Oral Surgery
All Four Wisdom Teeth at Once or Staged?
For healthy patients, removing all four at once means one 90-minute appointment, one 5-7 day recovery, and one week off work. The dental cost is identical either way. Here is the full comparison, recovery timeline, and decision framework.
Key Takeaways
- The dental cost is the same either way: Picasso charges per tooth (2 to 6M VND each), so total cost is 12 to 18M VND regardless of how many visits.
- All four at once means one recovery period (5-7 days) and roughly one week off work. Staged means two recoveries and roughly 10 days off work total.
- For healthy patients under 35 with recovery support available, all four at once is the practical choice.
- Staged extraction (2+2) is appropriate for patients with uncontrolled diabetes, active heart disease, bleeding disorders, severe anxiety, or no recovery support.
- International dental tourists: the all-four approach fits comfortably in a 10 to 14 day trip. Staged requires two trips or a very long single stay.
- Sedation is available at larger branches for anxious patients; note that sedation cost doubles with staged because it is charged per session.
The Core Decision: One Visit or Two
The question patients ask most often once they know all four wisdom teeth need to come out is whether to do them all in one session or split into two visits. The answer depends on one key insight: the dental cost is identical either way, so the decision comes down to how much you value consolidating your recovery time versus spreading the procedural stress across two visits.
Picasso charges per tooth regardless of how many teeth are extracted in a single visit. Simple extraction costs 2,000,000 VND, moderate 4,000,000 VND, difficult 5,000,000 VND, and near-nerve 6,000,000 VND. A typical case with two simple uppers and two moderate-to-difficult lowers totals 12,000,000 to 18,000,000 VND whether the patient comes once or twice.
Cost and Time-Off Comparison
Real numbers for a common case (2 simple upper plus 2 moderate-to-difficult lower wisdom teeth) at Picasso. Time-off is based on a typical office worker returning at 80 percent normal function.
| Factor | All four at once | Staged (2 upper, then 2 lower) |
|---|---|---|
| Dental cost | 12,000,000 to 18,000,000 VND | 12,000,000 to 18,000,000 VND (same) |
| Number of clinic visits | 1 procedure + 1 post-op review | 2 procedures + 2 post-op reviews |
| Total chair time | 90 to 120 min | 60 to 90 min x 2 = 120 to 180 min |
| Total anaesthetic sessions | One | Two |
| Recovery (back to 80% normal) | 5 to 7 days | 4 to 5 days x 2 = 8 to 10 days |
| Total time off work or school | ~1 week | ~10 days (split across 2 absences) |
| Soft-food restriction days | 3 to 5 days, once | 3 to 5 days, twice |
| Healing pattern | Symmetric (both sides heal together) | Asymmetric (one side already healed when the other is fresh) |
| Best for international tourism trips | Yes, fits 10 to 14 day trip | Requires two trips or a very long single stay |
| Sedation cost (if used) | 2 to 5M VND, once | 2 to 5M VND x 2 = 4 to 10M VND total |
Who Should Choose Which Approach
All Four at Once
- Generally healthy, no chronic medical conditions
- Age under 35 (faster healing)
- Can take 7 to 10 days off work as a single block
- Have someone to drive home and check on you for 24 to 48 hours
- International dental tourism trip of 10 to 14 days
- Wisdom teeth at similar difficulty levels across all four
- Manageable dental anxiety (with sedation if needed)
- Want to be done in one block of inconvenience
Staged 2+2
- Uncontrolled diabetes (HbA1c above 8)
- Active heart disease without cardiac clearance
- Bleeding disorder or current anticoagulant therapy
- Severe dental anxiety where 90+ minutes is unbearable
- Age over 50 with slower expected healing
- No recovery support person for 24 to 48 hours post-procedure
- Cannot take a full week off work in one block
- Very different difficulty between upper and lower teeth
- Compromised immune system
If you fall on the staged side of multiple criteria, the surgeon will recommend staged. If you are generally healthy but anxious, sedation often resolves the tension by letting you do all four in one calm sedated session. Discuss at consultation.
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Day-by-Day Recovery: All Four at Once
What to expect after the procedure. Times are for a typical healthy adult with no complications.
