Wisdom Teeth: Symptoms, Assessment and When Removal Is Needed
A guide to wisdom teeth coming through or impacted: eruption, symptoms and when to get help, assessment, and NICE and NHS guidance on removal. The NHS says a wisdom tooth causing no problems is usually left in place and monitored at check-ups.
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Clinically reviewed by Dr Ibraheem Ijaz, dentist · GDC 301711
Medical disclaimer: This page is for general information only. It does not replace an examination or treatment by a dentist.
This page is reviewed by Dr Ibraheem Ijaz, the practice's principal dentist and a General Dental Practitioner (GDC 301711). His qualifications are BDS, BSc (Hons), MSc (Leeds), PG Dip Implant Dentistry and PG Cert Restorative and Aesthetic Dentistry.
What are wisdom teeth?
Wisdom teeth are the third molars, the last teeth to come through. They usually come through between 18 and 24 (NICE), but the NHS says they can cause problems at any age.
How does normal eruption differ from problem eruption?
A wisdom tooth erupts normally when it comes through into correct alignment and works in the bite (NICE). Impaction, NICE says, is complete eruption prevented by lack of space, obstruction or an abnormal position, such as a tooth blocked by another tooth (NHS).
The flap of gum over a partly erupted tooth is the operculum. A 2021 review (Schmidt and colleagues) calls it a natural part of eruption that usually shrinks back once the tooth meets the opposing tooth, but if the tooth does not erupt correctly it may persist, and the gum around it may be inflamed repeatedly.
What are the types of wisdom tooth impaction?
Impaction is described by how far the tooth has come through and by its angle. The Royal College of Surgeons of England's Faculty of Dental Surgery (RCS England) calls impaction of lower wisdom teeth descriptive, not a reason for surgery, and the angle not in itself a diagnosis.
- Eruption: unerupted, partially erupted (some of the tooth is in the mouth) or fully erupted.
- Angle to the biting surface: mesioangular (tilted towards the tooth in front), distoangular (tilted away from it), vertical or horizontal.
For partially erupted, impacted lower wisdom teeth, RCS England links a horizontal or mesioangular tilt of 30 to 90 degrees to a significantly increased risk of decay at the back of the second molar, and lists a vertical or distoangular position as a risk factor for pericoronitis (inflammation of the gum around the crown).
To ask about wisdom teeth, book online or call 0114 288 2121.
When should you get help for wisdom tooth symptoms?
NHS actions for these symptoms run from seeing a dentist to calling 999:
- Wisdom tooth pain: see a dentist if toothache lasts more than 2 days, does not go away when you take painkillers, comes with a high temperature, pain when you bite, red gums or a bad taste in your mouth, or comes with a swollen cheek or jaw (NHS toothache guidance). If you do not have a dentist or cannot get an emergency appointment, call 111 or visit 111 online.
- Swelling: go to A&E if you have toothache and the area around your eye or your neck is swollen, or swelling in your mouth or neck is making it difficult to breathe, swallow or speak (NHS toothache guidance). Do not drive to A&E: ask someone to drive you or call 999 and ask for an ambulance.
- Gum infection (pericoronitis): an NHS-listed wisdom tooth problem; the pain and swelling actions apply. Our page on pericoronitis and wisdom tooth infection covers acute infection.
- High temperature or trismus (difficulty opening your mouth): both are NHS-listed dental abscess symptoms. Ask for an urgent dentist appointment or get help from NHS 111 if you think you have a dental abscess. Call 999 or go to A&E if you are finding it hard to breathe, speak or swallow, have a swollen or painful eye or suddenly start having problems with your eyesight, have a lot of swelling in your mouth, or are finding it hard to open your mouth.
- After a removal: NHS removal guidance says to ask for an urgent dentist appointment or get help from NHS 111 if you have bleeding that does not stop, pain and swelling that's severe or getting worse and painkillers are not helping, or pain with a bad taste in your mouth, a high temperature or feeling unwell. You can call 111 or get help from 111 online.
When is wisdom tooth removal indicated?
