Wisdom tooth removal

Page last reviewed: 13/07/2011

Wisdom teeth are the last teeth at the end of your gums. The medical name for wisdom teeth is the third molars and there are usually four of them.

Wisdom teeth usually grow through the gums during the late teens, or early twenties. The other 28 adult teeth are already in place by this time, so sometimes there is not enough room for the wisdom teeth in the mouth.

As they grow through, wisdom teeth are often obstructed by the other teeth and the lack of space, and can emerge at an angle. They may end up in the wrong place or 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 that the tooth has grown through. These are: 

  • mesial impaction: where the tooth grows at an angle facing towards the front of the mouth 
  • vertical impaction: where the tooth grows straight down but gets stuck against the tooth next to it
  • horizontal impaction: where the tooth grows horizontally and pushes against the tooth next to it
  • distal impaction: where the wisdom tooth turns away from the tooth next to it and becomes lodged in that position

Removing wisdom teeth

Not all impacted wisdom teeth will need to be removed but sometimes they can start to cause dental health problems. Your dentist will advise you if it is necessary to have your wisdom teeth removed.

Discuss issues such as charges, payment methods and waiting times with your dentist before your treatment begins.

Page last reviewed: 13/07/2011

Before deciding whether to have your wisdom teeth removed (extraction), your dentist will perform a thorough examination of your teeth, gums and jaw. This will usually involve taking an X-ray of your mouth to identify the problem.

Wisdom teeth that have become impacted or that have not fully broken through the surface of the gum can cause dental health problems. This is usually because they are difficult to clean.

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 they are positioned at the back of your mouth, and often at an angle where they are wedged against your other teeth, they are difficult to reach with a toothbrush. As a consequence, food particles and bacteria can get trapped around them and cause a build-up of plaque.

Plaque

Your mouth is full of millions of tiny bacteria. When you consume food and drink high in carbohydrates (sugary or starchy foods or drinks), the bacteria breaks the carbohydrates down into acid. The acid then combines with the bacteria, the saliva in your mouth and the small particles of food left after brushing to produce a sticky film called plaque.

Plaque can often go on to cause other dental health problems, such as those outlined below.

Dental health problems

  • Dental caries (tooth decay): where plaque begins to break down the surface of your tooth. When tooth decay becomes more advanced it leaves cavities (holes) in the tooth. Cavaties may also affect the second molars, which sit next to the wisdom teeth
  • Gum disease (also called gingivitis or periodontal disease): where the plaque releases toxins that irritate your gums, making them red, swollen and painful. Gum disease can also affect the first and second molars and the bone surrounding the tooth.
  • Pericoronitis: where the plaque causes an infection of the soft tissue that surrounds the tooth.
  • Cysts and tumours: if the tissue surrounding an impacted wisdom tooth becomes infected, there is an increased risk of a cyst or tumour developing. However, this is rare.
  • Cellulitis: a bacterial infection in the soft tissue that connects your gum to your teeth.
  • Osteomyelitis: an infection inside the bone of your tooth.
  • Abscess: where pus collects in your tooth or gums as a result of a bacterial infection.

If dental health problems such as those above cannot be treated another way, your dentist may recommend that you have your wisdom teeth extracted. Extraction may not be your dentist's first option because some of the above problems can be treated with antibiotics. However, if the problem returns or if you are in considerable pain due to a problem with your teeth, extraction may be the best option. 

Glossary

Bacteria

Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some others are good for you.

Cyst

A cyst is a fluid-filled sac or cavity in the body.

Pain

Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.

Tissue

Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.

X-ray

An X-ray is a painless way of producing pictures of inside the body using radiation.

 

Page last reviewed: 13/07/2011

Wisdom teeth develop during your late teens or early twenties, usually between 18-24 years of age. However, they can sometimes develop much later.

