How Wisdom Teeth Removal Works: The Procedure Step by Step
Medically reviewed by Dr. Sergio Calleja, DDS, MPH — Board-Certified Oral & Maxillofacial Surgeon · Last reviewed 2026-05-22
Wisdom teeth removal is one of the most common operations in the United States — and for a trained oral and maxillofacial surgeon, one of the most routine. All four teeth are typically removed in a single visit that takes about 45 minutes to an hour, with the whole appointment lasting around two hours, and you go home the same day.
Here is exactly what happens, step by step, as it works at our practice.
- 1
Consultation and 3D Imaging
Dr. Calleja examines your mouth and takes a low-radiation 3D CBCT scan — a cone-beam CT that shows each tooth, its roots, and its exact relationship to the nerve canal in the lower jaw and the sinus above the upper teeth. This is how the surgery is planned and how your personal risk profile is assessed before anything is decided. You will leave the consultation knowing which teeth need removal, which anesthesia option fits you, and what the cost will be.
- 2
Choosing Your Anesthesia
You have real options: local anesthesia alone (numb but fully awake), nitrous oxide (laughing gas) for mild relaxation, IV sedation — twilight anesthesia, where most patients sleep through the procedure and remember nothing — or full general anesthesia. Both IV sedation and general anesthesia are provided in the office by Dr. Calleja, who is trained and licensed in office-based anesthesia as part of oral and maxillofacial surgery residency. If you choose sedation, you fast beforehand and bring a driver.
- 3
The Extraction Itself
Once you are comfortable and completely numb, the surgery begins. For an erupted tooth, removal can be as simple as gently loosening and lifting it out. For an impacted tooth, Dr. Calleja opens a small window in the gum, removes a small amount of bone if the tooth is buried, and frequently sections the tooth — divides it into pieces — so it comes out through a smaller opening with less force on the jaw. Each tooth typically takes about 5 to 10 minutes.
- 4
Sockets, Stitches, and Gauze
Each empty socket is cleaned and inspected, and the gum is closed with sutures — small stitches that are usually dissolvable and disappear on their own within a week or two. Gauze is placed over the sockets and you bite down gently; that pressure is what forms the protective blood clot that starts the healing. You will get spare gauze and clear instructions on when to change it.
- 5
Recovery Room and Home the Same Day
You wake up gradually in our recovery area while the team monitors you. Once you are alert and stable — typically 30 to 45 minutes after sedation — your driver takes you home with written aftercare instructions in English or Spanish, prescriptions if needed, ice-pack guidance, and a direct number to reach us. Plan to rest for the remainder of the day.
Why an Oral Surgeon for Impacted Wisdom Teeth?
General dentists remove straightforward, fully erupted teeth every day, and for a simple case that can be entirely appropriate. Impacted wisdom teeth are a different job: the tooth sits in bone, often near the inferior alveolar nerve (the nerve that gives feeling to your lip and chin) or the maxillary sinus, and the surgery involves bone removal, tooth sectioning, and — for most patients — deep sedation.
Oral and maxillofacial surgeons complete four to six years of hospital-based surgical and anesthesia residency after dental school, which is why they can both perform the surgery and administer IV sedation or general anesthesia safely in the office. Dr. Calleja is board-certified by the American Board of Oral and Maxillofacial Surgery and reviews every case on a 3D CBCT scan before operating — including identifying the cases where a modified approach protects the nerve.
Frequently Asked Questions
How long does wisdom teeth removal take?
Usually about 45 minutes to an hour for all four teeth — often less, occasionally more for deeply impacted teeth. With check-in, anesthesia, and recovery time, plan on roughly two hours at the office.
Am I awake during wisdom teeth removal?
Only if you want to be. With local anesthesia alone you are awake but numb; with nitrous oxide you are awake but relaxed; with IV sedation you are typically asleep and remember nothing; with general anesthesia you are fully unconscious. Most wisdom-teeth patients at our practice choose IV sedation.
Do they break the tooth to get it out?
Often, yes — deliberately. Sectioning an impacted tooth into two or more pieces lets it come out through a smaller opening with far less pressure on the jaw and nearby structures. It is a standard technique that makes the surgery gentler, not rougher.
Will I have stitches, and do they need to be removed?
Most impacted-tooth sites are closed with a few small sutures. We typically use dissolvable stitches that fall out or dissolve on their own within one to two weeks — no removal appointment needed. If a non-dissolvable stitch is ever used, we tell you and schedule its removal.
Can I drive myself home?
Only if you had local anesthesia alone (or nitrous oxide, after a short recovery). After IV sedation or general anesthesia you must have a responsible adult drive you home and stay with you, and you should not drive, work, or make important decisions for the rest of the day.
Is wisdom teeth removal done in the office or a hospital?
For nearly all patients, in the office. The Waldorf and California, Maryland offices are equipped and staffed for in-office IV sedation and general anesthesia. Hospital settings are reserved for patients with significant medical conditions or unusually complex anatomy.
Have Questions About Wisdom Teeth Removal?
Dr. Calleja evaluates every case personally at the Waldorf and California, MD offices — consultations in English or Spanish.
This page is general patient education, not personal medical advice. Every patient's anatomy and health history are different — treatment details, risks, and recovery vary case by case and are reviewed with you during your consultation. For emergencies, call 911.