If you have teenagers, you know how these conversations usually go.
You take your kid to the dentist. They do the X-rays. The dentist says, “Her wisdom teeth are going to need to come out,” and hands you the name of an oral surgeon.
And because you are the parent, your brain immediately produces 47 follow-up questions.
Does she really need them out now? What happens if we wait? Is she going to be awake for this? How bad is the recovery? How swollen are we talking? And, because I am a mother, exactly how worried am I supposed to be?
So we asked Dr. Tyler Jacobs of Somerset Oral Surgery to walk us through the whole thing. Not just what happens during wisdom teeth removal, but what an oral surgeon is actually looking at when deciding whether they need to come out in the first place.
Turns out, it is a lot more than four teeth on an X-ray.
When do wisdom teeth actually need to come out?
The first thing Dr. Jacobs wants to know is why you are there. Is your child having pain? Swelling? Is food getting stuck in the back where they cannot clean it?
That last one sounds like the least dramatic problem of the bunch, but it can matter quite a bit. If a lower wisdom tooth comes only partway through the gum, food can get trapped underneath that gum tissue. You cannot really clean it out. The area becomes irritated, swollen and painful. It is called pericoronitis, and it is a common reason a wisdom tooth needs to be removed.
He also wants to know about symptoms that have already disappeared.
That surprised me. As a parent, if my kid says, “It hurt a month ago, but it’s fine now,” my instinct is usually, great. Problem solved. Apparently wisdom teeth do not always work that way.
The gum around a wisdom tooth can hurt and swell for a week or two, completely settle down, then flare up again months later. So your kid can walk into the oral surgeon feeling perfectly fine and still have a legitimate issue.
As Dr. Jacobs put it, it is not only about whether there are symptoms today. It is whether there have been symptoms before.
What does the oral surgeon look for during the exam?
Then comes the actual exam.
He looks at whether the wisdom teeth came in straight, partly came in or never came in at all. He checks for cavities. He looks at how the teeth are positioned and whether they realistically have room to erupt properly.
Then he does something I never would have known to ask about.
Even if a wisdom tooth is completely buried under the gum, he checks behind the second molar, the tooth directly in front of it, for bone loss.
A lower wisdom tooth can push against that molar and cause the bone behind it to wear away. And here is the part parents need to hear: it may not hurt. Your kid may have absolutely no idea it is happening.
That matters because the bone is what supports the tooth. Dr. Jacobs has treated patients who left their wisdom teeth in for years, continued losing bone behind that second molar and eventually lost not only the wisdom tooth, but the molar in front of it too.
He is not looking only at the teeth, either.
He checks the jaw joints and the muscles involved in opening and closing the mouth because sometimes the pain a patient is convinced is coming from a wisdom tooth is actually coming from somewhere else. Facial pain does not always point neatly to its source.
That is a pretty important distinction. If the pain is coming from the jaw joint or muscles, removing the wisdom teeth would not be expected to fix it.
When is a 3D scan useful?
Then there is the X-ray.
Dr. Jacobs generally starts with a panoramic X-ray, which gives him one flat image of all the teeth. He looks for infection, cysts, bone loss and the position of the wisdom teeth.
He is also paying very close attention to a nerve that runs through the lower jaw.
This nerve provides sensation to the lower lip and chin. It controls feeling, not movement. If it becomes irritated during wisdom tooth removal, numbness in the lip or chin is what a patient would notice.
For most people, the nerve is close enough to see but not close enough to change the plan.
The problem is that a standard X-ray is flat. It cannot show whether that nerve passes in front of the wisdom tooth, behind it or directly against it.
If Dr. Jacobs sees certain signs that make him question the relationship between the tooth and the nerve, he takes a 3D scan in the office. That lets him see the relationship between the tooth and the nerve far more precisely.
Most of the time, he said, the scan confirms that the nerve is safely in front of or behind the tooth and nothing changes.
What if the wisdom tooth is close to the nerve?
In a small number of cases, though, the roots of the wisdom tooth sit directly against the nerve. When that happens, he may consider a procedure called a coronectomy. Instead of removing the entire tooth, he removes the top and intentionally leaves the roots in place because those roots are the part touching the nerve.
That is not automatically necessary every time a tooth sits close to the nerve. He looks at the exact anatomy and whether he believes he can remove the tooth while keeping the risk low.
What age is best for wisdom teeth removal?
Then we asked the question basically every parent asks.
What age should kids get their wisdom teeth out?
The easy answer is that wisdom teeth typically come in between ages 17 and 21, and Dr. Jacobs generally considers roughly 16 to 20 an ideal window for removal.
The more useful answer is that age is not actually the deciding factor.
He cares more about what the teeth look like on the X-ray and how developed the roots are. He has seen 13- and 14-year-olds whose wisdom teeth were already nearly fully developed and clearly were never going to fit.
When the roots are about halfway to three-quarters developed, he said, that is often the point where you can make a meaningful decision. Remove them, or continue watching to see whether they come in correctly.
What happens if we wait?
Which brings us to the other question parents ask.
What happens if we just wait?
Dr. Jacobs did not give us some terrifying worst-case speech. He simply walked through what he actually sees.
Sometimes the gum around a partly erupted tooth continues getting irritated because food gets trapped underneath it. Sometimes cavities develop in the wisdom tooth. A cavity can eventually reach the nerve, causing pain, swelling or an abscess.
Sometimes a cyst develops around a tooth sitting inside the jawbone. That fluid-filled sac can damage the surrounding bone and structures.
