Wisdom Tooth Extraction Procedure: Exam, X-rays, Anesthesia, Removal and Stitches in Order

In Korea, wisdom tooth extraction starts with an exam and X-rays to check the tooth's position, root shape and distance from the nerve canal. A wisdom tooth that has erupted straight is pulled like an ordinary molar, but an impacted tooth buried in gum or bone is mostly removed in this order: gum incision, removal of some jawbone, sectioning of the tooth, removal of the tooth and stitches. After extraction you bite on gauze for about 30 minutes to stop the bleeding, receive prescription medicine and aftercare instructions, and go home.

Published 2026-11-08 · Updated 2026-11-08 · DentalStatics editorial team

Key facts

Basic examination	Visual, history and palpation checks assess the gums around the wisdom tooth and any systemic disease (source: KDCA National Health Information Portal)
X-ray examination	Panoramic and periapical X-rays confirm the position of the teeth, jawbone and mandibular canal (source: KDCA National Health Information Portal)
Dental CT	Added when the tooth is close to the mandibular canal or the roots are sharply curved (source: KDCA National Health Information Portal)
Order of impacted wisdom tooth extraction	Gum incision, bone removal, crown sectioning, tooth removal, stitches (source: KDCA National Health Information Portal)
Anesthesia	Local anesthesia for every patient; oral, inhaled or intravenous sedation or general anesthesia if needed (source: KDCA National Health Information Portal)

What is checked before extraction?

The dentist first assesses the wisdom tooth, the surrounding gums and any systemic disease through a visual, questioning and touch exam. High blood pressure, diabetes, heart disease, liver problems, steroid use and pregnancy all affect the decision to extract, so tell the dentist about every one of them.

Next, panoramic and periapical X-rays are used to view the teeth and entire jawbone. The panoramic image lets the dentist assess the approximate position of the mandibular canal, through which the lower jaw nerve passes, and the condition of the gum bone. If the tooth is very close to the canal or the roots are sharply curved, a dental CT is added.

How is a wisdom tooth that has erupted straight pulled?

A wisdom tooth that has come into the mouth properly is loosened with instruments and pulled like an ordinary molar after local anesthesia. In some cases the gum must be cut slightly or a little bone removed.

A wisdom tooth only partly covered by gum is hard to clean and easily develops gum inflammation or pus pockets, so many are pulled for this reason. For an upper wisdom tooth, the dentist also checks whether the root tip is close to the maxillary sinus before proceeding.

According to the KDCA extraction guidance, local anesthesia is given to all patients, and if anxiety is high, sedation can be added with an oral drug or inhaled nitrous oxide. Intravenous sedation is sometimes used when anxiety is severe or several teeth are pulled at once, and general anesthesia when the procedure is long or difficult.

In what steps is an impacted wisdom tooth pulled?

The KDCA explains that lower impacted wisdom teeth are mostly extracted in the following order. The mesioangular (tilted forward) and horizontal (lying sideways) types are the most common and mostly require a gum incision, bone removal and crown sectioning.

After local anesthesia, cut and fold back the gum covering the wisdom tooth
Remove part of the jawbone surrounding the tooth
Divide the tooth crown into several pieces
Remove the pieces and roots one by one and irrigate the area
Stitch the gum and stop the bleeding with gauze

When does extraction take longer?

A horizontally impacted tooth must have its crown sectioned, and the narrower the distance to the front edge of the jawbone, the more bone must be removed and the longer it can take. If the roots curve toward the cheek or tongue, they break easily and must be taken out piece by piece.

The KDCA explains that a small root fragment that is not inflamed and is very close to the inferior alveolar nerve is sometimes left in place. Difficulty also rises when the root is fused to the bone (ankylosis) or the root tip is bulbously enlarged, because more bone must be removed.

What happens after extraction is finished?

Gauze is placed over the extraction site, and you bite down firmly without moving it. By the KDCA wisdom tooth guidance this is about 30 minutes, and it is better to swallow the blood and saliva that collect in the mouth rather than spit. Even if there seems to be a lot of blood, most of it is mixed with saliva.

You usually receive 3 to 5 days of medicine, the date for stitch removal and aftercare instructions. The KDCA explains that pain is worst when the anesthesia wears off, so it is better to take the prescribed painkiller before discomfort begins. Recovery goes more smoothly if, before leaving, you confirm once more how to apply cold packs, when to start brushing and which symptoms mean you must return.

Common myths and facts

Myth: All wisdom teeth are pulled in the same way.

A wisdom tooth that has erupted straight is pulled like a regular extraction, but an impacted tooth needs a gum incision, bone removal and sectioning, so the procedure and time differ greatly.

Myth: A wisdom tooth can be extracted without an X-ray.

The root shape and the position of the mandibular canal must be checked to reduce complications such as nerve damage, so the KDCA describes panoramic and periapical X-ray exams as the basics.

Frequently asked questions

How long does wisdom tooth extraction take?

A tooth that has erupted straight takes relatively little time, but an impacted tooth takes longer because it needs bone removal and sectioning. The dentist, having seen the X-ray, will explain the expected time.

Does it hurt during wisdom tooth extraction?

Because local anesthesia is used, you mostly feel pressure during extraction rather than sharp pain. The KDCA explains that pain is worst about 3 to 5 hours after extraction, once the anesthesia wears off.

Is a CT scan always needed?

It is not needed in every case. It is added when a lower wisdom tooth is very close to the mandibular canal or the roots are abnormally curved, and you can discuss whether you need it with your dentist.

Is there anything to watch for the day before or the day of extraction?

Tell the dentist in advance about the medicines you take, especially blood thinners, and about any chronic conditions. Guidance says to avoid strenuous exercise or work for 1 to 2 days after extraction, so it helps to leave some room in your schedule.

When are the stitches removed?

The KDCA extraction guidance explains that stitches from an in-mouth extraction or a relatively minor operation are removed after about one week. The exact date is set by the dentist after looking at the wound, so even if the stitches bother you, do not touch them with your tongue or fingers and visit on the follow-up date.

References

Korean version →