It is recommended that impacted wisdom teeth that are free from disease should not be operated on. There are two reasons for this:

  • firstly, there is no reliable research-based evidence to suggest that it benefits patients to have healthy wisdom teeth removed, and
  • secondly, surgery itself involves risks (see the wisdom tooth removal - complications section), and patients should not be exposed to these risks unnecessarily.

Instead, your wisdom teeth should be monitored during your routine dental check-ups. It is not possible to predict which impacted wisdom teeth (if any) may start to cause you problems in the future. However, the angle that the tooth has come through at, and the degree to which it is stuck among your other teeth, may provide an indication. Your dentist will decide if and when surgery is necessary.

Find your local dental surgeries by entering your postcode into find and choose services.

Depending on how healthy your teeth and gums are, your dentist will also advise you about how often you need to have a dental check-up. If you have a problem between check-ups, you should contact your dental surgery to arrange an earlier appointment.

In case of an emergency outside normal working hours, contact your surgery on its usual number and you will be informed about how to access emergency dental care.

Glossary

Pain

Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.

Swelling

Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Page last reviewed: 13/07/2011

If your dentist recommends that you need to have your wisdom teeth removed, they will take an X-ray of your mouth. This will help them to determine whether they can remove your wisdom teeth, or whether you will 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 will be given a local anaesthetic by injection (most commonly lidocaine) to numb the tooth and the surrounding area.

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

A general anaesthetic, which causes a complete loss of sensation in the body, can be requested, but usually only if you are having the procedure in hospital.

Removing the wisdom tooth

If the tooth has not 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 will also 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 is no need for an incision.

You may feel some pressure just before the tooth is removed. This is because your dentist or surgeon will need to widen the tooth socket by rocking the tooth back and forth slightly before taking it out.

Surgery to remove wisdom teeth should not be painful because the area will be numb before the operation begins. However, if you do begin to feel some pain during the procedure, you should let your dentist know so that you can be given more general 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 should take to dissolve.

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 and you should try not to dislodge them.

For the next 24 hours your dentist may advise that you:

  • avoid rinsing your mouth out with liquid too vigorously
  • avoid sucking on a straw
  • avoid smoking and drinking alcohol
  • avoid consuming hot liquids, such as tea or soup 
  • minimise physical activity

They will also give you advice about how to look after your mouth after the extraction. See wisdom tooth removal - recovery for more information.

Glossary

Anaesthetic

Anaesthetic is a drug used to either numb a part of the body (local), or to put a patient to sleep (general) during surgery.

Incision

An incision is a cut made in the body with a surgical instrument during an operation.

Numbness

Numbness refers to a lack of sensation in a part of the body.

Pain

Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.

Page last reviewed: 13/07/2011

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

  • inflammation (swelling) for a few days until the area heals (a cold cloth applied gently around site of swelling will help bring the swelling down)
  • bruising of the jaw muscles, which often causes stiffness in the jaw (this should wear off within 7-10 days)
  • a feeling of comfort and a less-crowded mouth
  • a dirty taste in your mouth
  • tingling or numbness of your face, lips or tongue (this is rare)
  • varying degrees of pain (the level of discomfort will be related to how difficult the extraction was).

Self-care advice

To help your recovery, you can:

  • treat 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 or anything else that may dislodge the blood clots forming in the empty tooth socket, such as consuming hot drinks, as the blood clots help the healing process
  • avoid smoking and drinking alcohol
  • eat soft or liquid food for a few days and chew with your other teeth
  • after 24 hours, gently rinse the extraction site regularly with warm salt water

Other information that you might find useful: 

  • following the removal of your wisdom teeth there will be no difference to your face or appearance
  • if you are given antibiotics, make sure you finish the course
  • you can usually begin to brush teeth normally after several days
  • a check-up appointment will usually be arranged a week or so after the procedure, at which point any remaining stitches will be removed

You should report any excess bleeding, severe pain, or any other unusual symptoms to your dentist.

