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What Are Wisdom Teeth?

Wisdom teeth are the four adult teeth located in the back top and bottom corners of the mouth (third set of molars). For most people, wisdom teeth tend to grow in during the late teens or early twenties. When they grow in straight, they typically do not cause any problems and can remain in the mouth.

In many other cases, wisdom teeth do not have the room they need to grow in healthily. As a result, they instead grow in at an irregular angle or stay entrapped (impacted) in the jawbone or gum tissue. When wisdom teeth are impacted or misaligned, they are harder to clean and often lead to painful and debilitating symptoms. To treat misaligned or impacted wisdom teeth, surgical removal of the wisdom teeth may be required, which is a common oral surgery procedure that can reduce the risk of dental complications associated with wisdom teeth.

The Division of Oral and Maxillofacial Surgery and Dentistry (OMFS) at Massachusetts General Hospital offers long-term management and surgical removal of impacted and diseased wisdom teeth.

Misaligned Wisdom Teeth

Misaligned wisdom teeth may be positioned horizontally or angled toward or away from the other teeth. This misalignment may cause damage to the other teeth, jaw or nerve pain, and other symptoms. In addition, poor positioning may make these teeth harder to clean, allowing plaque and other debris to accumulate which, in turn, can lead to decay or infection of the teeth and surrounding tissues.

Impacted Wisdom Teeth

Impacted wisdom teeth are common and occur when the wisdom team either did not fully erupt or remain entrapped in the jawbone or surrounding soft tissue. A partially erupted wisdom tooth leaves direct access for bacteria to penetrate the area around the tooth and cause an infection. This can lead to painful swelling, stiffness in the jaw and sometimes more generalized illness. Typically, partially erupted teeth are more prone to tooth decay and gum disease.

Symptoms of Misaligned or Impacted Wisdom Teeth

Some patients with misaligned or impacted wisdom teeth do not experience any symptoms. For those that do, common symptoms include:

  • Painful swelling of the face
  • Stiffness in the jaw
  • Food trapped behind the wisdom teeth
  • Periodontal disease (disease of the gums)
  • Tooth decay
  • Damage to the other teeth or nerves

How to Care for Wisdom Teeth

Wisdom Teeth Evaluation and Management

Due to the complex and uncertain nature of wisdom teeth-related disease, Mass General oral surgeons recommend that everyone has a comprehensive third molar evaluation with an oral specialist when they are 18-21 years old to:

  • Document the current state of the wisdom teeth (position, development and any symptoms of wisdom tooth-related diseases)
  • Discuss treatment options, which may include surgical removal of the wisdom teeth or long-term management

If wisdom tooth management is chosen over surgical removal, the oral surgeon will discuss appropriate hygienic measures, how to recognize signs and symptoms of disease, and potential risk factors. Patients taking the wisdom tooth management course are recommended to visit with their oral specialist every two to five years.

Patients may choose to move forward with surgical removal of their wisdom teeth, if preferred.

Wisdom Teeth Surgical Removal

The best option to treat misaligned or impacted wisdom teeth is to surgically remove them. Extraction of wisdom teeth is performed safely on an outpatient basis under local, intravenous (IV) or general anesthesia.

What to Expect for Surgery to Remove Wisdom Teeth

Before Surgery

Ahead of surgery, the Mass General oral surgery care team will collect a complete and comprehensive account of the patient’s medical history, including an accounting of current medications and supplements, so that the doctor can provide a personalized care plan that best fits the patient's medical needs and goals.

You will meet with your oral surgeon to discuss what to expect for surgery, review the anesthesia options, and receive answers for any questions or concerns.

On the Day of Surgery

The surgery to remove wisdom teeth takes approximately 90 minutes. To learn more about what to expect on the day of your surgery at Mass General, please visit the Center for Perioperative Care website.

After Surgery

Since wisdom tooth removal surgery is performed on an outpatient basis, patients are discharged and return home on the same day as the procedure. Depending on the type of anesthetic that was administered, patients may be taken to a recovery room to rest for a few hours after surgery.

While recovering, patients can expect:

  • Minor bleeding at the extraction site
  • Pain or throbbing in the jaw
  • Bruising or swelling of the cheeks
  • To be asked to not eat hard foods, drink through a straw, brush or floss, or drink alcoholic, caffeinated and carbonated beverages for the first 24 hours after surgery
  • To rest and avoid strenuous activity for a few days

Our care team will provide specific instructions to ensure patients have the most comfortable recovery possible after wisdom teeth extraction.

Frequently Asked Questions About Wisdom Teeth

How can I prevent problems with my wisdom teeth?

Call 617-726-2740 or complete our secure online form to schedule an appointment with a Mass General oral surgeon. In this appointment, your doctor will assess the current state of your wisdom teeth and their likelihood for dental problems to develop. Your doctor will go over your treatment options with you. If your wisdom teeth appear to be growing in properly, long-term management may be recommended.

Wisdom teeth are notoriously harder to clean than other teeth, and will require extra care to ensure they remain hygienic. Your doctor will discuss how to take care of your wisdom teeth.

How do I know if I need to have my wisdom teeth removed?

Many people live their whole lives with healthy, fully erupted third molars without pain or symptoms; however, symptoms can arise from the misalignment or impaction of third molars and, as such, require surgery to remove them and prevent further complications.

In almost all cases, physicians will recommend wisdom tooth extraction as a preventative measure to avoid them from growing in misaligned or be impacted.

At what age should I have my wisdom teeth removed?

People can have their wisdom teeth removed at any age. However, the Mass General Oral and Maxillofacial Surgery team recommends that patients in their teens or early 20s have their wisdom teeth evaluated to see if surgery is advised, as this is the age when the wisdom teeth are still forming and have less risk to develop complications after surgery.