Does dental insurance cover wisdom teeth? | Guardian Direct

Does dental insurance cover wisdom teeth removal?

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Many dental insurance plans have some level of benefits for wisdom teeth extractions.

Wisdom teeth, also known as the third molars, are four teeth that grow at the back of each corner of your mouth sometime between the ages of 17 and 21. Because they grow so far back, they can cause problems like crowding out other teeth, becoming trapped under your gum line, or causing tooth decay because they are hard to reach and clean. That is why each year 5 million people have their wisdom teeth removed.¹

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Without dental insurance, wisdom teeth extractions can cost between $200 and $1,000 per tooth.² If you need all four wisdom teeth pulled, the bill can quickly add up. Dental insurance can help you cover the costs of removal so you can maintain your health and avoid more extensive tooth problems later in life.

What does it cost to have a wisdom tooth pulled?

A fully erupted wisdom tooth can cost between $200 and $700 to be pulled. An impacted tooth can run from $350 to $1,100 for just the extraction fees. As with most dental procedures, many factors determine the cost of having a wisdom tooth pulled.

Type of extraction

If the tooth is fully erupted into the mouth, the cost will be less than if it must be surgically removed from beneath the jawbone. The time involved in extracting an erupted wisdom tooth is far less than for an impacted tooth. Equipment such as surgical drills and medicated dressings needed for surgical extractions can add to the cost. 

Type of anesthesia

General anesthesia, which requires additional training and equipment for the oral surgeon and their staff can increase the cost. Likewise, sedation, which many general dentists as well as oral surgeons use, adds to the cost due to the equipment needed to administer and monitor you while sedated.

Credentials of your dentist

If your general dentist can pull your wisdom teeth, the cost will probably be less than it will be at an oral surgeon’s office. Oral surgeons often have years of specialized training, over and above that of general dental school. They sometimes have a nurse anesthetist or anesthesiologist on staff as well as specialized equipment for surgical procedures that are not found in a general dental office. The need for this extra equipment and staff adds to the cost for services.

Additional costs

Along with the basic fees for the actual extraction, there can be added fees for X-rays, scans, anesthesia, and medications. These can add several hundred dollars to the bill, especially if CT scans are needed.

Will dental insurance pay for wisdom teeth extractions?

Does dental insurance cover wisdom teeth removal

Many dental insurance plans have some level of benefits for wisdom teeth extractions. Benefits for wisdom teeth extractions can range from 50% to 80% of the dentist or oral surgeon’s fees. They are also subject to deductibles and co-pays. Yearly maximum limits on the amount the insurance will pay each year also apply to wisdom teeth extractions. If your annual limit is $1,000 and you have a total bill of $4,000, your yearly maximum is quickly met with no benefits left for the rest of the year.

In another scenario, suppose you have all four wisdom teeth that are fully erupted into your mouth but are causing some pain and swelling. On the low end of possible fees, your bill might run around $600 plus any additional fees for anesthesia and X-rays. Your total might be less than $1,000. If insurance pays 50%, your bill could be around $500 with plenty left on your insurance annual limit to cover more dental work during the year.

Some policies have a waiting period before extractions are covered. If you have only recently become covered by your dental insurance policy, make sure to verify that any waiting period is met before scheduling your wisdom teeth extraction.

How Guardian Direct insurance covers wisdom teeth extractions

Guardian Direct Dental Advantage Gold and Silver PPO plans cover 50% to 70% of the costs of a tooth extraction after a waiting period. Guardian Direct Managed DentalGuard DHMO plans also cover simple and complex tooth extractions at 100% with no waiting period after a copay.

Guardian Direct Dental Advantage Gold (PPO)

  • Simple extractions: 70% after a six-month waiting period

  • Complex extractions: 50% after a 12-month waiting period

Guardian Direct Dental Advantage Silver (PPO)

  •  Simple extractions: 50% after a six-month waiting period

  • Complex extractions: 50% after a 12-month waiting period

What are wisdom teeth?

Most people have four wisdom teeth. If they have room to grow in straight and aligned with the other teeth, healthy wisdom teeth can help you chew and do not need to be removed. Although you will feel some swelling and tenderness as they break through the gums the mild pain goes away when the tooth breaks through to the surface. However, if your mouth is not large enough to make room for another molar or if your wisdom teeth do not grow straight up into the mouth, you might need to have them removed. Some wisdom teeth grow at an angle and push against the roots of the other teeth. Some never grow all the way through the gums. Others develop fluid-filled sacs, called cysts, that can damage the jawbone. An impacted wisdom tooth is one that is trapped under the gums or down in the jaw. Any of these cases would require wisdom teeth removal.

Why should I have my wisdom teeth removed?

