Daniel is 24, his first wisdom tooth came through. «Pain isn't bad, but it's been two weeks.» Exam: tooth only half erupted, gums around it red and swollen (pericoronitis). On the OPG, three more impacted wisdom teeth. Typical situation for 18-25 year olds.

Wisdom teeth (third molars, the 8th tooth in each quadrant) are the last to erupt at ages 17-25. 85% of people have them, but evolutionary jaw shrinkage often leaves no room. Result: impaction (tooth stuck in bone), inflammation, pressure on other teeth. In 70% of cases extraction is needed.

When to extract (indications)

Not all wisdom teeth need to come out. Here are 6 clear indications.

1

Pericoronitis (gum inflammation around the tooth)

Most common reason. Half-erupted tooth, bacteria collect under the gum «hood», pus pocket forms. Symptoms: pain, swelling, bad taste, limited mouth opening. 80% recurrence within 2-3 years without extraction.

2

Caries on the wisdom tooth or the adjacent 7th

Hard to clean, plaque builds up. After 2-5 years, caries. Sometimes caries on the distal surface of the 7th (from contact with the wisdom tooth). Caries treatment on the 8th is ineffective with 80% recurrence. better to extract.

3

Cyst or tumor

An impacted wisdom tooth forms a follicular cyst or odontogenic tumor in 5% of cases. Visible on OPG. Extraction with histology mandatory.

4

Pressure on adjacent teeth (crowding)

The wisdom tooth pushes the 7th and causes front tooth crowding. Especially relevant if you plan orthodontics or already wear braces.

5

Chronic face and head pain

An impacted tooth may pressure the inferior alveolar nerve and cause unexplained pain. If other causes are ruled out, extraction often helps.

6

Prophylactic extraction

In young patients (18-22) before orthodontics or with high complication risk. Controversial, decided case by case. Modern approach: extract only with an existing problem, not purely prophylactically.

When NOT to extract (4 situations)

Not all wisdom teeth are harmful. 4 situations where extraction isn't needed.

✅ Fully erupted and functional: cleanable, painless, caries-free. Can be kept.

✅ Deeply impacted in bone, asymptomatic: no cyst, no pressure, no nerve risk. monitor every 2-3 years with OPG. In 30-40% they stay problem-free for life.

✅ Patient over 45 without symptoms: extraction complication risk rises significantly with age. If no problems until 45, risk of new issues is low.

✅ Roots close to the inferior alveolar nerve: risk of nerve injury and months-to-years lip numbness. Without acute indication, leave or do coronectomy.

Extraction cost in Hamburg 2026

Depends on difficulty, anesthesia type, number of teeth.

🦷 Erupted tooth (simple extraction): 80-150 € private, GKV covers fully.

🦷 Soft tissue impaction: 200-350 € private, GKV with small co-pay.

🦷 Bone impaction (osteotomy): 350-700 € private, GKV covers surgical part, no anesthesiologist.

🦷 Complex case (horizontal tooth, nerve-close): 500-1500 € private, partial GKV.

💉 General anesthesia (Vollnarkose): +400-800 €, not GKV-covered (exception: 4 teeth at once, then possible coverage).

💉 Sedation (nitrous oxide, Dormicum): +150-350 €, not GKV-covered.

📸 3D scan (CBCT/DVT) before surgery: 200-400 € (for complex cases near the nerve), private.

💰 All 4 teeth at once under general: 1500-3000 € private. Most patients pick this option.

How extraction works (step-by-step)

1

Before the visit

Eat 2-4 hours before (local anesthesia only. with general, fast 6-8 hours). No alcohol 24 hours. No smoking 12 hours (raises dry socket risk). Take scheduled meds. Bring list of meds and allergies. Bring a companion. you can't drive after general anesthesia.

2

Preparation and anesthesia (10-15 min)

Dentist checks mouth and X-rays. Local anesthesia (Articain 4%, safe). With general anesthesia, anesthesiologist places IV, you fall asleep in 2-3 min, wake up when everything is done.

3

Extraction (15-60 min per tooth)

Simple tooth: elevator and forceps, 5-15 min. Impacted: gum incision, osteotomy (bone removal), sometimes tooth sectioning to ease removal. Sutures (3-5 stitches). Wound flushed with antiseptic.

4

First 24 hours

Bite gauze for 30-60 min (compresses vessels). Take ibuprofen 400 mg 15 min before anesthesia wears off (prevents pain shock). Don't spit, blow nose, smoke, drink through straw, or rinse the first 24 hours. you can dislodge the blood clot. Cold compress 15 min on, 15 min off, 4-6 cycles.

5

Days 2-7: recovery

Soft food: soup, mashed potatoes, yogurt, fish. Warm, not hot. Gently rinse with salt water (1 tsp salt per glass) after each meal. Suture removal 7-10 days. Pain 3-5 days, swelling up to 7 days.

5 complications and risks

1

Dry socket (alveolar osteitis)

5-10% of cases. Blood clot dissolves, bone exposed. Severe pain 7-10 days. Treatment: irrigation, iodoform dental paste, antibiotic. Prevention: NO smoking first 72 hours, NO straw drinking.

2

Inferior alveolar nerve injury

0.5-5% of cases depending on anatomy. Symptom: numbness in lower lip, chin, tongue on one side. 90% temporary (3-6 months), 1-2% permanent. Prevention: CBCT before extraction if nerve-close, experienced surgeon.

3

Bleeding

Mild bleeding for 24 hours is normal. Strong pulsating bleeding: go to the clinic. Highest risk: aspirin, warfarin, clotting issues. Tell the dentist about all medications before surgery.

4

Wound infection

3-5% of cases. Symptoms 3-5 days after: worsening pain, pus, fever. Treatment: antibiotic (amoxicillin or clindamycin), sometimes wound debridement.

5

Sinus perforation (upper teeth only)

1-2% of upper wisdom teeth. Roots are near the sinus. Surgeon closes the opening immediately. Antibiotic, decongestant drops, no nose-blowing for 2 weeks.