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Wisdom tooth: does it have to come out, or can it stay?

Hurting now? Call, and until you get here: Toothache: what to do right now. Swollen gum or cheek: Dental emergencies and abscesses.
A wisdom tooth is the last tooth to come through, and not every wisdom tooth has to come out: it stays if it is fully through, causing no trouble, and you can clean it, and it comes out if it gets inflamed time after time or harms the molar beside it. The examination and the x-ray decide, not pain alone.

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A thin terracotta line drawing on handmade paper: an upright molar, and behind it a wisdom tooth lying tilted, half under the gum line, with olive sprigs around.

When it stays, and when it comes out

A wisdom tooth is the last molar at the very back of the jaw, top and bottom, and it usually comes through in the late teens or early twenties, after the rest of your teeth have taken their places. That is why it often does not find enough room: it comes through fully, halfway, or stays buried.

It stays when it has come through fully and straight and is causing no trouble: it does not get inflamed, you can clean it, and it does not harm the molar beside it. Then we keep an eye on it at your regular check-ups; it is not taken out just because it is there.
It is monitored when it is buried or half under the gum and causing no trouble: the decision comes from the x-ray and the examination, not from an automatic extraction. At your regular check-ups we check the gum around it and the molar beside it, and if it starts causing trouble, we look at it again then.

It comes out when it causes trouble, or when another treatment plan, sometimes an orthodontic one, calls for it after the examination. The most common kinds of trouble:

The gum over it keeps getting inflamed. When it is only half through, a flap of gum stays over it and food catches underneath, so the gum gets inflamed, swells and hurts, then settles, then comes back. A first episode, unless it is severe, is not necessarily a reason to take it out. It is inflammation that comes back time after time that says it is time to talk about an extraction.
Decay in it, or in the molar beside it. Because it sits at the very back of the mouth, a toothbrush struggles to reach it, and food catches there and does not get cleaned away, so it decays, or its neighbour decays on the side between them.
Pressure on, or harm to, the molar beside it. When it comes through tilted towards its neighbour, it can press on it, or leave an angle between them that cannot be cleaned. That neighbour is the molar you actually chew on, and protecting it is part of the decision.
A cyst around it. Sometimes the x-ray shows a cyst around a buried wisdom tooth. This is not common, and the decision about it is made at the examination.

What about pain on its own? It usually tells you there is inflammation right now, but it does not settle whether the tooth has to come out. More on that below, under When it is not right for now.

Fully through, half through, or buried in bone

Wisdom teeth come through at all angles, straight or tilted, and the x-ray shows where yours sits and how close it is to the nerve. That decides how it is removed, simple or surgical, and how we prepare for it:

Fully through. It shows above the gum like any other molar. If its roots are straight, it usually comes out with a simple extraction.
Half through. Part of it shows, and the rest is under the gum or the bone. This is the position in which the gum over it gets inflamed most often. How it comes out is decided on the x-ray: sometimes simple, sometimes surgical.
Buried in bone. It cannot be seen, and the x-ray is what shows it. If it has to come out, it needs a surgical extraction with more steps.

Drag and see: fully through, half through, or buried

An illustration. Where your tooth sits, and how close it is to the nerve, shows on the x-ray at the exam.

Whether your case needs a more detailed image is decided at the examination. What that closeness to the nerve means is covered under The downsides and the risks.

How the extraction is done, step by step

Taking out a wisdom tooth follows the same steps as any extraction, and the full detail is on Tooth extraction. Here is the short version, with no minutes attached, because the timing for your case is something you find out at the examination.

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The examination and the x-rayThe doctor examines the tooth, the gum over it and the molar beside it, and a digital x-ray in the clinic shows its position, its roots and how close it sits to the nerve. The first question: does it stay, or does it come out? If extraction is decided, you are told why, whether it is simple or surgical, and what comes after, before anything starts. Tell us about every condition you have and every medicine you take, and whether you are pregnant, and do not stop any medicine on your own. The cost is discussed after the examination, and what changes it, simple or surgical and where the wisdom tooth sits, is explained on What decides the cost of your treatment.
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Local anaestheticThe area is numbed before we begin: you are told before the injection, not after it. The prick itself is short and you do feel it; then the area goes numb. If the fear is strong, there is laughing gas alongside the local anaesthetic, not instead of it: a small mask over the nose, and you stay awake and can talk. It is an option the doctor decides on at the examination, for your case, not over the phone.
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The extraction itselfOnce you are numb, you usually feel pressure and movement, not pain; if you feel pain, you raise your hand and we stop, and more anaesthetic is given if it is needed. And honestly: a few steps cannot be interrupted halfway; you know which before we begin, not in the middle. A wisdom tooth that is fully through with straight roots usually comes out with a simple extraction. One buried in bone, or half under the gum when the x-ray shows it is necessary, needs a surgical extraction with more steps: a small opening in the gum, sometimes dividing the tooth into pieces so it comes out with less pressure on the bone, and stitches if needed.
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The gauze and the instructionsOnce the tooth is out, you bite firmly on a piece of gauze so the bleeding stops and a clot can form to close the socket. You are told the instructions for the first few days, and you leave the clinic knowing what to do on the first day, and who to call if something comes up.
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Follow-upAfter a surgical extraction, or if your case needs it, a follow-up appointment is set for the doctor to see how the site is healing.

