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Wisdom tooth removal

Introduction

The wisdom teeth, or third molars, grow at the back of your gums and are the last teeth to come through. Most people have four wisdom teeth, one in each corner.

Wisdom teeth usually grow through the gums during the late teens or early twenties. By this time, the other 28 adult teeth are usually in place so there isn't always enough room in the mouth for the wisdom teeth to grow properly.

Due to the lack of space, the wisdom teeth can sometimes emerge at an angle or get stuck and only emerge partially. Wisdom teeth that grow through in this way are known as impacted.

Impacted wisdom teeth

There are different types of impacted wisdom teeth, depending on the way the tooth has grown through:

  • mesial impaction – where the tooth grows at an angle facing towards the front of the mouth
  • vertical impaction – where the tooth is straight but can't break through the gums properly because it's stuck against the tooth next to it
  • horizontal impaction – where the tooth grows horizontally
  • distal impaction – where the wisdom tooth grows away from the tooth next to it and becomes lodged in that position

Why are wisdom teeth removed?

Wisdom teeth that have become impacted or haven't fully broken through the surface of the gum can cause dental problems.

Food and bacteria can get trapped around the edge of the wisdom tooth, causing a build-up of plaque, which can lead to dental caries (tooth decay), gum diseasecellulitis (infection) or other problems.

Read more about why it should be done

Do my wisdom teeth need to be removed?

You should make an appointment to see your dentist if you're experiencing severe pain or discomfort from your wisdom teeth. Your dentist will check your teeth and advise you about whether they need to be removed.

As with any teeth problems, it's important to see your dentist as soon as possible rather than waiting for your regular dental check-up.

In case of an emergency outside normal working hours, contact your surgery on its usual number and you'll be informed about how to get emergency dental care. You can also call NHS Direct Wales on 0845 4647 for advice on what to do.

If your wisdom teeth are impacted but no disease is present, the teeth don't need to be removed. This is because there's no proven benefit in removing healthy wisdom teeth, and you shouldn't be exposed to the possible risks unless the procedure is necessary (see below).

The removal procedure

The dentist will take an X-ray of your wisdom teeth to help determine whether or not they need to be removed. If they do, the dentist may be able to carry out the procedure or they may refer you to an oral surgeon.

Read about how a wisdom tooth is removed.

After your wisdom teeth have been removed, you may experience some swelling and discomfort, both on the inside and outside of your mouth. This is usually worse for the first three days but it can last for up to two weeks.

Your jaw may be stiff and sore and your face may be bruised. The bruising will begin to disappear, although it may take about two weeks to fade completely.

Read more about recovering from wisdom tooth removal.

Possible complications

As with all surgery, there are risks associated with wisdom tooth removal. One possible complication is ‘dry socket’, where there is a dull, aching sensation in your gum or jaw and sometimes a bad smell or taste coming from the empty tooth socket.

Dry socket is more likely to occur if you don't follow the after-care instructions that your dentist gives you following the removal of your wisdom teeth.

Read more about the possible complications of wisdom tooth removal.

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Why should it be done?

Wisdom teeth usually grow through the gums during the late teens or early twenties. Your dentist will carry out a thorough examination of your teeth, gums and jaw to check if your wisdom teeth are causing problems and if they need to be removed.

This will usually involve taking an X-ray of your mouth, to help your dentist get a clearer view of the position of your teeth.

Wisdom teeth that have become impacted or haven't fully broken through the surface of the gum may need to be removed if they're causing problems. Some of the problems may cause pain, while others do not.

Dental problems

If your wisdom teeth have only partially grown through, food and bacteria can get trapped under the edge of the gum, around the wisdom tooth. Even when they have fully emerged, wisdom teeth are difficult to clean.

As wisdom teeth are at the back of your mouth, and often wedged against your other teeth, they can be difficult to reach with a toothbrush. As a result, food particles and bacteria can get trapped around them, leading to a build-up of plaque.

Plaque is a sticky film formed when bacteria in your mouth combine with acid, saliva and small particles of food that are left after brushing. If plaque isn't removed it can cause a number of dental problems, such as those described below.

  • Dental caries (tooth decay) – plaque begins to break down the surface of your tooth. When tooth decay becomes more advanced it leaves cavities (holes) in the tooth. Cavities may also affect the teeth next to the wisdom teeth (second molars).
  • Gum disease (also called gingivitis or periodontal disease) – the plaque releases toxins (poisons) that irritate your gums, making them red, swollen and painful. Gum disease can also affect the teeth next to the wisdom teeth (first and second molars) and the bone surrounding the wisdom teeth.
  • Pericoronitis – the plaque causes an infection of the soft tissue that surrounds the tooth.
  • Cellulitis – a bacterial infection in the cheek, tongue or throat.
  • Osteomyelitis – an infection inside the bone of your jaw.
  • Abscess – pus collects around wisdom teeth and the surrounding tissue as a result of a bacterial infection.
  • Cysts and benign growths – very rarely, a wisdom tooth that hasn't burst through the gum develops a cyst.

Removing your wisdom teeth may not be your dentist’s first option because many of the above problems can be treated with antibiotics or antiseptic mouthwash. However, removal will be necessary if disease of, or around, the wisdom teeth can't be treated any other way.

Read more about how wisdom teeth are removed.

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How is it performed?

If your dentist recommends removing your wisdom teeth, they will take an X-ray of your mouth.

This will help your dentist to determine whether they need to remove your wisdom teeth. If this is necessary, it will also help them to decide whether they can perform the procedure or whether you'll need to be admitted to hospital so that a specialist (an oral surgeon) can perform the extraction.

Any charges and payment methods should be discussed before the procedure begins.

