Abstract: The degeneration of the third molar (wisdom tooth) represents a key marker of human dental evolution. Archaeological investigations of this phenomenon provide important insights into the living environment, dietary composition, health status, and evolutionary relationships of ancient populations. In this article, we systematically reviewed archaeological evidence of third molar degeneration in China from the Paleolithic through historical periods, focusing on 3 principal manifestations—impaction, congenital absence, and morphological abnormalities. Evidence indicates that third molar impaction can be traced back to Australopithecus from approximately 2.3 million years ago, with a notable qualitative transition occurring during the Neolithic period, when frequencies increased substantially. Congenital absence has been documented in Lantian Man (Homo erectus lantianensis) and shows marked regional and temporal variations across different historical periods. Morphological abnormalities primarily manifested as peg-shaped teeth and size reduction, reflecting the ongoing evolutionary process of dental degeneration. These archeological findings not only provide crucial support for understanding the biological mechanisms underlying human adaptation to environmental changes, but also provide historical references for modern oral medicine, particularly in disease prevention and treatment strategies. Furthermore, these archeological findings lay the foundation for promoting a deeper integration of archeology with modern medicine and add new dimensions to the study of human civilization.