Medical Encyclopaedia › Wisdom teeth (short definition)
In brief: Wisdom teeth are the third large molars at the very back of each half of the jaw. They usually erupt in young adulthood, but often only partially or not at all, because there is not enough space in the jaw. Not every wisdom tooth needs to be removed: whether surgery makes sense depends on symptoms, findings and the position of the tooth.
Typical problems
If a wisdom tooth remains entirely in the bone (impacted) or only partially erupts, problems can arise. Common is inflammation of the gum over a partially erupted tooth (pericoronitis) with pain, swelling, restricted mouth opening and bad breath. Other possible consequences are caries in the wisdom tooth or the neighbouring tooth, periodontitis behind the second molar, damage to the root of the neighbouring tooth and, rarely, cysts or tumours around the crown of the tooth. That wisdom teeth subsequently push the front teeth out of position is considered unproven.
When is removal advisable?
The German guideline on surgical removal of wisdom teeth recommends removal above all in the case of symptoms or pathological findings, such as recurrent inflammation, caries, cysts or damage to the neighbouring tooth, and in certain situations such as before orthodontic or prosthetic treatment. For symptom-free, healthy wisdom teeth, the evidence for preventive removal is limited; waiting with regular check-ups is a recognised option. An advantage of earlier removal can be that the roots are not yet fully formed and healing is often easier in younger people. The decision should be made individually after counselling.
Procedure
The basis is an X-ray (panoramic image); if the tooth is very close to the mandibular nerve, a three-dimensional scan (CBCT) may be useful. Removal is usually performed under local anaesthesia; on request or in difficult cases, also under sedation or general anaesthesia. For erupted teeth, simple extraction is often sufficient; displaced teeth are exposed after an incision in the gum, divided if necessary and removed. The wound is then stitched. Often all affected teeth on one side, or all four, are removed in one session.
Healing and behaviour afterwards
Swelling, pain and restricted mouth opening are normal in the first days and often peak on the second or third day. Cooling from the outside, painkillers as agreed, soft food and avoiding smoking, alcohol and physical exertion for a few days support healing. The blood clot in the wound should not be dislodged by vigorous rinsing or sucking. The stitches are usually removed after about a week.
Risks and complications
- secondary bleeding, bruising, wound infections
- painful wound-healing disorder (dry socket), more common in smokers
- temporary or, rarely, permanent sensory disturbances of the lower lip, chin or tongue due to irritation of the inferior alveolar or lingual nerve
- opening of the maxillary sinus with upper wisdom teeth
- damage to the neighbouring tooth, very rarely a jaw fracture with deeply displaced teeth
The risk of nerve damage depends mainly on the position of the tooth and is discussed before the procedure.
Costs and health insurance
If removal is medically justified, German statutory health insurers cover the costs of surgery under local anaesthesia. General anaesthesia is only covered in certain cases, for example for special medical reasons; otherwise it is a private service. Before the procedure, benefits, risks, type of anaesthesia, any additional costs and the alternative of waiting should be discussed.
Related terms in the encyclopaedia
Cyst, Tooth impaction, Pericoronitis, Tooth extraction, Inferior alveolar nerve, Dry socket, Panoramic X-ray, Cone beam CT, Local anaesthesia
Sources
- AWMF-S2k-Leitlinie Operative Entfernung von Weisheitszähnen (DGMKG, DGZMK)
- Ghaeminia H et al.: Surgical removal versus retention for the management of asymptomatic disease-free impacted wisdom teeth. Cochrane Database of Systematic Reviews 2020
- National Institute for Health and Care Excellence (NICE): Guidance on the extraction of wisdom teeth (Technology appraisal guidance TA1)
- Gemeinsamer Bundesausschuss (G-BA): Behandlungsrichtlinie für die vertragszahnärztliche Versorgung
Note: This article is for general information and does not replace advice, diagnosis or treatment from a doctor, dentist or pharmacist. Last updated: October 2026.