Impacted Wisdom Tooth · Retain vs Extraction

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] Pathology/symptoms (NICE)
   Any pathology/symptoms? Acute infection?
   • Pathology: recurrent pericoronitis (≥2)/unrestorable caries/cyst-tumor/adjacent root resorption/periodontal damage/infection → Pathology → extraction
   • Asymptomatic, no pathology (incidental impaction) → Asymptomatic no pathology → retain and monitor
   • Acute space infection/abscess/trismus → Acute infection → control first
2. [End] Asymptomatic no pathology → retain and monitor
   Asymptomatic impacted wisdom tooth with no pathology → no prophylactic extraction (NICE); periodic clinical/imaging monitoring.
3. [End] Pathology → extraction
   Pathology (recurrent pericoronitis/unrestorable caries/associated cyst-tumor/adjacent root resorption/periodontal disease/infection) → extraction; preoperatively assess the inferior alveolar/lingual nerve position (CBCT if needed; coronectomy to protect the nerve if very close).
4. [End] Acute infection → control first
   Acute space infection/abscess/Ludwig's risk/severe trismus → emergency infection management (drainage + antibiotics + airway assessment), then extraction once infection is controlled.

Source guidelines & references

• Impacted third molar management (NICE 2000; SDCEP; no prophylactic extraction of asymptomatic teeth)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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