Dra. Cléo Salustiano In this article
SummaryWhen does a wisdom tooth need to come out?What to do if a wisdom tooth gets inflamed, and how extraction worksFAQRead nextWisdom teeth: when they need to come out and when you can keep them
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A wisdom tooth needs to come out when it causes problems or carries a high risk: recurrent pericoronitis, decay in the wisdom tooth or its neighbor, bone loss or root resorption on the second molar, a cyst, recurring pain or a position that prevents cleaning. A wisdom tooth that came in straight, fits the bite and can be cleaned can be kept. An impacted wisdom tooth with no symptoms or changes is often just monitored. If it gets inflamed: gentle cleaning, warm salt-water rinses, your usual pain reliever and a dentist visit within a few days; fever or facial swelling call for the emergency room. Extraction is done under local anesthesia, and complex cases may be referred to an oral and maxillofacial surgeon. In Mooca, São Paulo, Dr. Cléo Salustiano (CRO-SP 170844) sees patients every day, 8 a.m. to 10 p.m.
A wisdom tooth needs to come out when it's causing problems or has a high risk of causing them: repeated inflammation of the surrounding gum, decay in the wisdom tooth or the tooth next to it, damage to the root of the neighboring tooth, a cyst, recurring pain, or a position that makes cleaning impossible. A wisdom tooth that came in straight, fits the bite and can be cleaned properly can be kept and monitored. The decision is made with a clinical exam and an X-ray — not just based on age or because "everyone gets them out."
In clinical practice, patients often come in because of pain at the back of the mouth, swollen gum behind the last tooth, a bad taste or trouble opening their mouth — typical signs of pericoronitis, inflammation of the gum partly covering the wisdom tooth. Others come in with no symptoms at all, just a question after seeing their wisdom tooth on an X-ray. Both situations call for an assessment, but the answer isn't always extraction.
Below, Dr. Cléo Salustiano (CRO-SP 170844), a dentist in Mooca, São Paulo, explains when wisdom teeth are usually recommended for extraction, when they can be kept and what to do if one becomes inflamed.
This article comes from Dr. Cléo Salustiano's dental office in Mooca, São Paulo (care in English, Portuguese and Spanish). See the general dentistry page to learn how the treatment is done here and book your assessment.
When does a wisdom tooth need to come out?
A wisdom tooth needs to come out when there's a current problem or a high risk of one: repeated inflammation of the surrounding gum, decay that isn't worth treating, decay or resorption on the root of the neighboring tooth, bone loss between the two teeth, an associated cyst or lesion, recurring pain, or a position that prevents cleaning. It may also be recommended for planning reasons, such as orthodontic treatment or a prosthesis.
Pericoronitis is the most common reason. When a wisdom tooth only partly comes in, the gum forms a kind of hood over it, where food and bacteria collect. The result is inflammation, pain, swelling, bad breath, trouble opening the mouth and sometimes fever. A single episode can be controlled with cleaning and care, but when it keeps coming back, extraction is usually the definitive solution.
The neighboring tooth, the second molar, matters too. A tilted wisdom tooth leaning against it creates a hard-to-clean area where decay and bone loss develop, sometimes without pain. In these cases, keeping the wisdom tooth can put at risk a tooth that's important for chewing. A panoramic X-ray and, in some cases, a CT scan show this relationship.
An impacted wisdom tooth — one that never came in and sits fully inside the bone — doesn't always need to be removed. If there are no symptoms, no changes on the X-ray and no risk to the neighboring teeth, the approach is often to monitor it with periodic exams. The decision weighs the risk of keeping it against the risk of surgery, which increases with age and with proximity to structures like the nerve in the lower jaw.
A wisdom tooth that fully came in, sits in a good position, meets the tooth above or below it and can be brushed and flossed can be kept like any other tooth. It may even be useful in the future for some prosthetic plans. In that case, just include it in your daily hygiene and check-ups.
| Situation | What it usually indicates | Most common approach |
|---|---|---|
| Inflamed gum over the wisdom tooth that keeps coming back | Recurrent pericoronitis | Treat the inflammation, then extract |
| Tilted wisdom tooth leaning on the neighboring tooth | Risk of decay and bone loss on the neighbor | Assess extraction with an X-ray |
| Large cavity in the wisdom tooth | Treatment is difficult due to its position | Usually extraction |
| Impacted wisdom tooth, no symptoms or changes | Low current risk | Monitor with periodic exams |
| Erupted wisdom tooth, good position, cleanable | Functional tooth | Keep it, with hygiene and check-ups |
| Cyst or lesion associated with the wisdom tooth | Change in the bone | Extraction and assessment of the lesion |
What to do if a wisdom tooth gets inflamed, and how extraction works
If a wisdom tooth becomes inflamed, what helps until your appointment is keeping the area clean with careful brushing and gentle warm salt-water rinses, avoiding chewing on that side and taking only the pain reliever you normally use. See your dentist within a few days. If you have fever, swelling in your face or neck, trouble swallowing or breathing, or can barely open your mouth, go to the emergency room.