And sometimes the bigger issue is not the wisdom tooth at all. It is the bone supporting the perfectly good tooth sitting in front of it.
That is the part he thinks about over decades.
A teenager can have some bone loss today and feel completely fine. The question is what that area looks like 10, 20, 30 or 40 years from now.
What are the anesthesia options?
Then we got to the part teenagers are usually much more interested in.
Am I going to be awake?
Turns out, that is largely a personal decision.
Dr. Jacobs told us he does not pressure patients one way or another because people have very different comfort levels and very different levels of dental anxiety.
There are three general options.
You can have local anesthetic only. You are awake and should not feel pain, but you will feel pressure and pulling and hear what is happening.
You can have local anesthetic with laughing gas. You are still awake, but the gas helps you relax. You still feel the pressure.
Or you can be asleep using IV sedation. Medication is given through an IV in the hand or arm. You sleep through the procedure while continuing to breathe on your own, then wake up and go home.
He was clear that the level of sedation, and the monitoring that goes with it, is decided for each patient, not off a menu.
Considering that wisdom tooth removal can involve cutting gum tissue, sectioning teeth and removing some bone, I completely understand why many people choose not to experience the play-by-play.
If a patient wants to be asleep, Dr. Jacobs first decides whether IV sedation can be done safely in the office.
If it cannot, Somerset Oral Surgery is also associated with a surgery center and Robert Wood Johnson University Hospital Somerset, where a board-certified anesthesiologist can provide general anesthesia with a breathing tube and hospital-level monitoring.
What is recovery usually like?
Then there is recovery, which is probably the part parents hear the most stories about.
According to Dr. Jacobs, two major things influence recovery: how old the patient is and how difficult the teeth were to remove.
He sees a difference after about age 25. Healing tends to take longer as patients get older, which is one reason someone in their 30s may have a different recovery than an 18-year-old.
The complexity of the surgery matters too. Very hard bone, deeply buried teeth or a procedure that required removing more bone can all make recovery tougher.
For most people, the first three days are the roughest.
Some pain and discomfort are expected. Swelling varies from person to person, but day three is typically when it peaks.
This is information I would absolutely want before seeing my kid on day three and deciding something has gone horribly wrong.
By day four, things should start heading in the other direction from that day-three peak. Swelling should begin decreasing and discomfort should begin improving.
Once that early peak has passed, swelling or pain that keeps getting worse instead of better is the thing he wants a call about, because it can be a sign of infection.
Food is simple. For the first couple of days, think liquids and very soft foods. His rule is nothing harder than scrambled eggs. After that, patients can gradually return to normal eating when they feel ready.
And if the lower wisdom teeth were removed, do not be surprised if your teenager cannot open their mouth very wide for about a week. That stiffness usually comes from swelling irritating the jaw muscles and should pass.
The biggest thing I took away from the conversation was that a wisdom teeth consultation is not really just about wisdom teeth.
An oral surgeon is looking at the tooth in front of them. The bone around them. The nerve underneath them. The jaw joint beside them. The symptoms your child has now and the symptoms they had six months ago.
They are also thinking about what that mouth may look like decades from now.
Which, as a parent, is really what I wanted to understand in the first place.
I did not need someone to tell me every teenager should get their wisdom teeth removed at exactly the same age.
I wanted to know what they were looking at when they told me mine should.
And now I do.
Common Questions
Does every teenager need wisdom teeth removed?
No. Age is not actually the deciding factor. Dr. Jacobs cares more about what the teeth look like on the X-ray and how developed the roots are – some teenagers need them out earlier, others are fine to keep watching.
When is a 3D scan needed?
When a standard, flat X-ray raises a question about how a wisdom tooth’s roots relate to the nerve running through the lower jaw, Dr. Jacobs takes a 3D scan in the office. That lets him see that relationship far more precisely before deciding on a plan.
What is a coronectomy?
It is a procedure Dr. Jacobs may consider when a wisdom tooth’s roots sit directly against the nerve. Instead of removing the entire tooth, he removes the top and intentionally leaves the roots in place, since those roots are the part touching the nerve.
Can wisdom teeth be removed with IV sedation?
Yes. Medication is given through an IV in the hand or arm, and the patient sleeps through the procedure while continuing to breathe on their own, then wakes up and goes home.
When should I call the office after surgery?
Once the early swelling peak has passed, typically around day three, swelling or pain that keeps getting worse instead of better is the thing to call about, because it can be a sign of infection.
What happens if we wait?
Sometimes the gum around a partly erupted tooth keeps getting irritated, a cavity can develop and eventually reach the nerve, or a cyst can form around a tooth in the jawbone. Bone loss behind the neighboring tooth can also continue quietly, with no symptoms, over years.
General information from an interview with Dr. Tyler Jacobs, DDS, MD, of Somerset Oral Surgery, recorded Sept. 15, 2026. It is not a substitute for an individual examination or medical advice.
About This Article
This article is produced by Garden State Circle and is part of our local guide to oral surgeons serving Bridgewater and Somerville.
Garden State Circle is supported by the businesses that partner with us, and Somerset Oral Surgery, Somerville is an authority partner. We interviewed Dr. Tyler Jacobs, DDS, MD, one of the two surgeons at the practice, about the wisdom teeth questions parents here actually ask. The partnership pays for the reporting; it does not decide the answers. Most of the answers below are not published anywhere else. Nothing on this page is medical advice. Every treatment described here carries risks that depend on your own health and history, and the person to discuss them with is a licensed provider who has examined you.
Written by Tiffany Slowinski, Co-Owner, Garden State Circle.
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