Wisdom teeth (third molars) do not behave the same way in everyone. In some people, they erupt fully and remain problem-free for life; in others, they stay partially impacted, causing food impaction, bacterial accumulation, recurring infections (pericoronitis), or decay on the neighboring tooth. Some remain completely impacted in the bone, “silent” yet potentially risky.

Therefore, there is no single universal rule. The correct decision depends on symptoms, radiographic findings, hygiene compliance, and age. This guide offers a clear, scientific, patient-friendly framework to help our patients in Bursa understand whether a wisdom tooth should be removed or monitored.

What Is a Wisdom Tooth and Why Can It Cause Problems?

Third molars attempt to erupt between ages 17–25. Due to evolutionary changes and modern diet, our jaws often do not have enough space for them. Common issues include:

1. Lack of space: The tooth tilts or cannot fully erupt.
2. Partially impacted (operculum): The gum flap forms a pocket for food and bacteria.
3. Difficult to clean: Toothbrush access is limited → plaque, odor, inflammation.
4. Pressure on the second molar: Leading to decay, root resorption, or bone loss.
5. Cyst formation: Impacted teeth can develop follicular cysts over time.
6. Soft tissue trauma: Cheek biting and chronic irritation.

Summary: Wisdom teeth have high “problem potential,” but not every wisdom tooth must be removed.

Symptoms: When Should I Take It Seriously?

1. Pain, swelling, or difficulty chewing/swallowing
2. Bad breath, bad taste, discharge from the gum flap
3. Limited mouth opening (trismus)
4. Cheek biting or gum/soft tissue sores
5. Sensitivity or decay on the second molar
6. Numbness/tingling in the chin or lower lip (possible nerve pressure)

If you notice one or more of these, do not delay evaluation. Waiting for the pain to “go away on its own” usually worsens the situation.

Removal or Monitoring? — How the Decision Is Made

The decision combines clinical symptoms + radiology + hygiene + patient compliance + age.

Strong indicators for removal:

1. Recurrent pericoronitis
2. Decay or root resorption on the second molar
3. Cystic changes or follicular space enlargement
4. Orthodontic/periodontal impact
5. Chronic cheek trauma, persistent odor, food impaction
6. Poor hygiene + poor follow-up compliance

Suitable for active monitoring (follow-up):

1. The tooth is asymptomatic
2. No radiographic pathology
3. No pressure on the second molar
4. The area can be kept clean
5. Patient reliably attends annual check-ups

Important: Monitoring is not passive waiting — annual clinical/panoramic follow-ups are required.

Why Is CBCT (3D Imaging) Important?

Panoramic X-rays are useful for screening but two-dimensional.

CBCT shows a millimetric 3D relationship between wisdom teeth and:

1. The mandibular canal (nerve)
2. The maxillary sinus
3. The cortical bone and root angulation

This allows safer planning, reduced trauma, and options such as coronectomy when appropriate.

For Lower Wisdom Teeth Close to the Nerve: Coronectomy Option

Coronectomy removes only the crown while leaving the roots in place when they are too close to the inferior alveolar nerve.

1. Advantage: Reduces risk of nerve injury (paresthesia).
2. Follow-up: Roots may migrate slightly; if asymptomatic, no intervention is needed.

Upper Wisdom Teeth & the Sinus

Upper third molars can be close to the sinus floor. Sinus-friendly techniques are preferred, and short-term precautions (avoiding forceful nose blowing, etc.) are recommended.

Atraumatic Extraction & Piezosurgery

To minimize swelling, pain, and complications, the approach includes:

1. Minimal bone removal
2. Root sectioning when needed
3. Piezosurgery for precise bone cuts
4. Low heat and plenty of irrigation
5. Primary closure whenever possible

“Should They Be Removed When Young?” — Timing Matters

Extractions between ages 16–22 can be easier because roots are not fully developed.

However, this does not mean all wisdom teeth must be removed automatically.

Asymptomatic, pathology-free, easily cleanable teeth may simply be monitored.