After the extraction: the first few days

The first few days are what protect the site while it heals, and the blood that clots in the socket is what closes it. The full instructions are under “After the extraction” on Tooth extraction; here is the short version:

Some swelling and discomfort for the first few days are expected. After a wisdom tooth, especially a surgical extraction, they can be more noticeable, with some stiffness in the jaw, and your mouth may not open quite as wide as usual. They ease with the days. The doctor decides on a suitable painkiller; do not pick one up on your own.
Bite on the gauze firmly, for as long as the doctor tells you. Light bleeding, or saliva tinged with blood on the first day, is expected.
No sucking, no straws, no spitting, and no smoking for the first stretch, and the doctor tells you how long, so the clot stays in place.
Soft food, cool or lukewarm, on the other side. Until the numbness wears off, do not eat on the numb side, and do not drink anything hot.
Rinsing starts when the doctor tells you, not before, and gently.

What is not normal: pain or swelling that grows after it had been easing, opening your mouth getting harder instead of easier, bleeding that does not stop with pressure, a bad taste or smell with pain, or numbness that stays after the anaesthetic wears off. These are gathered under When to call.

The downsides and the risks, before the advantages

Here are the limits of taking out a wisdom tooth, before its advantages, so you decide knowing what you are deciding:

Swelling and a stiff jaw for the first few days. Usually more noticeable than after an ordinary extraction, especially after a surgical one. It is expected and eases with the days, but it does mean planning for those first few days.
A socket that does not heal as it should. Sometimes the blood clot comes out of place or does not form well, and the bone beneath it is exposed; this is what is called a “dry socket”. It shows as pain that grows a few days later instead of easing, sometimes with a bad taste or smell. It happens more in smokers and after a surgical extraction, and the instructions for the first few days make it less likely. Sometimes the socket itself becomes infected, with pus or a fever. Either way, call; a fever or swelling that keeps growing does not wait: When to call.
Nerves and the sinus. In the lower jaw, two nerves run close to a wisdom tooth: one runs near its roots, and the x-ray shows how close the roots are to its canal; the other runs in the gum on the tongue side, and no x-ray shows it. Rarely, numbness in the lip, chin or tongue can last, and more rarely still it does not go away. Any numbness that stays after the anaesthetic wears off is reported the same day. In the upper jaw, the roots sometimes sit close to the sinus, and rarely a small opening forms between the socket and the sinus; it usually closes. If, after an upper wisdom tooth comes out, you notice air or liquid passing into your nose, call today. That is why the x-ray before the extraction is not a formality: it shows how close the roots are, and if that closeness changes anything in how the tooth is taken out or in the instructions afterwards, you are told before we begin.

The examination and the x-ray show whether taking it out is worth these limits, or whether it can stay and be monitored, and then the decision is yours.

Is there an alternative?

When the tooth is causing no trouble, the alternative is to leave it and keep an eye on it at your regular check-ups and on the x-ray; when the gum over it is inflamed for the first time, treating the inflammation at a visit is sometimes enough, and do not start an antibiotic on your own.

The advantages

It removes the source of inflammation that keeps coming back, when the wisdom tooth itself is the source.
It protects the molar beside it. When the wisdom tooth is pressing on it, or leaving an angle between them that decays, taking it out is sometimes what protects its neighbour and the bone around it.
One procedure, usually done in a single visit. A surgical extraction takes longer in the same sitting.