Glossary

Antibiotics
Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. For example amoxicillin, streptomycin and erythromycin.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Homeopathic
Homeopathy is when you take natural medicines that produce minor symptoms of a disease or infection, to encourage your body's immune system to produce
Stitches
1. A suture is a seam-like join between the bones in the skull.
2. A suture is a stitch used to hold together a wound or cut.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Swelling
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Numbness
Numbness refers to a lack of sensation in a part of the body.
Painkillers
Analgesics are medicines that relieve pain. For example paracetamol, aspirin and ibuprofen.

Things you should know:

  • if you're given antibiotics you should finish the course, but these aren't usually necessary  
  • paracetamol is known to be effective at treating the pain from wisdom tooth removal but always follow the manufacturer's dosage instructions
  • you should brush your teeth as normally as possible

Page last reviewed: 13/07/2011

Wisdom teeth removal (extraction) is the most commonly performed surgical procedure carried out by oral surgeons. As with any surgery, it does carry some risks, but fortunately these are quite small.

Risks from surgery

The risks from surgery to remove wisdom teeth include:

  • alveolar osteitis, (dry socket, see below)
  • temporary or permanent nerve damage, (paresthesia, see below)
  • infection, (see your dentist if you suspect the extraction site has become infected)
  • haemorrhage, (heavy bleeding - see your dentist if you are experiencing excess bleeding)
  • temporary local swelling, pain and restricted mouth opening, (see wisdom tooth removal - recovery for more information)

In some cases, general anaesthetic will be necessary, which does carry some additional risks (including death, in extremely rare circumstances).

Dry socket

Dry socket (alveolar osteitis) is one of the most common complications of wisdom tooth removal. You may be at more risk of developing dry socket if:

  • you do not follow your dentist's instructions after the extraction
  • you are a smoker
  • you have had the condition before
  • you are over 25 years of age
  • the extraction was complicated

Dry socket causes a dull aching sensation in your gum or jaw. Sometimes, the pain can be quite intense, it may be a throbbing pain or could spread to the side of your face. The pain may be accompanied by a bad smell or a bad taste coming from the empty tooth socket. 

Dry socket is thought to occur when a blood clot fails to develop in the tooth socket, becomes dislodged, or disintegrates (breaks down), and disappears. You will feel less pain in the days immediately after the extraction, but the pain will start to increase between three to five days after surgery. This is because the blood clot has disappeared and the healing process has been interrupted. 

If you look into the socket, you might be able to see the exposed bone, rather than any blood or tissue. This is where the name dry socket comes from.

Your dentist may cover the socket with a medicated dressing, which will be removed and replaced frequently until the socket heals.

There is also some evidence to suggest that using a mouthwash that contains chlorhexidine (an antiseptic) can help to reduce the likelihood of developing dry socket. Always read the manufacturer's instructions or ask your dentist for advice.  

Paresthesia

A small number of patients who have their wisdom tooth removed are affected by paresthesia (numbness due to nerve damage). Paresthesia is a condition that occurs when the nerve closest to the root of the tooth is bruised or damaged during surgery. 

Paresthesia can result in a temporary loss of feeling to the tongue, lower lip or lower jaw. This could mean that you are no longer able to feel pain, touch, or a change in temperature in this area. It should not affect your tongue movement or speech or cause facial deformity.

Parethesia normally lasts for a few days, weeks or months, but in rare cases it can be permanent if the nerve has been severely damaged. Older patients (who are over 35 years of age) are at increased risk of getting parethesia because the tooth roots are longer and closer to the nerve.

Glossary

Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Paresthesia
Paresthesia is an odd sensation of burning, prickling, tingling, 'pins and needles' or creeping on the skin.
Aching
An ache is a constant dull pain in a part of the body.

Page last reviewed: 13/07/2011

The two main risks are:

  • Nerve damage causing tingling and numbness. This is more likely if it was a difficult extraction. Around one in 10 people have numbness or tingling of their bottom lip, chin or tongue which can persist for several weeks. Less than one in 100 may have problems for more than a year. The surgeon will advise if you're at risk.
  • Dry socket (alveolitis) which can lead to pain and slow healing.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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