Oral and maxillofacial surgeons can be reasonably certain of the behavior of wisdom teeth and the outcomes of different management strategies. An organized approach based on symptom and disease status simplifies management recommendations. The patients who provide the greatest challenge to certainty are those whose wisdom teeth are asymptomatic and disease free. Patients who elect to retain a third molar should be advised about this risk of removal over time. Given the increased complication rate when third molars are removed with increasing age, it may be prudent to extract them by the middle of the third decade.