Removal of impacted wisdom teeth is advised for the future prevention of or in the current presence of certain pathologies, such as caries (dental decay), periodontal disease or cysts.

Prophylactic (preventative) extraction of wisdom teeth is preferred to be done at a younger age (middle to late teenage years) to take advantage of incomplete root development, which is associated with an easier surgical procedure and less probability of complications.

Infection resulting from impacted wisdom teeth can be initially treated with antibiotics, local debridement or surgical removal of the gum overlying the tooth.

Sometimes, when there is a high risk to the inferior alveolar nerve, only the crown of the tooth will be removed (intentionally leaving the roots) in a procedure called a coronectomy.

The prognosis for the second molar is good following the wisdom teeth removal with the likelihood of bone loss after surgery increased when the extractions are completed in people who are 25 years of age or older.

Supporters of early removal cite the increasing risks for extraction over time and the costs of monitoring the wisdom teeth.

[4] Wisdom teeth have been described in the ancient texts of Plato and Hippocrates, the works of Charles Darwin and in the earliest manuals of operative dentistry.

It was the meeting of sterile technique, radiology, and anesthesia in the late 19th and early 20th centuries that allowed the more routine management of impacted wisdom teeth.

The classification structure helps clinicians estimate the risks for impaction, infections and complications associated with wisdom teeth removal.

[5]: 141  Low grade chronic periodontitis commonly occurs on either the wisdom tooth or the second molar, causing less obvious symptoms such as bad breath and bleeding from the gums.

Some also believe in the Functional matrix hypothesis, which states that there is an evolutionary decrease in jaw size due to softer modern diets that are more refined and less coarse than our ancestors.

[6] Impactions completely covered by bone and soft tissue, do not communicate with the mouth, and have a low rate of clinically significant infection.

[5]: 141 ,[17] The diagnosis of impaction can be made clinically if enough of the wisdom tooth is visible to determine its angulation, depth, and if the patient is old enough that further eruption or uprighting is unlikely.

It has been suggested, absent evidence to support routinely retaining or removing wisdom teeth, that evaluation with panoramic radiograph, starting between the ages of 16 and 25 be completed every 3 years.

The conclusion of the review was that antibiotics given to healthy people to prevent infections may cause more harm than benefit to both the individual patients and the population as a whole.

[17] Many impacted wisdom teeth are extracted prior to the age of 25, when full eruption can be reasonably expected and before symptoms or disease have begun.

Following implementation of the NICE guidelines the UK saw a decrease in the number of impacted third molar operations between 2000 and 2006 and a rise in the average age at extraction from 25 to 31 years.

[12] Although most studies arrive at the conclusion of negative long-term outcomes e.g. increased pocketing and attachment loss after surgery, it is clear that early removal (before 25 years old), good post-operative hygiene and plaque control, and lack of pre-existing periodontal pathology before surgery are the most crucial factors that minimise the probability of adverse post-surgical outcomes.

[29] The Cochrane review of surgical removal versus retention of asymptomatic disease-free impacted wisdom teeth suggests that the presence of asymptomatic impacted wisdom teeth may be associated with increased risk of periodontal disease affecting adjacent 2nd molar (measured by distal probing depth > 4 mm on that tooth) in the long term.

Another study which was at high risk of bias, found no evidence to suggest that removal of asymptomatic disease-free impacted wisdom teeth has an effect on crowding in the dental arch.

[17] One trial in adolescents who had orthodontic treatment comparing the removal of impacted lower wisdom teeth with retention was identified.

[30][needs update] Another randomised controlled trial done in the UK has suggested that it is not reasonable to remove asymptomatic disease-free impacted wisdom tooth merely to prevent incisor crowding as there is not strong enough evidence to show this association.

It is indicated when there is no disease of the dental pulp or infection around the crown of the tooth, and there is a high risk of inferior alveolar nerve injury.

[32] Coronectomy, while lessening the immediate risk to the inferior alveolar nerve function has its own complication rates and can result in repeated surgeries.

When they lack a communication to the mouth, the main risk is the chance of a cyst or neoplasm forming in the tissues around the tooth (such as the dental follicle), which is relatively uncommon.

[15] Further, several studies have found that between 30% – 60% of people with previously asymptomatic impacted wisdom teeth will have them extracted due to symptoms or disease, 4–12 years after initial examination.

One large scale study on a group of young adults in New Zealand showed 95.6% had at least 1 wisdom tooth with an eruption rate of 15% in the maxilla and 20% in the mandible.

"Teeth of wisdom" being from the Latin, dentes sapientiæ, which in turn is derived from the Hippocratic term, sophronisteres, from the Greek sophron, meaning prudent.

In the late 19th and early 20th centuries, the collision of sterile technique, anaesthesia and radiology made routine surgery on the wisdom teeth possible.

John Tomes's 1873 text A System of Dental Surgery describes techniques for removal of "third molars, or dentes sapientiæ" including descriptions of inferior alveolar nerve injury, jaw fracture and pupil dilation after opium is placed in the socket.