If you’ve been told every wisdom tooth has to come out, or you’re bracing yourself for surgery you’re not sure you need, this one’s for you. The honest answer in 2026 is that plenty of wisdom teeth are better left alone — and figuring out which ones is the whole job.
The old rule has quietly changed
A generation ago it was routine to take out all four wisdom teeth in your late teens, symptoms or no symptoms, “before they cause trouble.” That logic made sense in a world without good imaging and with limited long-term data. It doesn’t hold up as well now.
The National Institute for Health and Care Excellence in the UK reviewed the evidence and recommended that prophylactic removal of pathology-free impacted third molars should be discontinued. That guidance is old now, but the conclusion has held. More recently, the Cochrane review on removing asymptomatic disease-free wisdom teeth concluded there’s insufficient evidence to say asymptomatic impacted wisdom teeth should be routinely removed, and that retained teeth should be checked at regular intervals instead.
In plain English: taking out teeth that aren’t causing problems, just in case, isn’t supported by the evidence. You and I make the call together based on what your mouth is actually doing.
Teeth we usually leave alone
Here’s what a “leave it” wisdom tooth looks like in our practice:
- Fully erupted — through the gum, sitting in the arch like any other molar
- Upright — not tilted into the tooth in front
- In a functional bite — meeting the tooth opposite, helping you chew
- Cleanable — your toothbrush and floss can actually reach it
- No decay — on the wisdom tooth or the molar next door
- Healthy gum around it — no recurrent swelling or deep pockets
- No cysts or surprises on the X-ray
If your wisdom teeth tick those boxes, there’s no good reason to operate. We’ll note it in your file, take an OPG every few years to confirm nothing’s changing, and get on with life.
Why “just in case” isn’t a free move
Every surgical procedure carries some risk. Wisdom tooth removal is a well-understood operation, but it isn’t nothing.
The common stuff is short-term and expected — swelling, bruising, a sore jaw, a few days of soft food. A proportion of lower extractions develop dry socket, which is painful but manageable. Infection and prolonged bleeding are less common.
The ones we really want to avoid are rare but serious. The inferior alveolar nerve runs through the lower jaw, sometimes very close to the roots of lower wisdom teeth, and disturbing it can cause temporary or (rarely) permanent numbness of the lip and chin. The lingual nerve runs nearby and can affect tongue sensation. For upper teeth, the roots can sit close to the sinus floor.
None of that is a reason to avoid removal when it’s genuinely indicated. It is a reason not to operate on a tooth that wasn’t going to cause you trouble.
If you’re weighing this up and want a proper look rather than a general answer, book a consult with me at Biltoft and we’ll take an X-ray, go through your specific anatomy, and tell you what we’d actually recommend.
Reasons we do recommend removal
Leaving teeth alone isn’t a blanket rule — it’s a default we move off when there’s a real reason. The reasons that consistently justify removal in our practice:
Recurrent pericoronitis
Pericoronitis is inflammation of the gum flap over a partially erupted wisdom tooth. Food and bacteria get trapped under the flap, the gum gets red and sore, sometimes there’s a bad taste or pus. One flare-up often settles with cleaning and good hygiene. Repeated flare-ups usually don’t — and that’s when we plan removal. Healthdirect’s wisdom teeth page lists recurrent gum infection as a standard indication.
Decay in the wisdom tooth or its neighbour
A partially erupted or awkwardly angled wisdom tooth often traps food against the molar in front of it. On X-ray we sometimes see decay on the back of the second molar that’s only there because of the wisdom tooth. Losing a second molar to decay caused by a wisdom tooth you could’ve removed is a bad trade.
Gum disease you can’t control
Deep pockets, bone loss on X-ray, bleeding that won’t settle — if the gum around a wisdom tooth is breaking down and we can’t get it healthy, the tooth becomes a liability for the one next to it.
Cysts or unusual findings
Occasionally an impacted wisdom tooth develops a fluid-filled sac around the crown. You won’t feel it until it’s advanced. When we see one on an OPG, that changes the plan — see our piece on impacted wisdom teeth for how that usually plays out.
