Wisdom teeth, the third molars, are the last to arrive and the most likely to run out of room. When a third molar is tilted, buried in bone or trapped under the gum it is described as impacted. Impacted teeth cause recurrent gum infections (pericoronitis), decay in the tooth in front of them, cyst formation and pain that patients often mistake for an ear or jaw problem. Removing them is the most common operation performed by oral and maxillofacial surgeons, and doing it well means less swelling, less pain and a lower risk to the nerve that runs beneath the lower teeth.
Is this treatment for you?
Consider a consultation about wisdom tooth surgery if you have:
- Recurring pain, swelling or bad taste at the back of the mouth
- Difficulty opening or swallowing during flare-ups
- Food trapping and decay behind the last molar
- A cyst or dark shadow around the tooth on an X-ray
- Referral from your orthodontist or dentist
When a wisdom tooth should come out
Not every wisdom tooth needs removal. A fully erupted, cleanable, functional third molar can stay. Removal is advised for repeated infection, decay in the wisdom tooth or its neighbour, a cyst or lesion on the radiograph, pain, damage to the roots of the second molar, or when the tooth is in the way of orthodontic or jaw surgery. We will show you the radiograph and explain which category you fall into.
Piezoelectric surgery for deep impactions
Dr Zaki Mehdi's FCPS dissertation compared conventional rotary drilling with piezoelectric ultrasonic bone cutting for lower third molars. Piezoelectric instruments cut bone selectively and leave soft tissue and nerves untouched, an advantage in deep impactions near the inferior alveolar nerve. Both techniques are available here and the choice is made on your anatomy.
Anaesthesia options
Most wisdom teeth, including impacted ones, are removed comfortably under local anaesthesia in 20 to 45 minutes. For very anxious patients or when all four teeth are removed in one sitting, intravenous sedation or a general anaesthetic in a hospital theatre can be arranged.
What happens, step by step
- 1
Assessment
Clinical exam and OPG; CBCT if the roots sit on the nerve canal.
- 2
Surgery
Local anaesthetic, a small gum flap, sectioning of the tooth if needed, careful removal and stitches.
- 3
Aftercare
Written instructions, medication and a direct number to call.
- 4
Review
Check at one week; dissolving stitches need no removal.
Recovery and aftercare
Swelling peaks on day two or three and resolves within a week. Some jaw stiffness and a bruise on the cheek are normal. Soft foods, no smoking, no rinsing for 24 hours and then warm salt-water rinses. Complete socket healing takes several weeks, but most patients are back to their routine in two to three days.
Common questions
Will my face swell?
Some swelling is expected after surgical removal and is a sign of normal healing. Cold packs in the first 24 hours and the medication we give you keep it manageable.
What is the risk of nerve damage?
Temporary numbness of the lip or tongue occurs in a small percentage of lower wisdom tooth surgeries and almost always recovers. Permanent numbness is rare, and CBCT planning and careful technique are how we keep it that way.
Can all four be removed at once?
Yes, commonly under sedation. Many patients prefer one recovery period rather than two.
Do I need to remove wisdom teeth that do not hurt?
Not necessarily. Pain-free is not the same as problem-free, so we assess the radiograph and the tooth in front before advising.
What this costs
Fees depend on the complexity of your case, the materials used and whether preparatory work such as grafting is needed. You receive a written, itemised estimate after your examination, before any treatment begins.
Medically reviewed by Dr Syed Muhammad Zaki Mehdi, BDS, FCPS (OMFS), CHPE, C-Implantology, Consultant Oral & Maxillofacial Surgeon. Last reviewed 16 September 2026. This page is general information and does not replace an examination.