Wisdom tooth removal
The removal of wisdom teeth, or third molars, is one of the most common procedures carried out in the UK.
The wisdom teeth 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.
Because of 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.
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 teeth, causing a build-up of plaque, which can lead to tooth decay, gum disease or other problems.
Your wisdom teeth don't usually need to be removed if they are impacted but they are not causing any problems. This is because there is no proven benefit of doing this and it carries the risk of complications.
When to see a dentist
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.
How wisdom teeth are removed
Your dentist may remove your wisdom teeth or they may refer you to a specialist surgeon for treatment in hospital.
Before the procedure, you will usually be given a local anaestheticinjection to numb the area around the tooth. You'll feel some pressure just before the tooth is removed, as your dentist or oral surgeon needs to widen the tooth socket by rocking the tooth back and forth.
In some cases a cut (incision) may be needed in your gum and the tooth may need to be cut into smaller pieces before it is removed.
The time it takes to remove the tooth will vary. Some procedures only take a few minutes, whereas others can take 20 minutes or longer.
After your wisdom teeth have been removed, you may experience 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.
As with all surgery, there are risks associated with removing a wisdom tooth. These include problems such as infection or delayed healing, both of which are more likely to occur if you smoke during your recovery.
Another possible complication is "dry socket", which 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 given by your dentist.
There is also a small risk of nerve damage, which can cause problems such as pain or a tingling sensation and numbness in the tongue, lower lip, chin, teeth and gums. This is usually temporary, but it can be permanent in some cases.
When wisdom teeth may need to be removed
Wisdom teeth usually only need to be removed if they don't come through properly and they are causing problems.
You may notice there is a problem with your wisdom teeth because you feel pain towards the back of your mouth. If this is the case, you should make an appointment to see a dentist.
However, some problems mean your teeth need to be removed even when they do not cause pain. These may only be picked up during a routine dental check-up.
If your dentist thinks you may need your wisdom teeth removed, they will usually carry out an X-ray of your mouth. This helps give them a clearer view of the position of your teeth.
If your wisdom teeth have only partially grown through, food and bacteria can get trapped under the edge of the gum around the tooth. This can also happen if your wisdom teeth come through properly, but they are difficult to clean because they are at the back of your mouth.
If food particles and bacteria get trapped around your wisdom teeth, this can lead 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 left after brushing.
If plaque isn't removed, it can lead to a number of dental problems:
tooth decay (dental caries) – develops when plaque begins to break down the surface of your tooth. When tooth decay becomes more advanced it leaves holes (cavities) in the tooth that can affect the surrounding teeth.
gum disease (also called gingivitis or periodontal disease) – occurs when plaque releases toxins (poisons) that irritate your gums, making them red, swollen and painful. Gum disease can also affect the surrounding teeth and the bone around the wisdom teeth.
pericoronitis – when 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 – when pus collects in your wisdom teeth or the surrounding tissue as a result of a bacterial infection.
cysts and benign growths – very rarely, a wisdom tooth that hasn't cut through the gum develops a cyst (a fluid-filled swelling).
Many of these problems can be treated with treatment such asantibiotics and antiseptic mouthwash, so removing your wisdom teeth is only recommended when other treatment hasn't worked.
How wisdom teeth are removed
Wisdom tooth removal can be carried out by a dentist or a specialist surgeon working in a hospital.
If your dentist recommends removing your wisdom teeth, they will take an X-ray of your mouth to help them determine who should carry out the procedure.
Before having your wisdom teeth removed, you'll be given an injection of local anaesthetic 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 will usually involve an injection into your arm.
General anaesthetic is rarely necessary. When it is needed, your wisdom tooth will be removed in hospital, although you should still be able to go home the same day as the procedure.
Removing the wisdom tooth
If the tooth hasn't come through the gum, a small cut (incision) will be made in the gum to access it. A small piece of the bone covering the tooth may also need to be removed.
The tooth may be cut into smaller parts to make it easier to remove through the opening. There's less need to make an incision if the tooth has broken through the gum.
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. However, if you feel pain during the procedure, tell your dentist or oral surgeon so they can give you more anaesthetic.
The length of time it takes to remove the tooth will vary. Simple procedures can take a few minutes, but it can take longer than 20 minutes if it's more complicated.
If an incision has been made, dissolving stitches may be used to seal the gum. Your dentist will tell you how long the stitches will take to dissolve (usually 7 to 10 days).
Your dentist may place 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.
In some cases, antibiotics may be prescribed if you have an ongoing infection.
For the 24 hours after removing your wisdom tooth, you should avoid:
rinsing your mouth out with liquid
drinking alcohol and smoking
drinking hot liquids such as tea or soup
strenuous physical activity
Recovering from wisdom tooth removal
It can take up to two weeks to fully recover after having your wisdom teeth removed.
During this time, 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
pain – this is worse if the extraction was complicated
an unpleasant taste in your mouth
tingling or numbness of your face, lips or tongue (although this is uncommon)
You should report any excess bleeding, severe pain or any other unusual symptoms to your dentist or oral surgeon immediately.
To reduce pain and aid your recovery, it can be helpful to:
use 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 at night
for 24 hours, avoid rinsing, spitting, hot drinks or anything else that may dislodge the blood clots that form in the empty tooth socket, as they help the healing process
avoid drinking alcohol and smoking
eat soft or liquid food for a few days and chew with your other teeth
gently rinse the extraction site with antiseptic mouthwash after 24 hours, and repeat this regularly over the next few days
Working and driving
It's usually recommended that you take a day or two off work after having a wisdom tooth removed.
You can drive immediately after the procedure if local anaesthetic was used, but you should avoid driving for at least 24 hours if a sedative was used, or 48 hours if the procedure was carried out under general anaesthetic.
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 for about a week or so after the procedure. At this point, any remaining stitches may be removed.
Complications of wisdom tooth removal
As with any procedure, removing your wisdom teeth carries some risks. However, these risks are usually small.
Risks can include:
dry socket – where a blood clot fails to develop in the tooth socket, or if the blood clot becomes dislodged
nerve injury – this can cause temporary or permanent problems such as pain and numbness
infection – signs include a high temperature, yellow or white discharge from the site of extraction, and persistent pain and swelling
You should see your dentist if you have signs of infection after the procedure, or if you are bleeding heavily from the site of extraction.
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 ache 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. If you look into the socket, you might be able to see exposed bone rather than a blood clot.
You're more at risk of developing dry socket if:
you don't follow your dentist's instructions after the extraction
you've had the condition before
you're over 25 years old
the extraction was complicated
Contact your dentist or surgeon if you suspect you have dry socket. They can flush any debris out of the socket or cover it with a medicated dressing, which may be removed and replaced frequently until it heals.
Although far less common than dry socket, injury to sections of a nerve called the trigeminal nerve is another possible complication of wisdom tooth removal. This can cause pain, a tingling sensation and numbness in the tongue, lower lip, chin, teeth and gums.
In most cases the damage is temporary, lasting for a few weeks or months. However, it can be permanent if the nerve has been severely damaged.
A nerve injury can interfere with your daily activities, making things such as eating and drinking difficult and painful.
Every attempt will be made to minimise the possibility of nerve damage when your wisdom tooth is removed, and you should be informed about the risk of complications before the procedure.
It's sometimes necessary for general anaesthetic to be used when you have a wisdom tooth removed.
It carries some additional risks, but complications are very rare, occurring in less than one case for every 10,000.
Wisdom tooth removal