Wisdom Tooth Removal in Hyderabad — Simple vs Impacted, Explained by a Surgeon
By Dr. Ram Mohan S, MDS Oral & Maxillofacial Surgeon · Reviewed 17 October 2026
Ten minutes or forty. That is the difference between a wisdom tooth that has come through normally and one stuck in the bone. A fully erupted upper wisdom tooth is a routine extraction. A lower tooth lying on its side against the next molar is surgery: bone removal, sectioning, sutures. At V R Dental, I do the impacted cases myself — Dr. Ram Mohan S, MDS Oral & Maxillofacial Surgeon — in-clinic at both Kukatpally and Bowrampet. Nobody is referred out halfway.
Simple extraction or surgical removal: how we decide
The decision is made on imaging before you sit in the chair. Never during the procedure.
- OPG (panoramic X-ray) shows the angle of the tooth, how much sits below the gum, and the shape of the roots.
- CBCT (3D scan) is added when a lower tooth’s roots run close to the inferior alveolar nerve, or an upper tooth sits against the sinus. It shows me exactly where the nerve is, so the tooth can be sectioned and lifted away from it.
- Clinical examination checks mouth opening, gum infection (pericoronitis), and the state of the molar in front.
A simple extraction: the tooth is fully visible, the roots are straight, and it comes out in one piece. Surgical removal: the tooth is partly or fully under bone or gum, tilted, or has curved roots. A small gum flap is raised, a little bone is removed, the tooth is cut into sections and taken out piece by piece, and the gum is stitched.
Types of impaction and what each involves
- Mesio-angular (tilted forward): the commonest. The crown leans on the second molar; food traps and decay in both teeth follow. Surgical removal with sectioning.
- Horizontal: the tooth lies flat. Always surgical. The crown is separated from the roots and removed in parts.
- Vertical: upright but not fully through. Sometimes simple, sometimes needs bone removal, depending on depth.
- Disto-angular (tilted backward): often the hardest lower impaction, because the tooth has to be lifted away from the ramus of the jaw.
- Soft-tissue impaction: through the bone but trapped under a flap of gum. A minor procedure. Either the flap is removed or the tooth is.
When a wisdom tooth should be removed
- Repeated pericoronitis (a swollen, painful gum flap over a partly erupted tooth)
- Decay in the wisdom tooth, or in the back of the second molar it presses on
- A cyst or widened follicle around an unerupted tooth on X-ray
- Crowding, pressure or pain that imaging links to the tooth
- Before orthodontic treatment or jaw surgery, when the orthodontist or surgeon asks for it
- An upper wisdom tooth biting into the lower gum because its partner is missing
When a wisdom tooth should not be removed
Not every wisdom tooth has to go. A tooth that is fully erupted, cleanable, meeting its partner and causing no symptoms can stay. A deeply buried tooth with no pathology in an older patient is often safer watched than removed, especially when the roots wrap around the nerve. I will tell you which group you are in. Removing a tooth that is not causing a problem is surgery without a reason.
Does it hurt? What “painless” actually means
The procedure is done under local anaesthesia. You feel pressure and movement. You do not feel pain. For anxious patients, or when all four teeth come out in one sitting, conscious sedation can be added so you are relaxed and remember little of it.
What “painless” cannot mean is a pain-free week afterwards. A surgical removal leaves soreness and swelling for a few days. Anyone who promises otherwise is describing the anaesthesia, not the recovery. What you can expect is discomfort that is predictable, controlled with the medication prescribed, and better each day.
Recovery day by day
- Day of surgery: bite on the gauze for 30–45 minutes. Rest. Cold compress on the cheek in 15-minute cycles. Liquids and cold soft food. No spitting, rinsing, straws or smoking.
- Days 1–2: swelling peaks on day two. Soft diet. Medication on schedule. Gentle warm salt-water rinses from the second day.
- Days 3–4: swelling starts to drop. Stiffness opening the mouth is normal after lower surgical removals.
- Days 5–7: most people are close to a normal diet. Sutures come out, or dissolve, at the one-week review.
- Weeks 2–4: the socket fills with gum. Bone fills in over the following months.
Desk work: one to two days after a simple extraction, two to three after a surgical removal.
Dry socket and how we prevent it
A dry socket (alveolar osteitis) happens when the blood clot protecting the bone is lost in the first few days and the bone is left exposed. The giveaway is pain that gets worse, not better, from about day three, often with a bad taste. It is more common after lower surgical removals, in smokers, and in women taking oral contraceptives.
We lower the risk by removing the tooth with as little trauma to bone as possible, irrigating the socket, placing sutures, and giving you written instructions on what not to do for 72 hours. If it happens anyway, it is treated at a review visit with cleaning and a medicated dressing. The pain settles within a day or two.
Other things worth knowing before surgery
- Nerve sensation: a lower wisdom tooth close to the nerve carries a small risk of temporary numbness in the lip or chin. CBCT planning is how we keep that risk low. We discuss it with you before surgery, not after.
- Upper teeth and the sinus: upper wisdom tooth roots can sit against the sinus floor. We see this on imaging and manage it during surgery.
- All four at once: sensible when all four need to go and you want one recovery instead of two. Planned under local anaesthesia, with sedation if needed.
- Antibiotics: prescribed when there is active infection or the surgery calls for it. Not routinely.
Frequently asked questions
Is painless wisdom tooth extraction possible?
The extraction itself is painless under local anaesthesia, and sedation is available for anxious patients or multiple teeth. Some soreness and swelling in the days after a surgical removal is normal and is controlled with prescribed medication.
How many days does it take to recover from wisdom tooth removal?
One to two days for a simple extraction. Three to five for a surgical removal before you feel largely normal, with swelling gone by about a week. The socket takes a few weeks to heal fully.
Should all four wisdom teeth be removed together?
Only if all four need removal. When they do, one sitting means one recovery. We plan it under local anaesthesia, with sedation if you prefer.
Why is a lower impacted wisdom tooth more difficult than an upper one?
Lower teeth sit in denser bone, are more often tilted or horizontal, and lie close to the nerve supplying the lip and chin. They almost always need sectioning and sutures. Upper wisdom teeth sit in softer bone and usually come out more easily.
How do you know if my wisdom tooth is impacted?
An OPG X-ray shows where the tooth sits and whether bone or gum covers it. A CBCT scan is added when the roots lie close to the nerve or sinus, so the surgery can be planned around them.
Can I eat after wisdom tooth removal?
Yes. Cold and soft food on the day of surgery, a soft diet for two to three days, then back to normal food over the week. Avoid hot, spicy and hard food for the first few days.
Consult a surgeon before you decide
A painful, repeatedly infected or impacted wisdom tooth needs one consultation with an OPG. That visit tells you whether it needs removal, whether it is simple or surgical, and what recovery to expect. Available at both V R Dental clinics, Kukatpally and Bowrampet.
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