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Wisdom teeth removal

Wisdom teeth, found at the back of the mouth, can cause problems for some people and may need to be removed. If your wisdom teeth need to be taken out, you will meet with the dentist or oral surgeon carrying out your procedure to discuss your care. Following is an overview of what you can expect, although your treatment may differ from what's described here as it will be designed to meet your individual needs.

About your wisdom teeth

Wisdom teeth usually emerge from your gums between the ages of 17 and 24. They are the last of the large grinding teeth at the back of your mouth (molars). Some people never develop wisdom teeth or you could have up to four appearing – one in each corner of your mouth.

Wisdom teeth diagram

For most people, wisdom teeth don't cause any problems and so they don't need to be removed. However, if there isn't enough space for them to grow at the back of your mouth they become 'impacted' wisdom teeth, causing pain, swelling and/or infection.

Having your impacted wisdom teeth surgically removed (extracted) can relieve these symptoms. It may be possible for your dentist to remove your wisdom teeth, or you may be referred to an oral surgeon.

Antibiotics can help treat an infection, but your symptoms may flare up again. Having your wisdom teeth removed is often the only way to permanently relieve your symptoms.

Preparing for wisdom teeth removal

Your dentist or oral surgeon will explain how to prepare for your procedure. For example, if you smoke, you may be asked to stop as smoking increases your risk of getting a wound infection, which can slow your recovery.

The operation is usually done under local anaesthesia. This completely blocks pain from your gums and you will stay awake during the procedure. You may be offered a sedative to help you relax during the operation. If you go to a hospital and your wisdom teeth are particularly challenging to remove, you may be given general anaesthesia. This means you will be asleep during the procedure. Your dentist or oral surgeon will talk with you about which type of anaesthesia is most suitable for you.

If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your dentist or oral surgeon's advice.

Your dentist or oral surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help prepare questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during wisdom teeth removal?

The procedure for removing your wisdom teeth will depend on how deeply impacted your teeth are. Many wisdom teeth can be extracted simply like any other molar. Once the anaesthetic has taken effect, your dentist or oral surgeon will widen the socket (the area your tooth sits in) using a tool called an elevator or a pair of special forceps. The tooth will be moved from side to side until it is loose enough to be removed completely.

However, if your tooth is more difficult to remove, your dentist or oral surgeon will cut through your gums and may remove some of your jawbone to reach your tooth. They'll remove your wisdom teeth and then close your wounds with stitches if necessary. Most wisdom teeth only take a few minutes to remove, but the more difficult cases can take around 20 minutes.

What happens afterwards?

You will need to rest until the effects of the general anaesthetic or sedation have passed.

After a local anaesthetic, it may be several hours before the feeling returns to your jaw. Take special care not to chew on the area or have any hot food or drinks, as you may not be able to feel any injury to the area such as a burn.

You will be able to go home when you feel ready.

If you had a general anaesthetic or sedation you will need to arrange for someone to drive or take you home. Try to have a friend or relative stay with you for the first 24 hours after the procedure.

Before you go home you'll be given advice about looking after your teeth and gums. You may be given painkillers, antibiotics and mouthwash solutions to take home. You may also be given a date for a follow-up appointment.

Dissolvable stitches will disappear on their own in seven to 10 days. Non-dissolvable stitches are removed a week after surgery by your dentist.

Recovering from wisdom teeth removal

If you need them, take over-the-counter painkillers such as paracetamol. Follow the instructions in the accompanying consumer medicines information leaflet or ask your pharmacist for advice. Don't take aspirin because this can make bleeding worse.

If your gum bleeds, fold a clean handkerchief or piece of gauze, place it on your bleeding gum and bite on it for at least 10 to 15 minutes. Don't rinse your mouth out or lie down until the bleeding has stopped.

Don't vigorously rinse out your mouth during the first 24 hours after having a wisdom tooth removed because this can disturb blood clots that help the healing process. After meals, rinse gently with warm salt water (half a teaspoon of table salt dissolved in a glass of water).

Brush your teeth as usual, but keep your toothbrush away from the healing wound for the first couple of days. At first, you may feel small fragments of bone with your tongue. These are the edges of the tooth socket and will soon disappear as your gum heals.

To begin with, eat soft foods, gradually returning to your usual diet once your jaw feels less stiff.

Most people don't experience any problems after having their wisdom teeth removed. However, if you develop any of the following symptoms contact your dentist or your GP immediately:

  • Bleeding that doesn't stop after applying pressure, or that lasts for more than half an hour
  • Difficulty in breathing or swallowing
  • Severe pain that isn't helped by painkillers
  • A high temperature
  • Swelling that continues for more than three days after your operation.

What are the risks?

Wisdom teeth removal is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side effects

These are mostly temporary effects of a successful treatment, for example feeling sick as a result of a general anaesthetic. You may have some facial swelling, bruising, pain or jaw stiffness for up to two weeks. These symptoms are usually at their worst for the first two or three days and then gradually improve.

Complications

Most people won't experience any problems during or after the operation. But as with any operation, possible complications include an unexpected reaction to the anaesthetic or excessive bleeding.

Specific complications to having your wisdom teeth extracted are uncommon but may include:

  • infection
  • accidental damage to other teeth and your jaw during your operation
  • severe pain caused by dry socket – this is when the blood clot breaks away from the wound exposing the bone and nerves, causing pain and delaying healing
  • numbness in your lower lip or tongue, or changes to taste - this can be caused by nerve damage and there is a small chance that this could be permanent
  • jaw stiffness – it's possible that you may not be able to open your mouth fully.

The exact risks are specific to you and will differ for every person, so we haven't included statistics here. Ask your dentist or oral surgeon to explain how these risks apply to you.

Further information

Australian Dental Association
http://www.ada.org.au/

Sources

British Dental Health Foundation. Wisdom teeth. [online] Warwickshire, UK: British Dental Health Foundation. c2010 [accessed 30 Jun 2011] Available from:
http://www.dentalhealth.org/tell-me-about/topic/routine-treatment/wisdom-teeth

British Dental Health Foundation. What to do following an extraction. [online] Warwickshire, UK: British Dental Health Foundation. c2010 [accessed 30 Jun 2011] Available from:
http://www.dentalhealth.org/tell-me-about/topic/routine-treatment/what-to-do-following-an-extraction

Cowan P. Treatment of third molar teeth - surgery. J Ir Dent Assoc, 2006. 52(1):7.

Department of Health (UK). The Pregnancy Book 2009. [online] Whitehall, London: Department of Health. Oct 2009 [accessed 30 Jun 2011] Available from:
http://www.dh.gov.uk/

Michalowicz BS, DiAngelis AJ, Novak MJ, et al. Examining the safety of dental treatment in pregnant women. J Am Dent Assoc 2008; 139(6):685-95. http://jada.ada.org

Last published: 30 July 2011

Disclaimer
This information has been developed and reviewed for Bupa by health professionals. To the best of their knowledge it is current and based on reputable sources of medical research. It should be used as a guide only and should not be relied upon as a substitute for professional medical or other health professional advice.

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