Background: Third molar extraction is one of the most frequent procedures in oral surgery practice. Aim: To investigate the indications for this procedure in patients referred to a private and the oral surgery clinic of the Korle Bu Teaching Hospital, (KBTH), both in Accra, Ghana. Methods: This is a retrospective study of 402 patients treated between January 2007 and June 2009. Age and sex, indication for extraction; tooth extracted, type of impaction were analyzed. Results: 192 (47.8%) were male and 210 (52.2%) female; with male: female ratio of 1:1.1. Their age ranged between 15 and 70 years with a mean of 24.8 years. 243 (60.5%) were between 21-30 years, 87 (21.6%) between 31-40 years and 48 (11.9%) were over 40 years old. The commonest indication for surgery was pericoronitis (49.25%)... followed by dental caries (26.1%). 94.8% involved the mandible and 5.2% the maxilla. 47.8% were in mesioangular, 26.1% in vertical, 22.4% horizontal and 3.7% in distoangular positions. Alveolitis sicca dolorosa and prolonged numbness of the lower lip were two main associated complications seen in six patients. Conclusion: The main reason for surgical extraction of impacted third molars was recurrent pericoronitis, occurring mostly in a relatively younger age group; followed by dental caries then prophylactic surgical extraction.