When it is not right for now, or should wait

In these cases the answer is usually not “no”. It is “not now”, or “with a different arrangement”, and you are told what has to happen first:

Acute inflammation with a lot of swelling. Here it is the extraction that waits, not the examination: inflammation with swelling needs to be seen the same day. Extracting through an active infection is harder, so sometimes the inflammation is treated first at a visit, and the extraction afterwards is usually easier; the doctor decides the order. Do not start an antibiotic on your own. If the swelling is under the jaw, or comes with a fever or difficulty opening your mouth, call now: When to call.
Pregnancy. Mention it on the first call. An urgent extraction, with pain or infection, does not wait, and it is done in coordination with your obstetrician. A wisdom tooth already planned for removal that is quiet for now, with no pain and no inflammation, usually waits for a suitable time the doctor decides.
Blood thinners. Not a closed door in many cases, but the plan changes: arrangements for bleeding, and sometimes coordination with your own doctor beforehand. And do not stop them on your own, before the appointment or after it.
Diabetes that is not under control, or another long-term condition. High blood sugar slows healing and makes infection more likely. So an extraction that can wait, waits until your blood sugar is under control with your own doctor, and an urgent one is arranged around your case. Medicines for the bones, or radiotherapy to the jaw area: say so in your first sentence. The details for people with long-term conditions are on Dental treatment for people with long-term conditions.

So, take it out now, or wait?

“Just pull it and be done” is something pain makes a lot of people say, and it is understandable. But a decision made at the height of the pain lets the pain decide for you, and an extraction cannot be undone. With a wisdom tooth that is inflamed right now, we sometimes treat the inflammation first at a visit, then decide, without the pain pushing you, whether it stays or comes out, and when. What does not wait is gathered below, under When to call.

What to do from now, and when to call

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Hurting now?Book as soon as you can, and do not settle on an extraction while you are in pain: the examination and the x-ray are what tell you whether the tooth has to come out. Do not start an antibiotic on your own. What to do until the appointment: Toothache: what to do right now.
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Been told it has to come out, and want to be sure?You have every right to understand first. Book an examination and bring any x-ray you have, and you will find out whether it can stay and be monitored or needs to come out, and why.
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Not hurting, but want to know where it stands?A regular check-up and an x-ray show where it is, and whether it can simply stay while we keep an eye on it. Nothing is decided without you being told why.
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Have your list of medicines readyEvery medicine you take, any long-term condition, and whether you are pregnant, written down and ready for the first visit.
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If you are in Amman for a whileIf you are only in Amman for a stretch, a posting, a contract, a semester, or you come and go, tell us your dates at the first visit, and you will find out what can fit around them. The extraction itself is usually done in one visit, but the site needs its first few days to settle, and after a surgical extraction, or if your case needs it, there is a follow-up appointment. Better to know that before you book flights than after. If this tooth has been x-rayed abroad, bring whatever you have.
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Book the examinationIt settles whether your wisdom tooth can stay and be monitored, and if not, how it comes out and what comes after. Then you decide, in your own time, with no pressure.

When to call

Whether the tooth is still in, or you had it out with us or anywhere else, these need a call the same day:

Call today: the gum over your wisdom tooth is swollen, and the pain is growing.
Call today: a bad taste or pus from around the tooth, or from the extraction site.
Call today: after an extraction, bleeding that does not stop with pressure on the gauze.
Call today: after an extraction, pain or swelling that grows instead of easing.
Call today: numbness in the lip, chin or tongue that has stayed after the anaesthetic wore off.

After an extraction, some swelling and a stiff jaw for the first few days are expected. What needs a call today: when they grow instead of easing. What needs a call now: a fever with them. What needs a hospital: swelling that reaches the eye or the neck, or difficulty swallowing or breathing.

This does not wait

Go to the nearest hospital emergency department now, not an appointment:

Difficulty breathing or swallowing.
Swelling that has reached the eye or the neck.

And let us know afterwards.

Call now:

Swelling under the jaw.
Fever with the pain.
Difficulty opening your mouth.

Call the clinic now⁦+962 7 8887 9175⁩

If the clinic is closed or you can't reach us: go to the nearest hospital emergency department. Don't wait. The details: Dental emergencies and abscesses.

If you are not in Jordan, go to the nearest emergency service where you are.

Call and we will find you the earliest slot, and tell you what to do until you arrive. Before any painkiller, ask the doctor first, so it suits your case. If a tooth that has not come out yet is hurting right now: Toothache: what to do right now.

And who treats you?

The clinic has a team of dentists, Dr. Adnan Alakhras among them. At the first visit you find out where your wisdom tooth sits on the x-ray and how close it is to the nerve, the state of the gum over it and of the molar beside it, and usually whether it can simply stay and be monitored, before you hear a word about extraction. Sometimes the answer needs a second x-ray. His qualifications are on his page: Read about the doctor and the clinic.

Questions people ask

Does it hurt?