Surgery Day: Step-by-Step

1. Evaluation: Exam + panoramic/CBCT review + planning + informed consent
2. Anesthesia/Sedation: Local anesthesia for most; sedation for high-anxiety or multi-tooth cases
3. Surgery: Planned incision, minimal bone removal, root sectioning when needed
4. Clot & Sutures: Aim for stable clot and primary closure
5. Instructions: Ice–medications–diet–hygiene–follow-up provided in writing
6. Duration: Simple cases 10–20 minutes; impacted teeth take longer

Does It Hurt? Pain Management Overview

No pain during the procedure — you may feel pressure/vibration.

Sedation improves comfort and perception of time.

Post-op: mild–moderate discomfort for 24–72 hours is normal and managed with prescribed medication + ice.

Most patients return to desk work in 1–2 days.

Possible Risks & How We Reduce Them

1. Nerve injury: Minimized with CBCT, atraumatic technique, coronectomy in select cases
2. Bleeding/swelling: Managed with atraumatic surgery + medication
3. Dry socket: Avoid smoking, straws, spitting for 48 hours; protect the clot
4. Infection: Medication + hygiene + follow-ups
5. Sinus-related issues: Managed with sinus-protective techniques

7-Day Healing Plan

1. Days 0–1: Ice 20 min on/20 off, head elevated, no straws/spitting, avoid heat/spices
2. Days 2–3: Peak swelling; soft–cool foods; medications on schedule
3. Days 4–7: Reduced sensitivity; stitches check; gentle brushing after 24 hours; recommended mouthwash

Avoid: Smoking/alcohol for ≥72 hours (preferably 1 week), heavy exercise for 7–10 days, seeds/rice/sesame for 1 week.

Antibiotics, Painkillers & Special Conditions

1. Antibiotics are not routine; used based on infection risk
2. Analgesic/anti-inflammatory: follow prescribed schedule
3. Anticoagulants: coordinated planning with relevant specialists
4. Diabetes/other conditions: controlled systemic health improves healing

Cost–Benefit Perspective

Delaying extraction can lead to more costly treatments on the second molar.

In appropriate cases, multiple extractions in one session simplify scheduling and budget.

Sedation adds cost but increases comfort during long/complex sessions.

Common Scenarios

1. A: Recurrent pericoronitis → strong indication for removal
2. B: Decay on second molar → extraction + restoration plan
3. C: Asymptomatic, cleanable → monitoring
4. D: Roots close to nerve → coronectomy discussion
5. E: Upper molar near sinus → sinus-safe extraction

Myths & Facts

1. “All wisdom teeth must be removed.” → False
2. “Face shape changes after extraction.” → False
3. “Wisdom teeth always cause crowding.” → Not alone — many factors involved
4. “Dry socket is inevitable.” → False
5. “If not removed young, it becomes impossible later.” → False

Frequently Asked Questions

Why do wisdom teeth hurt?

Food and bacteria trapped under the gum flap → infection (pericoronitis).

Can all four be taken out in one session?

Yes, in suitable cases — sedation improves comfort.

Is an empty space a problem?

No; wisdom teeth are not essential for function or aesthetics.

Is coronectomy safe?

Yes, in correct indications; requires follow-up.

Is CBCT necessary?

Yes when nerve/sinus proximity is suspected — it makes surgery safer.

How long does healing take?

Soft tissue: 1–2 weeks; most swelling resolves in several days.

When should I book a visit?

Recurring pain/swelling, decay, food impaction, bad odor, or cyst suspicion → do not delay.

Our Approach in Bursa

1. Personalized CBCT-based planning
2. Piezosurgery & atraumatic techniques
3. Coronectomy when appropriate
4. Sedation options
5. Written home-care kit & close follow-up

Our goal: predictable, low-pain, fast-recovery care that gets you back to daily life safely.

Final Word: A Personal Answer to “Should Mine Be Removed?”

Not every wisdom tooth must be removed.

But if symptoms, pathology, or damage to the neighboring tooth exists, delaying treatment often makes the situation worse.

With accurate diagnosis, 3D planning, and gentle surgical technique, the process is safe and predictable.

Let’s evaluate your personal risk–benefit balance and determine the safest plan for you.

Disclaimer: This guide does not replace medical advice. Final treatment decisions require clinical examination, radiology (CBCT when needed), and specialist evaluation.