| Time | What you feel | What to do | What is normal |
|---|---|---|---|
| Hours 0 to 4 | Numbness, gauze in mouth, mild bleeding | Bite gently on gauze 30 to 45 min. No driving. | Mild ooze from sockets for 1 to 2 hours. |
| Hours 4 to 24 | Anaesthesia wears off, swelling begins, moderate ache | Ibuprofen 400 to 600 mg plus paracetamol 1 g. Cold compress 20 on/20 off. Sleep with head elevated. | Swelling visible day 1, peaks day 2 to 3. |
| Day 1 | Peak swelling, moderate ache 3 to 5 out of 10 | Soft food only (yoghurt, eggs, soup, smoothies). No straws. No spitting. No smoking. | Cheeks visibly puffy. Pain manageable with OTC analgesics. |
| Day 2 | Swelling at peak, similar pain | Continue ibuprofen plus paracetamol. Salt-water rinse gently 3 times daily (starting day 2). Soft food. | Bruising may appear on cheek or jaw. Looks worse than it feels. |
| Day 3 | Swelling starts to decrease, pain drops | Reduce painkillers. Add warm compress to outside cheek to help resolution. | First clear improvement day-over-day. |
| Days 4 to 5 | Most swelling gone, mild discomfort only | Resume normal-soft diet (pasta, rice, fish). Brush around sockets gently. No sticky food. | Most patients off all painkillers by day 5. |
| Days 6 to 7 | Discomfort minimal, sockets healing | Resume work or school. Resume light exercise. Continue salt-water rinse. | Sockets still visible but pain mostly gone. |
| Week 2 | Sockets closing, tissue healing | Normal eating. Resume normal activity. Stitches removed if non-dissolving. | Sockets noticeably smaller. No pain. |
| Weeks 4 to 6 | Complete bone-level healing | Normal life. Schedule 3-month review if requested. | Asymptomatic. |
Dry socket (lost blood clot exposing bone) affects roughly 2 to 5 percent of wisdom-tooth extractions, more common in lower than upper. Symptoms: severe throbbing pain on day 3 to 5, bad taste, visible empty socket. Treatment is a 5-minute medicated dressing at the clinic, not an emergency but warrants prompt contact.
Procedure Duration and Sedation Options
How long the appointment takes
45 to 90 minutes of chair time for the extractions themselves, plus 30 minutes for check-in, anaesthesia, X-rays, and post-op briefing. Total appointment time is roughly 90 to 120 minutes. Simple upper wisdom teeth come out fastest (10 to 15 minutes each). Impacted lower wisdom teeth take longest (20 to 30 minutes each). The surgeon usually does upper teeth first, then lower teeth, so the more straightforward work is completed while the patient is freshest.
Sedation for anxious patients
Picasso offers oral sedation and conscious IV sedation at the larger branches for anxious patients having all four removed at once. Sedation does not change the procedure itself but the patient is in a deeply relaxed state and often does not remember much of the appointment. Sedation adds 2,000,000 to 5,000,000 VND to the procedure cost depending on type and duration. General anaesthesia is also available in select hospital-based cases. If anxiety is the only reason you are considering staged extraction, sedation for a single all-four session is usually the better solution both financially and practically.
Notes for International Patients
Minimum trip length: 10 days
Day 1: arrival and settling in. Day 2: consultation and X-rays. Day 3 or 4: procedure (depending on availability). Days 5 to 10: recovery in country, with the post-op review at day 7 to 10 before the flight home. 10 days is the absolute minimum; 14 days is more comfortable and allows buffer for any unexpected delays.
Do not fly within 5 to 7 days of the procedure
Cabin pressure changes can increase bleeding risk and pain in fresh sockets. Most surgeons recommend at least 5 to 7 days post-extraction before a long-haul flight. Picasso does not perform the procedure on the day before a scheduled departure.
Travel insurance and invoices
Many travel insurance policies cover wisdom-tooth extraction as preventive dental work. Picasso provides itemised invoices in English for claims. The invoice format meets standard claim requirements. Bring your policy documentation to the consultation to confirm what is covered before proceeding.
Accommodation recommendation
A flat or serviced apartment with a kitchenette is more comfortable than a small hotel room because you will be on soft food for 5 to 7 days. Picasso branches are near suitable accommodations in each city; ask at consultation for current recommendations near your preferred branch.
Combining with other dental work
Many international patients combine wisdom-tooth extraction with cleaning, fillings, or crowns in the same trip. Sequence matters: wisdom-tooth extraction usually goes first because the recovery is the most disruptive. Cosmetic work like whitening or veneers comes after the gum tissue has settled. Discuss the optimal sequence at consultation.
All-Four Cost: Vietnam vs Australia, UK, US
Typical case mix: 2 simple upper plus 2 moderate-to-difficult lower wisdom teeth. Vietnam pricing is 70 to 85 percent below home-country private dental fees for the same surgical standard.
| Country | Typical all-four total | What is usually included |
|---|---|---|
| Vietnam (Picasso) | 12,000,000 to 18,000,000 VND / ~$480 to $720 USD | Examination, X-ray, local anaesthetic, all four extractions, post-op review |
| Australia (private) | AUD $1,500 to $4,500 | Often excludes X-ray and review (priced separately); sedation extra |
| UK (private) | 800 to 2,500 GBP | X-ray usually extra; oral surgeon referral may add cost |
| US (private) | USD $1,500 to $5,000 | X-ray and consult fee usually billed separately; insurance partial cover typical |
| With IV sedation (additional) | +2 to 5M VND / +$80 to $200 USD at Picasso | Equivalent in AU/UK/US adds $500 to $2,000 USD per session |
Even after international flights and 10 to 14 days of accommodation, the all-in cost for an Australian patient travelling to Vietnam for all-four extraction is typically AUD $2,500 to $4,000 vs AUD $3,000 to $6,000 in Australia. For complex impacted cases requiring oral surgery referral in the home country, the gap widens to AUD $4,000 or more in savings.