The symptom pattern points that way
Pain that keeps coming back. Jaw stiffness that isn’t settling. Pressure on the tooth in front. If the symptoms and the X-ray both line up, we’d usually act. There’s more on this in our guide to the signs that genuinely mean removal.
Specific orthodontic cases
Occasionally an orthodontist asks for removal as part of a treatment plan. That’s a conversation between the ortho, you, and us — not a default.
What a consult with us actually looks like
A wisdom teeth visit at Biltoft is pretty unhurried. We’ll talk through any symptoms, have a look in your mouth, and take an OPG — the panoramic X-ray that shows all four wisdom teeth, their angles, their roots, and where they sit relative to the nerve and sinus. From that we sort you into one of three plans:
- Leave them alone and monitor. Often the right answer, especially for upright, fully erupted teeth that are cleanable.
- Conservative treatment. A clean, a better routine, occasionally antibiotics for an active infection — buying time, sometimes permanently.
- Plan removal. When there’s a real indication, not a hypothetical one.
If removal is on the cards, we do straightforward extractions under local anaesthetic. Our fee is $500 to $650 per tooth. We don’t offer IV sedation or general anaesthetic at Biltoft — if your case is complex (very anxious patient, all four impacted, roots tangled with the nerve) we refer you to a specialist oral surgeon and tell you why. It’s honest rather than ideal, and it means you end up in the right setting.
The fuller picture of how we think about wisdom teeth is in our wisdom teeth guide if you want the overview.
The short version
Old rule: take them all out before they cause trouble.
Current rule: leave the ones that are healthy and working, remove the ones that are causing or clearly going to cause problems, monitor the ones in the middle.
If you’ve been told you need all four out and you’re not convinced, it’s worth a second opinion. Bring your most recent OPG if you’ve got one. Ring us on (02) 6672 1980 or book online and we’ll take a proper look. Individual cases vary — we’ll give you the plan that suits your mouth, not a one-size-fits-all.
— Dr Daniel Johnston, Biltoft Dental, Murwillumbah
Frequently asked questions
If my wisdom teeth aren't hurting, should I still get them out? +
Usually not. If they're fully erupted, sitting upright in your bite, cleanable with a toothbrush and floss, and there's no sign of decay or gum trouble, leaving them alone is a legitimate plan. We'll keep an eye on them at your regular check-ups. We don't remove healthy, symptom-free wisdom teeth just because they're there.
Didn't dentists used to take them all out as a precaution? +
They did, and some still do. But the thinking has shifted. NICE in the UK recommended discontinuing prophylactic removal of pathology-free impacted third molars back in 2000, and the most recent Cochrane review concluded the evidence is insufficient to say asymptomatic wisdom teeth should be removed. Current practice in Australia leans toward watch-and-monitor unless there's a real reason to act.
What are the actual risks of wisdom tooth removal? +
Common issues are swelling, bruising, and a sore jaw for a few days. Dry socket affects a small portion of lower extractions. Less commonly there's infection or prolonged bleeding. The more serious but rare risks are temporary or permanent numbness of the lip, chin or tongue if a nerve runs close to the root, and sinus involvement for upper teeth. We talk through the specific risks for your case before we do anything.
What does count as a real reason to remove a wisdom tooth? +
Recurrent infection around a partially erupted tooth (pericoronitis), decay in the wisdom tooth or the molar next to it that can't be restored, gum disease around it you can't control, cysts on the X-ray, or a tooth that's damaging the one in front. Orthodontic reasons in specific cases. That's a very different conversation to 'get them all out while you're young.'
If we leave them, do I need to do anything special? +
Clean them like any other tooth — brush the back surfaces properly, floss where you can, and come in for your regular check-ups. We'll keep an eye on them, usually with an OPG X-ray every few years to make sure nothing's changing under the gum. If a problem develops later, we act then.
How much does wisdom tooth removal cost at Biltoft if it is needed? +
Our fee is $500 to $650 per tooth under local anaesthetic. We don't offer IV sedation or general anaesthetic in-house — if your case needs that, we'll refer you to a specialist oral surgeon. Individual cases vary and we'll give you the exact number at your consult.