Oral and Maxillofacial Surgery

Wisdom teeth

A wisdom tooth is impacted when bone or a neighbouring tooth blocks it from erupting fully. Removal usually takes about 45 minutes, and most patients return to desk work in two to three days. For impacted lower third molars the surgery is often billed to medical insurance rather than dental, so we check both plans before you book and tell you the number on the call.

Your medical plan may be the one that pays

For this procedure we run a medical eligibility check alongside the dental one and tell you which is expected to be primary before you book. A dental-only check finds the smaller of your two benefits and stops there.

Check my coverage (305) 432-6719

Why impaction matters

An erupted wisdom tooth that is clean, functional and reachable with a toothbrush is not automatically a problem. An impacted one is different, because the tissue over a partially erupted tooth forms a pocket that cannot be cleaned. That pocket is where pericoronitis starts — the swelling and soreness at the back of the jaw that most people describe as their wisdom tooth "acting up".

Impaction also puts the third molar against the root of the second molar. Decay on the back surface of a second molar is difficult to restore and is a common reason a tooth that was never the problem ends up needing treatment.

Position matters as much as presence. A lower third molar sitting close to the inferior alveolar nerve is a different operation from an upper one, which is one reason the two are quoted and consented separately.

What the surgery involves

You arrive having eaten nothing for the period given in your pre-operative instructions. What is used to keep you comfortable is agreed at your consultation and depends on how many teeth are involved, how deeply they sit, and your medical history.

Local anaesthetic is placed at each site. For an impacted tooth a small incision releases the gum, a conservative amount of bone is removed, and the tooth is usually sectioned so it can be lifted out in pieces rather than forced whole. Sectioning reduces the force applied to the surrounding bone.

Sites are irrigated and closed with sutures that dissolve on their own over one to two weeks. Four impacted third molars typically take 45 to 60 minutes. You rest in the chair until you are steady, then a driver takes you home.

Dr. Cudjoe performs every wisdom tooth procedure at this practice, from the sedation through to the last suture. The surgeon who assesses you at the consultation is the surgeon who operates, and no part of the procedure is delegated.

Recovery, day by day

Day one: bleeding settles within a few hours with firm gauze pressure. Ice, twenty minutes on and twenty off, does more for the following day than anything else you will do. Eat cold and soft. Do not use a straw and do not smoke.

Days two and three: swelling peaks. This is the point people are surprised by, because it is worse than day one. Bruising may appear along the jaw. Most patients return to desk work on day three.

Days four to seven: swelling settles and the diet widens. Pain that had been improving and then sharply worsens around day three to five is the signature of a dry socket — call us rather than waiting it out.

Week two onward: sutures dissolve and the sockets close over. Full bone fill takes several months, though you will not usually notice it after the first couple of weeks. Return to exercise after about a week.

Risks, stated plainly

Every one of these is discussed before you consent.

Dry socket, where the clot is lost from the site, typically three to five days afterwards. It is treatable in a short visit.
Temporary numbness of the lip, chin or tongue after removal of a lower third molar close to the nerve. This resolves in most cases; a persistent change is uncommon but possible and is discussed before you consent.
Infection at the site, which usually responds to antibiotics and irrigation.
Bleeding that needs re-packing, more likely for patients on anticoagulants — tell us what you take before the day.
Sinus communication when an upper third molar sits against the sinus floor, which is managed at the time and usually closes without further surgery.

Alternatives

Surgery is not always the answer, and we will say so.

Monitoring. An asymptomatic, fully erupted, cleanable tooth can be reviewed with radiographs rather than removed. Sometimes the right decision is to leave it alone, and we will say so.
Operculectomy, removing only the tissue flap over a partly erupted tooth, where the tooth itself is well positioned.
Coronectomy, removing the crown and leaving the roots, considered when the roots are intimate with the nerve and the risk of full removal outweighs the benefit.

Questions people ask us

Do all four have to come out?

No. The decision depends on impaction, the position of the nerve, decay, gum inflammation and whether the tooth is doing any work. Some are reasonable to leave and monitor, and we will tell you when that is the case.

Will my medical insurance cover this instead of my dental plan?

Often, yes, for impacted third molars. Coverage depends on your specific plan, which is why we run both a medical and a dental eligibility check before you book rather than guessing.

How long does recovery actually take?

Swelling peaks around day two or three and settles by the end of the first week. Most people return to desk work on day three and to exercise after about a week.

What is dry socket, and how would I know?

It is the loss of the blood clot from the extraction site, usually three to five days afterwards. The signature is pain that was improving and then gets sharply worse, often with a bad taste. Call us — it is straightforward to treat and you should not wait it out.

Can I drive myself home?

Not if you have been sedated. You need an adult who can take you home and stay with you for the first few hours, and we cannot start without one. Where the procedure is done under local anaesthetic alone, driving yourself is usually fine.

What happens if I wait?

Some impacted teeth stay quiet for years. Others produce repeated pericoronitis, decay on the second molar, or a cyst around the crown. Surgery also tends to be more straightforward at a younger age, when the roots are less developed and the bone is less dense.

Written and reviewed by Peter K. Cudjoe, D.M.D., Oral and Maxillofacial Surgery. Last reviewed July 30, 2026.