Real Patient Experiences
Verified Google reviews from Picasso patients who had wisdom tooth extractions, quoted verbatim.
"I had extensive dental work done here by Dr Adrian which included removal of 3 wisdom teeth, a crown, teeth cleaning and 3 fillings. From the start I could not have been happier with the service. Everything was clearly explained including time frame, price and what to expect at every appointment."
Ruth, Hanoi Old Quarter. Google review.
"Highly recommend. Got a cleaning, wisdom tooth extraction and a crown. Everything was painless and properly done. Came in 3 times and was served immediately. Dr. Vo is very skilled, wish she was my local dentist in Canada."
Tommy Mai, Canada. HCMC Thao Dien. Google review.
"I have been patient at Picasso Dental Clinic for the past few years and have always been 100% satisfied with their work. Whether it is for hygienists, teeth whitening or wisdom teeth, I have always been taken care of by high level specialists! They are always available in case of emergency, and amazing reception."
Van Thanh Cong Nguyen, Da Nang. Google review.
Frequently Asked Questions
Should I have all four wisdom teeth removed at once?
For healthy patients with similar difficulty levels across all four teeth, yes. Removing all four at once means one recovery period (5 to 7 days), one set of post-op restrictions, and roughly one week off work or school. The total dental cost is the same as staged extraction because per-tooth pricing applies either way. Staged extraction (2+2) makes sense for patients with medical conditions, severe dental anxiety, limited recovery support, or very different complexity between teeth.
How long is the recovery after removing all four at once?
5 to 7 days for most patients. Day 1 to 2: peak swelling and discomfort, soft food only, painkillers as needed. Days 3 to 5: swelling subsides, eating expands, discomfort drops to a 2 to 3 out of 10 level. Days 6 to 7: most patients return to work or school. Full healing of the extraction sockets takes 4 to 6 weeks but is asymptomatic after the first week. For international patients, the trip should include at least 7 to 10 days after the procedure before a long-haul flight.
How much does it cost to remove all four wisdom teeth at Picasso?
Per-tooth pricing applies. Simple wisdom tooth 2,000,000 VND, moderate 4,000,000 VND, difficult 5,000,000 VND, near-nerve 6,000,000 VND. A common mix of upper simple plus lower moderate-to-difficult totals roughly 12,000,000 to 18,000,000 VND (~$480 to $720 USD) for all four. Australia equivalent: AUD $1,500 to $4,500. UK: 800 to 2,500 GBP. US: $1,500 to $5,000. Vietnam pricing is 70 to 85 percent lower for the same surgical standard.
Is the staged approach (2 at a time) ever cheaper?
No. The dental cost is the same because per-tooth pricing applies either way. What changes is the total time off work (roughly double for staged), the number of clinic visits, and the cumulative inconvenience. The only situation where staged is financially better is if travel insurance has a per-incident cap that would not cover all four in one visit; this is rare. For most patients, all-four-at-once is the cheaper option once time-off is factored in.
Who should NOT have all four removed at once?
Patients with: uncontrolled diabetes (HbA1c above 8), active heart disease without cardiac clearance, bleeding disorders or current anticoagulant therapy without a management plan, severe dental anxiety where the longer procedure would not be tolerable, immunocompromise from medication or untreated systemic disease, or no available person to assist during the first 24 to 48 hours of recovery. These patients should consider staged extraction or extraction under sedation.
How long does the all-four procedure take?
45 to 90 minutes of chair time for the extractions themselves, plus 30 minutes for check-in, anaesthesia, X-rays, and post-op briefing. Total appointment time roughly 90 to 120 minutes. Simple upper wisdom teeth come out fastest (10 to 15 minutes each). Impacted lower wisdom teeth take longest (20 to 30 minutes each). The surgeon usually does upper teeth first, then lower teeth.
Can I have it done under sedation if I am anxious?
Yes. Picasso offers oral sedation and conscious IV sedation at the larger branches for anxious patients having all four removed at once. Sedation does not change the procedure itself but the patient is in a deeply relaxed state and often does not remember much of the appointment. Sedation adds 2,000,000 to 5,000,000 VND to the procedure cost depending on type and duration. If anxiety is the main reason you are considering staged extraction, sedation for a single all-four session is often the better solution.
When should I have my wisdom teeth removed if they are not bothering me?
If your wisdom teeth are asymptomatic, fully erupted, in functional position, and cleaning normally, no extraction is needed. If they are impacted (even if asymptomatic), the prevailing recommendation is removal in the late teens or early 20s when the bone is less dense and healing is faster. Beyond age 30, healing slows and complication risk increases. For patients in their 30s or older with asymptomatic impacted wisdom teeth, the watch-and-wait approach is sometimes appropriate but should be reviewed annually with X-rays.
For urgent cases, see emergency wisdom tooth removal. For impacted tooth grades and pricing detail, see impacted wisdom tooth removal. For the full service overview, see wisdom tooth extraction.
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