When do wisdom teeth actually need to come out?

Wisdom teeth (third molars) typically emerge between ages 17 and 25. Many people assume all wisdom teeth need to be removed, but that is not the case. A wisdom tooth only needs extraction when it is causing a problem or is very likely to cause one.

Your dentist will recommend removal if the wisdom tooth is:

• Impacted – growing sideways into the adjacent molar, stuck against bone, or trapped under the gum
• Partially erupted with recurring infection – a flap of gum over a partially emerged wisdom tooth traps food and bacteria, causing pericoronitis (painful gum infection that can recur every few weeks)
• Decayed and unrestorable – wisdom teeth at the very back of the mouth are difficult to clean and fill; if decay is advanced, extraction is more predictable than restoration
• Pushing on adjacent teeth – causing pain, resorption of the second molar root, or contributing to crowding
• Associated with a cyst – a fluid-filled sac around an unerupted tooth (visible on X-ray) that can damage surrounding bone if left untreated

If a wisdom tooth is fully erupted, in good alignment, free of decay, and easy to clean, there is no clinical reason to remove it. Your dentist will monitor it at regular check-ups.

The different types of wisdom tooth extraction

Not all wisdom teeth extractions are the same. The complexity – and cost – depends on how the tooth is positioned.

Simple extraction

The tooth has fully erupted through the gum and has straightforward root anatomy. The dentist numbs the area with local anaesthetic, loosens the tooth with an elevator instrument, and removes it with forceps. The whole procedure takes 5–15 minutes per tooth. Stitches may or may not be needed.

Surgical extraction (soft-tissue impaction)

The tooth is partially erupted or covered by gum tissue but not significantly blocked by bone. The dentist makes a small incision in the gum, may remove a small amount of bone around the tooth, sections the tooth if necessary, and removes it. Stitches are placed to close the gum. Takes 15–30 minutes per tooth.

Surgical extraction (bony impaction)

The tooth is fully trapped within the jawbone, often angled horizontally or against the second molar. The dentist opens the gum, removes bone overlying the tooth, sections the tooth into pieces, and removes each piece individually. This is the most complex type and takes 20–45 minutes per tooth. An OPG or CBCT scan is essential to plan the approach and identify nerve proximity.

What happens during the procedure

Here is a step-by-step overview of what to expect on the day:

1. Review and consent: Your dentist reviews the X-ray, explains the plan, discusses risks (numbness, dry socket, infection), and obtains your written consent
2. Anaesthesia: Local anaesthetic is injected to numb the tooth and surrounding tissue completely. If you have opted for sedation (oral sedation or nitrous oxide), this is administered before the local
3. Extraction: The dentist performs the extraction as described above – simple or surgical depending on the tooth’s position
4. Haemostasis: Gauze is placed over the socket and you bite firmly for 20–30 minutes to form a stable blood clot
5. Post-op instructions: Written care instructions are provided covering pain relief, diet, activity restrictions, and warning signs to watch for

You will need someone to drive you home if sedation was used. Even with local anaesthetic only, it is a good idea to have someone available for the first few hours.

Recovery timeline – day by day

Day 1 (extraction day): Numbness wears off in 2–4 hours. Mild to moderate aching is normal. Take prescribed pain relief before the anaesthetic wears off. Apply an ice pack to the outside of the cheek (20 minutes on, 20 minutes off) to reduce swelling. Eat cold soft foods only. Do not rinse, spit, or use a straw.

Day 2–3: Swelling peaks. This is normal and does not mean something is wrong. Continue ice packs, pain relief, and soft diet. Begin gentle warm saltwater rinses (half a teaspoon of salt in a glass of warm water) after meals – do not swish vigorously, just let the water flow over the area.

Day 4–5: Swelling starts to subside. Pain should be decreasing each day. If pain is getting worse (not better) after day 3, contact your dentist – this may indicate dry socket. Gradually introduce firmer soft foods.

Day 7–10: Most patients feel back to normal. Dissolvable stitches begin to fall out. Bruising (if any) fades. Resume normal diet, avoiding very hard foods directly on the extraction site for another week.

Week 3–4: Gum tissue has closed over the socket. No dietary restrictions.

Week 6–8: Bone has filled in beneath the gum. Full healing complete.

How to avoid dry socket

Dry socket (alveolar osteitis) is the most common complication after wisdom teeth removal. It occurs when the protective blood clot in the socket is lost, exposing bone and nerve endings to air, food, and bacteria. The result is intense, throbbing pain that typically starts 2–4 days after extraction and radiates to the ear.

To minimise your risk:

• Do not smoke for at least 72 hours (ideally 7 days) – smoking is the single biggest risk factor
• Do not use straws for 5 days – the suction can dislodge the clot
• Do not spit forcefully – if you need to clear saliva, let it drip gently into the sink
• Do not rinse for the first 24 hours – after that, use gentle saltwater rinses only
• Avoid alcohol for 48 hours – alcohol thins the blood and impairs clot formation
• Sleep with your head elevated on an extra pillow for the first 2 nights

If you develop worsening pain after day 2, contact Pakenham Creek Family Dentist on (03) 5940 1110. Dry socket is easily treated with a medicated dressing that provides almost immediate relief.

What to eat after wisdom teeth removal

First 24–48 hours (cold and soft):

• Yoghurt, custard, ice cream
• Smoothies and protein shakes (drink from a cup, not a straw)
• Mashed potato or mashed avocado
• Scrambled eggs
• Soup – lukewarm only, not hot

Days 3–7 (soft, minimal chewing):

• Soft pasta, risotto, well-cooked rice
• Soft bread, pancakes
• Banana, steamed vegetables
• Fish, minced meat, slow-cooked stews

Avoid for at least 7 days: chips, nuts, popcorn, crusty bread, spicy food, acidic citrus, very hot drinks, and alcohol.

How much does wisdom teeth removal cost in Pakenham?

Indicative full fees (before health-fund rebates):

• Simple extraction (fully erupted): $250–$350 per tooth
• Surgical extraction – soft tissue impaction: $400–$500 per tooth
• Surgical extraction – bony impaction: $550–$650 per tooth
• OPG X-ray: $95–$100

With HICAPS on-the-spot health-fund claiming, out-of-pocket costs are typically 40–60% less than the full fee. Pakenham Creek Family Dentist also offers Afterpay, Zip Pay, SuperCare, and NDP payment plans for larger treatment costs. A written estimate is always provided before the procedure.

When to see an oral surgeon instead of a general dentist

Most wisdom teeth – including many surgical extractions – can be safely performed by an experienced general dentist under local anaesthetic. However, your dentist may refer you to an oral and maxillofacial surgeon if:

• The roots are wrapped around or very close to the inferior alveolar nerve (visible on OPG/CBCT)
• You require general anaesthesia rather than local or sedation
• There are complex medical conditions that increase surgical risk
• Multiple deeply impacted teeth need to be removed simultaneously

Your dentist will discuss this with you after reviewing the X-ray. A referral to a surgeon does not necessarily mean the case is dangerous – it means a specialist setting is the safest option for that particular tooth.