Wisdom Teeth – When to Remove Them, When to Leave Them

Published 27 July 2026 · 5 minute read · Zahnärzte auf der Holtenauer

"Wisdom teeth have to come out anyway" is a common assumption – and it isn't true as a blanket rule. Whether a wisdom tooth can stay or should be removed is always a case-by-case decision.

Why wisdom teeth cause problems so often

The third molars usually erupt between ages 17 and 25 – at a point when the jaw has already stopped growing in most people and simply doesn't have room for four more teeth. The result: wisdom teeth are often partially or fully stuck in the jaw (impacted) or grow at an angle instead of straight up (displaced).

A partially erupted wisdom tooth has an open connection to the mouth that's almost impossible to keep clean. Food debris and bacteria can collect there, leading to painful inflammation of the surrounding gum – known as pericoronitis.

When removal makes sense

According to the dental clinical guideline, removal is indicated if one or more of these apply:

• Recurring or past inflammation around the erupting tooth (pericoronitis).
• Decay on the wisdom tooth itself or – more often – on the neighbouring tooth, because the surface between them can no longer be cleaned.
• An unfavourable position that's likely to damage the neighbouring tooth or bone.
• Cysts or other changes visible on the X-ray around the unerupted tooth.
• Orthodontic reasons, for instance if the wisdom tooth is putting pressure on the rest of the row of teeth.

If none of these signs are present and the tooth sits deep and unremarkably in the bone, monitoring is often the better choice: the risk of surgery – such as a temporary sensory disturbance from proximity to the lower jaw nerve – can outweigh the benefit of removal for deeply positioned, symptom-free teeth. We work through this trade-off individually with you based on the examination and X-ray.

How the procedure works

1. Planning. Using an X-ray, and three-dimensional imaging for more complex positions, we assess the tooth's position and its proximity to the nerve and maxillary sinus.
2. Local anaesthetic. The procedure itself can be carried out well under local anaesthetic for most patients. For pronounced anxiety or several teeth at once, treatment under sedation is also possible.
3. Removal. Depending on position, a simple lift-out is enough, or – for a tooth fully covered by bone – it's removed in small segments to protect the surrounding tissue.
4. Aftercare. Cooling in the first 24 hours, soft food for a few days, and the prescribed oral hygiene guidance around the wound noticeably speed up healing.

Mild swelling and a pulling sensation in the first few days after the procedure are normal. Please let us know right away if you experience persistent severe pain, fever, or swelling that increases instead of subsiding.