Anaesthesia

Before having your wisdom teeth removed, you'll be given local anaesthetic by injection to numb the tooth and surrounding area.

If you're particularly anxious about the procedure, your dentist or surgeon may give you a sedative to help you relax. This may come in the form of a tablet (diazepam or temazepam), or gas (nitrous oxide) that you breathe in through a mask. A numbing gel may also be rubbed into the area to be injected.

General anaesthetic (where you're put to sleep) is rarely needed. When wisdom tooth removal under general anaesthetic is needed, it is done in hospital.

Removing the wisdom tooth

If the tooth hasn't come through the gum, a small incision will be made in the gum to access it. A small piece of the bone covering the tooth may need to be removed.

The tooth may be broken into smaller parts to make it easier to extract through the opening. If the tooth has partially or fully broken through the gum, it will be easier to remove because there's less need to make an incision.

You'll feel some pressure just before the tooth is removed. This is because your dentist or oral surgeon needs to widen the tooth socket by rocking the tooth back and forth before taking it out.

Surgery to remove wisdom teeth shouldn't be painful because the area will be numb before the operation begins. However, if you begin to feel some pain during the procedure, tell your dentist or oral surgeon so that they can give you more anaesthetic.

After surgery

If an incision has been made, it may be necessary to use dissolving stitches to seal the gum. Your dentist will tell you if this has been done and how long the stitches will take to dissolve (usually 7 to 10 days).

Your dentist may place some gauze over the site of the extraction and ask you to keep pressure on it by biting your jaws together for up to an hour. This is to allow a blood clot to form in the empty tooth socket. Blood clots are part of the healing process, so try not to dislodge them.

For the 24 hours after removing your wisdom tooth, your dentist will advise you to avoid:

  • rinsing your mouth out with liquid
  • smoking and drinking alcohol
  • drinking hot liquids, such as tea or soup 
  • lots of physical activity

Your dentist will also give you advice about how to look after your mouth after the extraction.

Read more about recovering from wisdom tooth removal.

 

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Recovery

You may experience pain and other symptoms after having your wisdom teeth removed. However, you can take measures to reduce the pain and assist your recovery.

After you have had your wisdom teeth removed you may experience:

  • swelling (inflammation) of your mouth and cheeks – this will be worse for the first few days but will gradually improve; gently pressing a cold cloth to your face will help reduce the swelling
  • a stiff, sore jaw – this should wear off within 7 to 10 days; the skin around your jaw may also be bruised for up to two weeks
  • an unpleasant taste in your mouth
  • tingling or numbness of your face, lips or tongue (although this is rare)
  • pain, which may be severe if the extraction was complicated

Self care advice

To help reduce pain and assist your recovery, you may wish to:

  • relieve the pain using painkillers, such as paracetamol or ibuprofen (always read and follow the manufacturer’s dosage instructions)
  • avoid strenuous activity and exercise for a few days
  • use an extra pillow to support your head and provide extra comfort at night
  • avoid rinsing, spitting and drinking hot drinks, or anything else that may dislodge the blood clots that form in the empty tooth socket, because they help the healing process
  • avoid smoking and drinking alcohol
  • eat soft or liquid food for a few days and chew with your other teeth
  • gently rinse the extraction site after 24 hours, and then regularly, with antiseptic mouthwash 

Returning to normal

After your wisdom teeth have been removed, and any swelling and bruising has disappeared, your mouth and face should return to normal.

You will usually be able to brush your teeth normally after a few days. Make sure that you finish any course of antibiotics that you've been given.

A check-up appointment may be arranged a week or so after the procedure. At this point, any remaining stitches may be removed. You should report any excess bleeding, severe pain or any other unusual symptoms to your dentist or oral surgeon immediately.

Read more about the complications of wisdom tooth removal.

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Complications

Wisdom teeth removal is the most common surgical procedure carried out by oral surgeons. As with any form of surgery, it carries some risks, but fortunately they're quite small.

The risks from surgery to remove wisdom teeth include:

  • dry socket – also known as alveolar osteitis, which is described in more detail below
  • numbness and partial numbness – this can result from temporary or permanent nerve damage, which is described in more detail below
  • infectionyou should visit your dentist if you think that the extraction site has become infected
  • bleeding (haemorrhage) – also visit your dentist if you're bleeding heavily at the site of extraction

Dry socket

Dry socket (alveolar osteitis) is one of the most common complications of wisdom tooth removal. It occurs when a blood clot fails to develop in the tooth socket, or if the blood clot becomes dislodged or disappears. This can happen three to five days after surgery.

The empty socket causes an aching or throbbing pain in your gum or jaw, which can be intense. There may also be an unpleasant smell or taste from the empty tooth socket.

You're more risk of developing dry socket if:

  • you don't follow your dentist’s instructions after the extraction
  • you're a smoker
  • you've had the condition before
  • you're over 25 years old
  • the extraction was complicated

If you look into the socket, you might be able to see the exposed bone, rather than a blood clot. Your dentist may cover the socket with a medicated dressing, which may be removed and replaced frequently until the socket heals.

There's evidence to suggest that using a mouthwash containing chlorhexidine (an antiseptic) can reduce the likelihood of developing dry socket. Before using mouthwash, always read the manufacturer’s instructions or ask your dentist for advice.

Numbness and partial numbness

A small number of patients who have their wisdom tooth removed are affected by numbness and partial numbness due to nerve damage. This can occur when the nerves closest to the root of the tooth are bruised or damaged during surgery.

There may be a temporary loss of feeling to the front of your tongue, lower lip or the side of your mouth where the tooth was removed. This could mean that you can't feel pain, touch or a change in temperature in this area.

Numbness and partial numbness usually lasts for a few weeks or months, although in rare cases it can be permanent if the nerve has been severely damaged.

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