Wisdom Tooth Removal

What are wisdom teeth?

Your wisdom teeth, also known as third molars, are the very last ones to grow in at the back of your mouth. This usually happens when you are around 18 years old.

How many wisdom teeth do I have?

You’ll usually have four wisdom teeth, one on each side of the upper and lower jaws. However, some people will not have all four, and some people will have their wisdom teeth buried under the gum so you will not be able to see them.

What is an impacted wisdom tooth?

When our jaws are not big enough to fit all of our teeth, it can be difficult for wisdom teeth to fully come through. When this happens, we say that the wisdom tooth is ‘impacted’ or stuck. Unfortunately, sometimes this can be quite painful.

Do wisdom teeth need to be removed?

There are several reasons why your dentist may recommend removing your wisdom teeth. The most common reason is because the gum tissue covering the tooth becomes infected, which can cause pain and other complications. Other reasons why a wisdom teeth might need to be removed are:

• Decay or a hole in the wisdom tooth itself, or the tooth in front of it
• An abscess, or infection, at the root of the wisdom tooth
• Sometimes if the molar tooth in front of the wisdom tooth is affected by gum disease, removal may be necessary
• A fluid-filled cyst can form around the wisdom tooth which may require removal

How is an impacted wisdom tooth removed?

The procedure begins by administering 2 or 3 local anaesthetic injections around the gum of the wisdom tooth. Your surgeon will wait at least 2 minutes to allow the anaesthetic to take effect. They will then check around the tooth to ensure it is comfortably numb. At this stage you may feel a pressure sensations or your jaw may move up or down. This is normal. When the anaesthetic has taken effect you should not feel any sharpness or pain.

To remove the wisdom tooth, sometimes a small cut in the gum is made near the tooth. This is so that we can see the tooth and surrounding bone more clearly. Sometimes, a small amount of bone around the tooth is removed and the tooth is split into smaller pieces to make it easier to remove. During this stage of the procedure you may hear some buzzing sounds and feel some vibrations.

After the tooth has been removed, stitches may be placed in the area to help with healing. These stitches will dissolve on their own usually within 4 weeks.

What can I expect after the surgery?

After surgery, the amount of pain you experience can vary depending on how difficult the tooth was to remove. Typically, it takes about 5 to 7 days to recover. Pain can be managed with painkillers like paracetamol and ibuprofen. Your surgeon will discuss what pain control you can use.

Swelling is very common and usually peaks on the second and third day after surgery, gradually disappearing over about 7 to 14 days. You may have difficulty opening your mouth for a few days. This is known as trismus, and it is best to eat softer foods that do not require much chewing. You may also see some bruising on your face and neck. Usually antibiotics are not necessary.

It is important to avoid planning any trips or important social events immediately after the surgery. You may also need to take a few days off from work. Your surgeon will provide further information and instructions after the surgery is completed.

What can go wrong?

Having a wisdom tooth removed is a safe and common procedure. However, as with any medical procedure, there are some risks involved.

Bleeding

After the procedure, some bleeding is normal and it should stop within 60 minutes. You may notice some blood in your saliva for a day or two afterwards. If you bleed excessively, bite down on a swab or gauze for 40 minutes. You can use a rolled-up handkerchief, but not a tissue. If bleeding persists, please contact your dentist or surgeon.

Sometimes a dry socket can occur after having a wisdom tooth removed, particularly in the lower jaw. If you experience increasing pain, bad breath or a bad taste in your mouth 3-10 days after the extraction, you should contact your dentist or surgeon. They may need to wash out the socket and place a dressing, but antibiotics are not usually necessary.

In rare cases, infection may occur after the procedure. You may experience a fever, tenderness under your jaw line, and skin hardness, redness and tenderness. Contact your dentist or surgeon immediately if you experience these symptoms. You may need antibiotics.

It is common to have some difficulty opening your mouth after the procedure (trismus). If this does not improve in the days following the surgery it could be a sign of infection.

If the tooth next to your wisdom tooth has a large filling or crown, it may be damaged or dislodged during surgery. If this happens your dentist may need to repair the tooth once the extraction socket has healed. In some cases, repair is not possible due to the extent of damage.

There are two nerves that lie close to lower wisdom teeth. One nerve provides feeling to your lower lip, chin and lower teeth, while the other provides feeling to your tongue and helps with taste. 

Sometimes these nerves can be bruised during surgery, which can cause tingling/ numbness/ burning/ discomfort in your lip, chin or tongue. Less commonly, you may experience an altered or loss of taste sensation. In most cases, these symptoms go away on their own, but in a few cases, recovery may not be complete.

Very rarely, painful sensations may be felt in the damaged nerves. Between 2 and 20% of people experience  tingling or numbness that can last several weeks or months, and between 0.5 and 2% may have permanent problems. If you experience any of these symptoms, you should contact your dentist or surgeon as soon as possible.

Removing upper wisdom teeth is generally simpler and quicker than removing lower wisdom teeth. While there are no nerves close to the upper wisdom teeth that can be damaged, there is a small risk of breaking the bone behind the wisdom tooth (tuberosity), which can cause bleeding or create a passageway between the mouth and sinus. If this happens, it may need a surgical operation to repair it either at the time of your wisdom tooth removal or at a later date.

Your dentist or surgeon may tell you about other risks that are specific to your situation. They may also recommend ways to modify the procedure to reduce the risk of complications, especially if your surgery is high risk. One such modification is called a coronectomy, and a separate information leaflet is available that explains this.