An impacted wisdom tooth is one that does not have enough room to come through into the mouth in a useful position. It might be jammed against the tooth in front, lying on its side inside the bone, or stuck part-way through the gum. At Dentist Pymble, we assess and surgically remove impacted wisdom teeth for patients across the Ku-ring-gai region, and the questions we get are always the same: how do I know mine is impacted, does it have to come out, and what does the surgery actually involve. This page answers all of those.
What is an impacted wisdom tooth?
A wisdom tooth is called “impacted” when it cannot erupt into a functional position in the mouth. The lower wisdom teeth are far more often impacted than the upper ones, mostly because the lower jaw has less space behind the second molar. There are four common patterns:
- Mesioangular — angled forward into the tooth in front (the most common type)
- Distoangular — angled backward into the jaw
- Horizontal — lying on its side
- Vertical — pointing up but stuck against bone or gum
The angle and depth of the impaction drive the complexity of the surgery and the recovery. A mesioangular impaction pressing on the second molar is usually more urgent than a fully bony vertical impaction that has been quiet for years.
What problems can impacted wisdom teeth cause?
The main risks are decay on the wisdom tooth or on the side of the tooth in front, infection of the gum over a partially erupted tooth (pericoronitis), cyst formation around the crown, and — less commonly — damage to the second molar from pressure or root resorption. Sometimes the only clue is a deep, dull ache at the back of the jaw that flares up under stress or during a cold.
Symptoms worth taking seriously: a bad taste at the back of the mouth that won’t go away, swelling of the gum behind the last tooth, pain when biting at the back, difficulty opening the mouth, and swollen lymph nodes under the jaw. Any of these deserve a prompt look, ideally with an x-ray.
How are impacted wisdom teeth diagnosed?
The first step is a clinical exam. We look at how much of the tooth (if any) has erupted, whether the gum around it is inflamed, and whether the second molar in front is showing any signs of damage. We then take a digital x-ray — usually an OPG (a full-mouth panoramic x-ray) — to see the angle, depth, and proximity of the tooth to the nerve that runs through the lower jaw. For more complex cases, particularly when the roots appear to be touching or wrapping around the nerve, we organise a 3D CBCT scan to get a precise three-dimensional picture before any surgery.
Do all impacted wisdom teeth need extraction?
No — and the answer depends on the case, not on a blanket rule. The teeth we usually recommend removing are those causing symptoms, those decayed beyond repair, those resorbing the tooth in front, and those associated with a cyst. The teeth we often leave alone are fully bony, symptom-free, monitored with periodic x-rays, and in a patient with a low surgical risk.
For a young patient with a clearly mesioangular impaction pressing on the second molar, the calculus is usually straightforward: take it out before it causes more trouble. For a 55-year-old with a deep, asymptomatic, fully bony impaction that has been stable on imaging for a decade, leaving it in place with periodic review is often the more sensible call. The right answer is a shared decision after looking at the imaging together.
What does surgical wisdom tooth removal involve?
Surgical removal is done under local anaesthetic, with oral or IV sedation available for nervous patients, and under general anaesthetic in a day-stay hospital setting for complex cases referred to a specialist oral surgeon. Once the area is numb, a small incision is made in the gum, a thin layer of bone over the tooth is removed, and the tooth is either lifted out whole or sectioned into smaller pieces that come out through a smaller opening. Stitches are usually placed, and the whole procedure takes 30-60 minutes depending on complexity.
We will always discuss the proximity of the roots to the nerve in the lower jaw before surgery. The risk of temporary nerve irritation (a numb lip or chin that recovers over weeks to months) is real but uncommon; the risk of permanent nerve injury is rare. Knowing where the nerve sits in three dimensions before surgery is the main way we keep that risk low.
What is recovery like after impacted wisdom tooth surgery?
The first 24-48 hours are the most uncomfortable. Expect facial swelling that peaks around day 2-3, some oozing from the socket, and a dull ache that responds to over-the-counter pain relief (ibuprofen plus paracetamol is the usual combination, assuming no medical reason to avoid them). Keep your head elevated, use cold packs on the cheek for 15 minutes on, 15 minutes off for the first day, and stick to a soft food diet.
From day 2, gentle saltwater rinses after meals help keep the socket clean. Avoid smoking, vaping, alcohol, and straws for at least 72 hours — all of them increase the risk of dry socket, which is the most common post-surgical complication. Most people are back at work or study within 5-7 days, with full gum healing over 2-4 weeks. We see you for a review at 1-2 weeks to check healing and remove any non-dissolving stitches.
If you are in Pymble, Gordon, Turramurra, Wahroonga or anywhere else in the Ku-ring-gai area and you have been told you have an impacted wisdom tooth, call our practice. We see neighbouring Gordon patients and other nearby residents, and we will be honest with you about whether removal is the right call or whether monitoring is.
Frequently asked questions
How do I know if my wisdom tooth is impacted? Often you cannot tell from the outside. Some impacted teeth cause no symptoms at all and are picked up only on an x-ray taken for another reason. Others cause repeated infections, pain on biting, swelling, or a bad taste at the back of the mouth. The only way to confirm is with an x-ray.
Is impacted wisdom tooth removal more painful than a normal extraction? The surgery itself is no more uncomfortable — you are numb the whole time. The recovery tends to involve more swelling and a few more days of soreness, particularly for deeper impactions, but this is well managed with over-the-counter pain relief and is rarely severe.
What is dry socket? Dry socket (alveolar osteitis) is inflammation of the bone inside the socket when the blood clot is lost too early. It typically starts 2-4 days after surgery and causes a severe throbbing pain that is not relieved by ordinary pain relief. It is more common after lower wisdom tooth surgery and is treated by the dentist with a medicated dressing.
Can I go to work the day after wisdom tooth surgery? Most people take 2-3 days off for a straightforward surgical extraction, and 5-7 days for a more complex one. If your work is physical, plan for a few extra days. If it is desk-based, you can usually manage with over-the-counter pain relief and a flexible start time.
How much does impacted wisdom tooth removal cost in Pymble? The cost depends on the complexity, the type of anaesthesia, and whether the case is referred to a specialist. We provide a written quote after the assessment and OPG, and our team can run a health-fund check on the day.