Wisdom teeth are the third molars at the very back of your jaw, and they arrive between about 17 and 25 — usually into a mouth that has no room left for them. When there is room and they come in straight, they can stay. When there is not, they push, trap food, get infected, or damage the healthy molar in front of them. Removal is one of the most common procedures in dentistry, and at American Dental Group it is done in-house by Dr. Homan Hanasab, DDS, MS, CAGS.
How to tell whether yours need to come out
An X-ray answers this properly, but these are the signs that bring most patients in:
- Aching or pressure at the back of the jaw, often worse when chewing.
- A flap of swollen gum over a partly erupted tooth that keeps getting sore. This is pericoronitis, and it tends to recur because food gets under the flap and cannot be cleaned out.
- Repeated infection, a bad taste, or a smell from the back of the mouth.
- Decay you can see on the wisdom tooth or on the molar in front of it. Wisdom teeth sit where a toothbrush barely reaches, so both teeth are at risk.
- Difficulty opening your jaw fully, or swelling in the cheek or under the jaw.
- Nothing at all. Plenty of problem wisdom teeth are found on a routine X-ray before they hurt, which is the easiest time to deal with them.
Not every wisdom tooth needs removing. If yours are fully through, upright, biting against an opposing tooth and cleanable, we will tell you to keep them and watch them.
What "impacted" means
An impacted wisdom tooth is one that cannot come through into a normal position. The usual reasons are that the jaw ran out of space, or that the tooth is angled the wrong way. Impaction comes in a few patterns, and the pattern changes how involved the surgery is:
- Soft-tissue impaction — the crown has cleared the bone but gum still covers part of it.
- Partial bony impaction — part of the crown is still held in bone.
- Full bony impaction — the tooth is completely encased in bone.
- Angular impaction — the tooth is tilted forward into the second molar, or backwards, or lying horizontally.
The forward-tilted pattern is the one we most want to catch early, because the pressure point sits against the root of a healthy molar and can cause decay or resorption in a tooth that was doing nothing wrong.
The procedure, step by step
- Consultation and panoramic X-ray. A single image showing all four third molars, their root shapes, and how close they sit to the nerve in the lower jaw and the sinus in the upper. This is what determines the surgical plan — and occasionally the advice to leave a tooth alone.
- Anaesthetic and sedation. Local anaesthetic is standard. Sedation is available for impacted cases and for anxious patients; we go through the options, fasting instructions and transport arrangements before the day.
- Removal. An erupted tooth may lift out in minutes. An impacted one is exposed through a small opening and usually sectioned, so it comes out in pieces through a smaller window. That conserves bone and generally means an easier recovery than taking it out whole.
- Closing the site. The socket is irrigated and sutured where needed. You bite on gauze until a clot forms, and you go home with written aftercare.
All four are usually done in one appointment, typically 45 to 90 minutes, so there is one recovery rather than several.
Recovery, day by day
- Day 0. Gauze pressure, ice on and off, soft cold food. No straws, no smoking, no rinsing, no spitting — suction is what dislodges the clot.
- Days 1–3. Swelling peaks around 48 to 72 hours, and some jaw stiffness and bruising is normal. Keep up pain relief on schedule rather than waiting for pain. Start gentle warm salt-water rinses after the first 24 hours.
- Days 4–7. Swelling falls, and you move from soft food back toward normal. A sudden deep ache spreading to the ear around day three to five is the classic sign of dry socket — call us, it is easy to treat.
- Week 2 onward. Most patients are fully back to normal. The socket itself fills in with bone over the following months.
Our general post-surgical care instructions cover much of the same ground and are worth reading before your appointment.
Risks, stated plainly
Wisdom teeth removal is routine, and complications are uncommon, but you should know what they are. Dry socket is the most frequent. Infection is possible and is why aftercare matters. Lower wisdom teeth sit near the inferior alveolar nerve, so temporary numbness of the lip or chin can occur, and permanent numbness is rare; the panoramic X-ray exists partly to assess that distance in advance. Upper wisdom teeth sit near the sinus, which is occasionally opened and usually heals on its own. We go through the risks specific to your X-ray at the consultation, not as a generic list.
Wisdom teeth, gum health and the tooth next door
A partly erupted wisdom tooth creates a pocket that cannot be cleaned, and pockets are where periodontal disease starts. It is common to see bone loss on the back of the second molar purely because the wisdom tooth behind it made that surface impossible to clean. If your evaluation shows that pattern, treating the gums is part of the plan — see periodontal treatment.
For extractions other than third molars, see tooth extraction. If a tooth is lost and needs replacing, start at dental implants.
What it costs
Cost depends on how many teeth are removed, whether they are erupted or impacted, and whether you choose sedation — a simple extraction and a full bony impaction are different procedures. You get a written, itemised estimate after your X-ray, with your insurance benefits already verified.
Most dental plans cover extractions, often at a higher percentage than elective treatment, and surgical removal of impacted teeth is usually coded separately. Some medical plans contribute as well. CareCredit, Cherry, Alphaeon and Sunbit financing are accepted — see patient information.
Serving West Covina and the San Gabriel Valley
Our office is at 436 N. Sunset Ave, West Covina, CA 91790, minutes from the 10 and the 605. We see wisdom-teeth patients from Covina, Baldwin Park, La Puente, El Monte, Rowland Heights and Hacienda Heights. Back to general dentistry.