As your wisdom teeth grow in, your dentist may watch for signs that they need to be removed. Your dentist may take X-rays to monitor the growth of the wisdom teeth and to watch for the following conditions:

  • Tooth erupts through the gums but forms a food trap behind another tooth. This can lead to cavities on the other tooth.

  • Tooth erupts at an angle making it impossible for you to keep clean

  • Tooth erupts but is crowding and putting pressure on the other teeth

  • Tooth is causing you to bite your cheek or tongue

  • Tooth only comes partially through the gums causing chronic infection

  • Tooth is trapped under the gums or in the jaw

  • A cyst forms around the tooth

Your wisdom teeth might need to be removed if you experience pain, infection, damage to adjacent teeth, develop cavities, cysts, or tumors in the area. They may need to be removed if you want to have your teeth straightened with braces or aligners. 

How are wisdom teeth pulled?

Having a wisdom tooth taken out can be a simple or complex surgical procedure. Your general dentist might take it out herself if the tooth is fully or partially erupted into your mouth. This means that some or all the top of the tooth can be seen and accessed with instruments to lift it out of the socket.

If the wisdom tooth is still underneath the gums or bone, your dentist might send you to an oral surgeon. Oral surgeons have training beyond dental school to learn how to handle complicated surgery for the mouth and jaw. Wisdom teeth extractions are a common procedure for oral surgeons.

You can have one or more wisdom teeth pulled during one appointment. Many people opt to have all four wisdom teeth out at the same time, so they only have to go through the experience once.

What complications can occur after wisdom teeth extraction?

Having a tooth pulled is never without risk. Most heal normally and cause no long-term complications. However, surgical extractions of wisdom teeth sometimes result in problems.

Dry sockets

These occur when the blood supply to the tooth socket does not clot properly. Dry sockets can delay the healing process.

Trapped food and bacteria

The open hole, or socket, provides a trap for food debris and bacteria to accumulate. This condition resolves after the gums start to heal over.

Sinus problems

When upper wisdom teeth are pulled, the open socket sometimes connects to the sinus. The inflammation can cause temporary sinus infections and problems.

Nerve damage

The nerves in the lower jaw, lip, tongue, and chin can sometimes be damaged and remain numb. This may be temporary or permanent but is a rare occurrence.

What questions should I ask my dentist before having my wisdom teeth pulled?

Not every wisdom tooth needs to come out. Many people live long, happy lives with all four wisdom teeth intact and functioning. 

There are many factors to consider when deciding whether to have your wisdom teeth taken out.

  • Are your wisdom teeth causing damage to your other teeth?

  • Are your wisdom teeth causing pain or swelling?

  • Does your dentist see any cysts or tumors forming around the roots of the wisdom teeth?

  • Are your wisdom teeth trapping food?

  • Are your wisdom teeth difficult or impossible to clean with a toothbrush and floss?

  • Are you having problems with your jaw joint that might be caused by wisdom teeth?

  • Do you have any other health conditions, such as diabetes or an autoimmune disease, that keeps you from fighting off infections?

Wisdom teeth that can be kept clean, are fully erupted, and cause no pain or other problems may not need to be pulled. Your dentist will monitor the condition of your wisdom teeth and the areas surrounding them during regular check-ups. Wisdom teeth always have the potential for flaring up and causing problems. Keeping the areas clean and having regular check-ups will help ensure that, if your wisdom teeth do start to cause problems, your dentist will catch them early and provide whatever care is needed.

There can be some advantages to keeping your healthy wisdom teeth. They can supply support for a dental bridge if another molar needs to be pulled later and they provide a longer, stronger chewing surface. 

Working with your dentist and your insurance company

To avoid any surprises when the bill arrives, your dentist may be able to file a pre-treatment estimate with your insurance company. This provides a written document showing all the dentist’s expected fees including X-rays, scans, anesthesia, and other add-ons. Your insurance company may then review your policy and give you and your dentist a written estimation of how much it will pay for the services. 

Although this is just a close estimation, it is a safe way to know up front what your financial obligation will be. That gives you time to work with your dentist on a payment plan to cover your out-of-pocket expenses.

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Making the decision to have your wisdom teeth pulled

If you decide to have your wisdom teeth pulled, contact your dentist to review your overall health conditions, the position and growth pattern of your wisdom teeth, and decide together the best course of treatment. Dental insurance can help you cover the costs of removal so you can maintain your health and avoid more extensive tooth problems later in life.

Links to external sites are provided for your convenience in locating related information and services. Guardian, its subsidiaries, agents and employees expressly disclaim any responsibility for and do not maintain, control, recommend, or endorse third-party sites, organizations, products, or services and make no representation as to the completeness, suitability, or quality thereof.

This is not dental care advice and should not be substituted for regular consultation with your dentist. If you have any concerns about your dental health, please contact your dentist's office.


  1., 2015

  2., 2020


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