NICE TA1, Guidance on the extraction of wisdom teeth (2000, being updated), limits surgical removal of impacted wisdom teeth to patients with evidence of pathology. NICE and NHS indications include:
- NICE, impacted wisdom teeth: unrestorable caries (decay that cannot be repaired), pathology of the pulp or around the root tip that cannot be treated, cellulitis, abscess or osteomyelitis (infection of the jawbone).
- NICE, impacted wisdom teeth: resorption of the tooth or its neighbours, a fractured tooth, disease of the follicle including a cyst or tumour, or a tooth impeding surgery or reconstructive jaw surgery, or involved in or within the field of tumour resection.
- NICE, pericoronitis: how far severity or recurrence should influence the decision remains unclear, but second or subsequent episodes should be considered the appropriate indication for surgery.
- NHS, wisdom teeth without enough space to come through fully, which may need removing when this causes pain and swelling, infections in your gums (pericoronitis), food getting stuck, tooth decay, gum disease, a cyst or a dental abscess.
With toothache, NHS guidance is A&E if the area around your eye or your neck is swollen, or swelling makes it difficult to breathe, swallow or speak.
When is wisdom tooth removal not recommended?
Contraindications include:
- NICE, impacted wisdom teeth: prophylactic removal of pathology-free impacted third molars should be discontinued in the NHS.
- NICE, impacted wisdom teeth: plaque formation is a risk factor but is not in itself an indication for surgery.
- NICE, pericoronitis: the evidence suggests a first episode, unless particularly severe, should not be considered an indication for surgery.
- NHS, wisdom teeth: a tooth that is not causing problems will usually be left where it is and monitored at routine dental check-ups.
A 2020 Cochrane review found too little evidence to decide whether symptom-free, disease-free impacted wisdom teeth should come out, and RCS England reports growing evidence that discouraging preventive removal of lower ones may delay inevitable surgery and add second-molar damage.
How are wisdom teeth assessed?
For lower wisdom teeth, RCS England advises a history, a clinical examination and, when surgery is being considered, a panoramic X-ray. The examination should cover eruption, position against the second molar, the bite, and gum and decay status; the X-ray checks for disease in or around the tooth, root shape and closeness to the inferior alveolar nerve.
RCS England does not recommend routine X-ray screening of unerupted lower wisdom teeth with no disease or symptoms, nor routine 3D cone beam CT (CBCT). CBCT may be considered in carefully selected cases where a standard X-ray shows the tooth close to the nerve canal and the findings are expected to change management. Our guide to dental X-rays explains each type.
Frequently asked questions
Do wisdom teeth need removing?
Usually not, unless they cause problems (NHS). NICE recommends not removing pathology-free impacted wisdom teeth; its indications for removal include pathology, such as unrepairable decay, and second or subsequent pericoronitis episodes, though the role of severity or recurrence remains unclear. RCS England says some high-risk lower positions may need intervention sooner rather than later.
Is wisdom tooth removal available on the NHS?
Yes, where there is a clinical need. NICE limits NHS surgical removal of impacted wisdom teeth to evidence of pathology. With an NHS dentist, you pay a Band 2 charge, currently £76.60 in England, unless you are entitled to free NHS dental treatment (NHS guidance).
Can a partially erupted wisdom tooth be left in place?
Usually, if it causes no problems (NHS). RCS England says a functional lower one can be considered the same as any erupted molar, but impacted ones angled forwards 30–90° may require intervention sooner rather than later. Being open to the mouth can let bacteria in, and poor oral hygiene is a pericoronitis risk factor.
What happens if you keep an impacted wisdom tooth?
A 2020 Cochrane review advises regular clinical assessment if a symptom-free, disease-free impacted wisdom tooth is kept. It found very low-certainty evidence that keeping one may be linked to a higher long-term risk of gum disease at the second molar. RCS England says unerupted lower wisdom teeth still need clinical review, though significant disease is unlikely.
Do wisdom teeth cause crowding?
No clear cause-and-effect link has been shown. RCS England says crowding has many causes and, while most studies suggest lower wisdom teeth play some role, it may not be clinically significant. A 2020 Cochrane review, from one high-risk-of-bias trial in adolescents after orthodontics, found no evidence removal has a clinically significant effect on arch dimensions.
Other general dentistry topics are among the options in this section. Read about routine dental care at our practice.
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