Removing wisdom teeth

What is wisdom tooth removal?

Wisdom tooth removal is an operation to take out one or more of the molars at the very back of your mouth, usually because they are causing pain, infection or damage to nearby teeth. These teeth, also called third molars, are typically the last to come through, often during your teens or early twenties, though they can cause trouble at any age.

What conditions does it treat?

You are likely to be offered removal if a wisdom tooth does not have enough room to come through properly and is causing:

• repeated infection and swelling in the gum around the tooth
• decay in the wisdom tooth itself, or in the tooth next to it, that a filling cannot fix
• an abscess at the root of the tooth, or gum disease affecting the tooth beside it
• a cyst, a fluid-filled sac that can form around a tooth that has not come through properly
• food and bacteria repeatedly trapped around the tooth.

What are the benefits of removing wisdom teeth?

Taking out a problem tooth removes the source of the pain, swelling or infection it has been causing, and stops decay or gum disease spreading to the healthy tooth next door. Where a cyst has started to form, removal also prevents it from enlarging or damaging the surrounding bone.

If your wisdom teeth are impacted but are not giving you any trouble, there is usually no benefit to taking them out. Dentists generally leave these alone and simply keep an eye on them at your regular check-ups, since removal carries its own small risks without a proven advantage in this situation.

Are there different types of surgical approaches?

How much is involved depends on how the tooth is sitting. If it has already broken through the gum, it can often be taken out much like any other tooth. If it is impacted, meaning stuck below the gum or against another tooth, the dentist or surgeon needs to cut a small opening in the gum, and sometimes remove a little of the surrounding bone or divide the tooth into pieces to get it out.

Anaesthetic choice varies too. A local anaesthetic injection into the gum is enough for most people. If you are anxious or the tooth is more complex, this can be combined with sedation through an injection into your arm, or occasionally a general anaesthetic is used, meaning you are asleep for the whole procedure.

What happens before the operation?

Before deciding on treatment, your dentist will typically:

• take an X-ray of your mouth to see how your wisdom teeth are positioned
• decide whether they can remove the tooth themselves or refer you to a specialist surgeon at a hospital or clinic
• discuss which type of anaesthetic is right for you, and any charges involved
• if you are having sedation or a general anaesthetic, ask you to arrange for someone to bring you in, take you home, and stay with you for the rest of that day.

What happens during the procedure?

1. You have an injection of local anaesthetic to numb the gum, sometimes alongside sedation, or occasionally a general anaesthetic so you are asleep.
2. If the tooth has not fully come through, the dentist or surgeon cuts a small opening in the gum to reach it.
3. The socket is widened, and a little of the surrounding bone may be removed if the tooth is difficult to access.
4. The tooth is lifted out whole, or divided into two or three smaller pieces to make removal easier.
5. The gum is closed with a few dissolvable stitches, if needed.
6. Straightforward teeth can take just a few minutes; more difficult ones can take up to 20 to 40 minutes.

What does recovery look like?

If you had sedation or a general anaesthetic, you stay at the clinic or hospital until you are recovered enough to leave, and someone needs to take you home and stay with you for the rest of the day. Most people go home the same day either way; an overnight stay is only likely after a general anaesthetic.

Once home, expect some soreness, swelling and a stiff jaw, usually worst around the second or third day, along with possible bruising to the cheek that can take up to two weeks to fade. Painkillers such as paracetamol and ibuprofen, taken regularly rather than only once pain has built up, help considerably, and a soft diet is easier while chewing feels uncomfortable.

From the day after surgery, gently rinsing with warm salt water several times a day, including after meals, helps keep the area clean while it heals, and most people find this useful for around two weeks. Hold off on rinsing your mouth on the actual day you have the tooth out, and avoid smoking and alcohol too, since all of these can dislodge the blood clot that protects the healing socket.

Most people are back to normal daily activities within a day or two and fully recovered within one to two weeks. Gentle exercise is usually fine again within the first week, but check with your surgeon first if your sport carries any risk of a blow to the jaw.

What are the risks and complications?

Removing a wisdom tooth is a common and generally safe procedure, but possible risks include:

• dry socket, where the blood clot over the healing socket does not form properly or comes away too soon, causing pain that gets worse rather than better a few days to around ten days after surgery; this is unpleasant but not dangerous, and your dentist can treat it by cleaning the socket and placing a soothing dressing
• some bleeding on the day of surgery, which usually settles by biting firmly on gauze or a clean cloth for around 10 to 20 minutes
• infection, which may need a course of antibiotics; signs include a high temperature, feeling unwell, or tender, hot or swollen skin around the jaw
• temporary tingling or numbness in your lip, chin or tongue, affecting roughly 1 in 10 people generally (as many as 1 in 5 if your tooth sits particularly close to a nerve), usually settling within a few weeks
• restricted mouth opening (jaw stiffness) for a few days, occasionally up to two weeks
• the tooth next door having its filling or crown knocked or damaged during the procedure
• for upper wisdom teeth specifically, a small chance of a passage forming between the mouth and the sinus, which usually heals by itself but occasionally needs a further small procedure to repair.