tooth that is fully through, healthy, reachable for cleaning and painless rarely needs removing. Taking out sound teeth "just in case" is seldom justified — a point we take seriously.

A wisdom tooth that has erupted normally comes out much like any other extraction, under local anaesthetic. An impacted tooth is a minor surgical procedure: a small incision in the gum, sometimes removing a little bone or dividing the tooth into sections, then a stitch or two to close.

It is done under local anaesthetic, with sedation available if you would prefer it, and usually takes twenty to forty minutes. A 3D (CBCT) scan beforehand shows exactly how the tooth sits — useful for the lower wisdom teeth in particular.

Recovery follows the same pattern as any extraction: swelling and discomfort peak around day two or three, then ease steadily over the first week. Surgical removal of an impacted tooth tends to swell more and may take a little longer. Stitches, where used, dissolve or are removed at around seven to ten days.

The aftercare is the same too — gentle salt-water rinses after the first day, soft foods, and no smoking or straws early on. Our companion guide on recovering from a tooth extraction covers the day-by-day detail and the dry-socket warning signs.

Most removals are uncomplicated, but it is fair to know the risks:

• Dry socket — more common with lower wisdom teeth, and largely preventable (no smoking, straws or vigorous rinsing early on);
• Swelling and jaw stiffness for a few days, especially after surgical removal;
• Nerve proximity — lower wisdom teeth can sit near a nerve that supplies feeling to the lip and tongue. In a small number of cases this causes temporary numbness afterwards, and very rarely it lasts. A 3D scan maps this beforehand so the risk can be judged and discussed openly.

Contact a dentist promptly if, after removal, you notice:

• bleeding that will not slow after firm gauze pressure;
• pain that worsens after day two or three rather than easing (possible dry socket);
• a fever, spreading swelling, or pus (signs of infection);
• numbness of the lip or tongue that does not recover.

Difficulty breathing or swallowing is a medical emergency and needs urgent care.