At the dental office, acute inflammation is usually treated first with cleaning and irrigation of the area and, when needed, prescribed medication. If extraction is recommended, it's generally done after the inflammation subsides, for more comfort and safety. In some cases, the upper tooth biting down on the inflamed gum also needs adjusting.
Wisdom tooth extraction is done under local anesthesia. Fully erupted wisdom teeth are usually simpler to remove; impacted or steeply tilted ones may require minor surgery, opening the gum and sometimes sectioning the tooth. More complex cases, such as wisdom teeth very close to the jaw nerve, may be referred to an oral and maxillofacial surgeon.
After extraction, the most important care in the first 24 to 48 hours is: bite on gauze to control bleeding, apply cold compresses to the outside of your face, eat soft foods that are cold or lukewarm, avoid spitting, rinsing vigorously and using straws, don't smoke, and take the prescribed medications. Swelling and discomfort are expected in the first few days and tend to ease.
In Mooca, Dr. Cléo Salustiano assesses wisdom teeth with an exam and X-ray and explains whether the recommendation is to extract, treat or monitor — and when a case is referred for more complex surgery. No surgical procedure is risk-free, and the risks are explained before any decision, along with the care that supports a smooth recovery.
Does everyone need their wisdom teeth removed?
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No. A wisdom tooth that came in straight, fits the bite and can be cleaned properly can be kept. Extraction is recommended when there's repeated inflammation, decay, damage to the neighboring tooth, a cyst, recurring pain or a position that prevents cleaning. An assessment with an X-ray decides.
How do I know if I need my wisdom teeth out?
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Common signs are pain at the back of the mouth, swollen gum behind the last tooth, a bad taste, trouble opening your mouth and food getting stuck there. But a wisdom tooth can also cause problems without pain, such as decay on the neighboring tooth. A clinical exam with an X-ray shows whether extraction is recommended.
What is pericoronitis?
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It's inflammation of the gum partly covering a wisdom tooth that hasn't fully come in. Food and bacteria collect under this hood of gum, causing pain, swelling, bad breath and trouble opening the mouth. When it keeps coming back, removing the wisdom tooth is usually the definitive solution.
Inflamed wisdom tooth: what can I do at home?
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Brush the area carefully, rinse gently with warm salt water, avoid chewing on that side and take only the pain reliever you normally use. See your dentist within a few days. If you have fever, facial swelling or trouble swallowing or breathing, go to the emergency room.
Does an impacted wisdom tooth need to come out?
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Not always. If the wisdom tooth is fully inside the bone, with no symptoms, no changes on the X-ray and no risk to neighboring teeth, the approach is often to monitor it with periodic exams. When there's a cyst, resorption of the neighboring tooth or another problem, extraction is recommended.
Do wisdom teeth push other teeth and make my smile crooked?
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It's a common concern, but the link between wisdom teeth and crowding of the front teeth is debated and isn't considered, on its own, a reason to extract. Teeth can shift throughout life for many reasons. When orthodontic treatment is planned, the orthodontist assesses whether the wisdom tooth interferes.
Is there an ideal age to remove wisdom teeth?
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When extraction is recommended, it's usually simpler in young adults, because the roots aren't fully formed and the bone is more flexible, which tends to make recovery easier. But there's no required age: the recommendation is based on a problem or risk, not on age.
Does wisdom tooth extraction hurt?
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Not during the extraction, since it's done under local anesthesia. In the following days, discomfort, swelling and difficulty opening your mouth are common, and they usually ease gradually with the recommended medications and care. Impacted wisdom teeth tend to have a somewhat longer recovery.
What care is needed after wisdom tooth removal?
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Bite on gauze to control bleeding, apply cold compresses to the outside of your face, eat soft foods that are cold or lukewarm, don't spit, don't rinse vigorously, don't use straws, don't smoke and take your medications. Resume brushing carefully, avoiding the surgical area on the first day.
What is dry socket?
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It's a complication in which the blood clot at the extraction site breaks down or is lost, leaving the bone exposed. It causes severe pain that usually starts a few days after the extraction, sometimes with a bad taste. Smoking, spitting and using straws raise the risk. If it happens, the dentist treats the area.
Can I have all four wisdom teeth removed at once?
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Sometimes, depending on the teeth's position, complexity and your general health. Often the extraction is done one side at a time, so you can chew on the other side while you recover. Your dentist or oral and maxillofacial surgeon decides the approach for your case.
Can a decayed wisdom tooth be treated instead of extracted?
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It can, when the wisdom tooth is in a good position, works in the bite and can be properly cleaned and restored. When its position makes treatment and hygiene difficult, the filling tends to fail, and extraction is usually the more predictable option. The assessment weighs these factors.
Where can I have my wisdom teeth assessed in Mooca?
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In Mooca, Dr. Cléo Salustiano (CRO-SP 170844) assesses wisdom teeth with an exam and X-ray and explains whether to extract, treat or monitor. The office is at Rua Hipódromo, 1141, near Bresser-Mooca station (Metro Line 3-Red), open Monday to Sunday, 8 a.m. to 10 p.m. She sees patients in Portuguese, English and Spanish. WhatsApp: (11) 97409-7834.
