Wisdom Teeth: Should They Come Out?

What removal of impacted tooth involves

An impacted tooth has failed to erupt into its normal position, usually because there is no room for it or it is angled wrongly. Lower third molars — wisdom teeth — are by far the most common, followed by upper canines. The codes are graded by how much tissue covers the tooth, which determines how much surgery is needed. Soft tissue impaction means the tooth is covered by gum only. Partially bony means part of the crown is covered by bone. Completely bony means the tooth is entirely encased in bone, and the version with unusual surgical complications describes cases involving difficult anatomy or unexpected findings. Each step up means more bone removal, more chair time and a higher fee.

When this treatment is used

Indicated for impacted teeth causing recurrent infection, decay in the tooth or its neighbour, resorption of the adjacent root, cysts, or pain. Removal of asymptomatic wisdom teeth purely as a preventive measure has become considerably more debated.

Should asymptomatic wisdom teeth come out?

The routine extraction of all four wisdom teeth in every late teenager is no longer the consensus it once was. Guidance in several countries now recommends against removing impacted third molars that are causing no symptoms and showing no disease, on the grounds that surgery carries real risks and many such teeth never cause trouble. The counter-argument is that surgery is easier and healing better at nineteen than at forty, that a partially erupted lower wisdom tooth is very likely to cause recurrent infection eventually, and that decay on the back of the adjacent second molar — a common consequence — is difficult to treat and sometimes costs that tooth. The reasonable position is case by case: partially erupted teeth with a history of infection, teeth causing decay in their neighbour, and teeth with cysts should come out. Fully buried teeth with healthy surrounding bone and no symptoms can often be monitored with periodic imaging.

The risks worth understanding before consenting

Nerve injury is the one that matters. The inferior alveolar nerve runs through the lower jaw close to the roots of lower wisdom teeth, and the lingual nerve runs near the tongue side. Temporary altered sensation of the lip, chin or tongue occurs in a small percentage of lower wisdom tooth removals, and permanent alteration in a much smaller fraction — but permanent numbness of the lip is a genuinely life-affecting outcome. A cone beam scan showing the relationship between the roots and the nerve canal changes the risk assessment and sometimes the plan — for instance to coronectomy. Other recognised risks: dry socket, infection, sinus communication for upper teeth, and jaw stiffness. None of this argues against surgery when it is needed; it argues for the surgery being needed.

Costs and insurance in summary

Typical fee range across the group: $0–$0 where a single band applies. Several codes here are priced individually and carry their own range on their own page. Fees rise with the depth of impaction. Four wisdom teeth under sedation in one appointment is a substantial total, and sedation is a separate charge.

Benefit category: Major oral surgery, typically 50–80% on a typical plan. Generally covered where there is documented pathology or symptoms. Prophylactic removal of asymptomatic teeth is increasingly questioned by payers.

Common restrictions: Radiographs showing the impaction are required; The depth of impaction claimed must match the imaging; Prophylactic removal of asymptomatic teeth may be denied; Medical insurance sometimes covers general anaesthesia for multiple extractions.