The extraction is done under local anaesthetic: the area is numbed before we begin, and you are told before the injection, not after it. The prick itself is short and you do feel it; then the area goes numb. Once you are numb, you usually feel pressure and movement, not pain; if you feel pain, you raise your hand and we stop, and more anaesthetic is given if it is needed. And honestly: a few steps cannot be interrupted halfway; you know which before we begin, not in the middle. After the numbness wears off, expect some swelling and discomfort for the first few days; after a wisdom tooth they can be more noticeable, and they ease with the days. If the pain starts growing instead of easing, call and we will find you the earliest slot, and tell you what to do until you arrive. Before any painkiller, ask the doctor first, so it suits your case. If it hurts badly now and the clinic is closed: what to do until morning. If fear itself is the problem, say so from the first moment and we will go at your pace, and laughing gas is an option the doctor decides on at the examination. When the visit is hard.

How long does it take?

The extraction itself is usually done in one visit, and a simple extraction is quicker than a surgical one, because a surgical extraction has more steps in the same sitting. If there is active inflammation, it is sometimes treated first at a visit, and the extraction comes after. The timing for your case is discussed at the examination, as an expectation, not a promise. After the extraction, the site needs the first few days to settle.

Are there payment plans?

Not at the moment. The doctor is looking into it, and wants a trustworthy partner before he commits to anything; the details are under Payment and insurance on What decides the cost of your treatment. What you can do now: book the examination, and the decision after it is yours. You will find out whether your wisdom tooth can simply stay and be monitored, and if not, whether the extraction is simple or surgical, and what comes after. The cost itself is discussed after the examination, not over the phone.

Do I have to have all four out?

No, not necessarily. Each wisdom tooth has its own decision: one may be fully through and clean and stay, while one in the other jaw is buried and keeps getting inflamed. The examination and the x-ray show where each one stands, and you are told which one stays and is monitored, which one comes out, and why. Some people do not have all four in the first place. If more than one is to come out, how they are arranged, in one sitting or more, is discussed at the examination for your case.

Do wisdom teeth push the other teeth out of line, or undo braces?

It is a question people ask a lot, and the honest answer is this: there is no clear evidence that wisdom teeth are what cause crowding in the front teeth, or teeth moving back after braces, and crowding has more than one cause. Teeth can shift with age, and after any orthodontic treatment they keep a tendency to move back, which is why the retainer is part of the plan. So taking out a wisdom tooth for this reason alone is not a rule: it is decided with the orthodontist at the examination and on the x-ray, according to your plan and your case. The details are on Braces.

Can I have it out while I am pregnant?

It is decided with the doctor, so mention it on the first call. An urgent extraction, with pain or infection, does not wait, and it is done in coordination with your obstetrician. A wisdom tooth already planned for removal that is quiet for now, with no pain and no inflammation, usually waits for a suitable time the doctor decides. X-rays and anaesthetic in pregnancy are talked through at the examination: an x-ray that can wait, waits, and one that is needed for a diagnosis is taken with the precautions the doctor decides for your case; the local anaesthetic and any painkiller are decided for your case and how far along you are; and laughing gas is postponed during pregnancy. The same rule is explained in Braces during pregnancy: what waits and what doesn’t.

It doesn’t hurt. Why take it out?

You do not have to take it out just because it is there. If it is fully through, causing no trouble, and you can clean it, it stays, and we keep an eye on it at your regular check-ups. If it is buried or half through and causing no trouble, the decision comes from the x-ray and the examination; it is not automatically an extraction. But some problems start without pain: decay in it or in the molar beside it, pressure on its neighbour, or, rarely, a cyst the x-ray shows. Then you are told what the doctor saw and why an extraction makes sense, and you decide. There is no rule that every wisdom tooth has to come out early: the decision is about your tooth, once it has been examined.

We suggest only the treatment you need, we tell you why, and we protect your tooth before we think about extraction.

Your next step

The examination. You come in, you are examined, and the x-ray shows where your wisdom tooth sits and how close it is to the nerve, and you find out whether it can stay and be monitored or needs to come out, and why. If extraction is the answer, you know how it is done, whether it is simple or surgical, and what comes after. Whether you live around the corner or are only in Amman for a while, you then decide in your own time, with no pressure.

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Pages that go with this one

Written by: RyanMedical review: Dr. Adnan Alakhras · pending approvalSources: The clinic’s services as published: tooth extraction, wisdom tooth extraction, surgical extraction and treatment of dental infections under local anaesthetic; laughing gas for children and adults; and digital x-rays in the clinic · National Institute for Health and Care Excellence (NICE), guidance on the removal of wisdom teeth · NHS, patient page on wisdom tooth removal · American College of Obstetricians and Gynecologists, guidance on oral health during pregnancy · Questions patients actually ask, in Amman and from abroad

This page explains wisdom teeth in general; it is not a diagnosis of your case. The decision is made at the examination and on the x-ray, and the cost is discussed after the examination.