Wisdom Tooth Extraction: What to Expect
Having wisdom teeth (third molars) removed is one of the most common surgical procedures. Wisdom teeth grow at the back of your gums and are the last teeth to arrive. Most people have one in each corner, and they usually erupt during the late teens or early twenties. By that time the other 28 adult teeth are normally already in place, so there is not always enough room in the mouth for the wisdom teeth to come through properly.
Because of the lack of space, wisdom teeth may come in at an angle, become impacted, or only partially emerge. If your teeth are causing severe pain, you should make an appointment to see a dentist. They will examine your teeth and tell you whether they need to be removed. If your dentist thinks your wisdom teeth may need to come out, they will usually take a panoramic X-ray, which shows the position of the teeth more clearly. As with any dental problem, it is important to see your dentist as soon as possible rather than waiting for your next routine check-up.
Why are wisdom teeth removed?
If your wisdom teeth are impacted but are not causing any problems, they usually do not need to be removed. This is because there is no proven benefit to removing them and the procedure carries a risk of complications.
Sometimes impacted or partially erupted wisdom teeth do cause dental problems. Food and bacteria can become trapped around the edge of the wisdom tooth, causing a build-up of plaque that can lead to:
- Tooth decay (caries)
- Gum disease (also known as gingivitis or periodontal disease)
- Pericoronitis — when plaque causes an infection of the soft tissue around the tooth
- Cellulitis — a bacterial infection of the cheek, tongue or throat
- Abscess — a build-up of pus caused by a bacterial infection in or around the tooth
- Cysts — a fluid-filled swelling that can develop around the wisdom tooth
Removal is generally recommended when other treatments do not work. Dentists and surgeons follow approved guidelines for the removal of wisdom teeth, and the decision is made together with your clinician.
How are wisdom teeth removed?
Your dentist may be able to remove your wisdom teeth, or may refer you to a specialist surgeon. Before the procedure the operation is usually explained to you and you may be asked to sign a consent form.
A local anaesthetic injection is usually given to numb the area around the tooth. Just before the tooth is removed you will feel some pressure, because your dentist or oral surgeon needs to widen the socket by loosening the tooth from side to side. A small cut in your gum may be needed, and sometimes the tooth has to be cut into smaller pieces before it is removed.
Removing a wisdom tooth can take from a few minutes to 30 minutes, and occasionally up to an hour. After your wisdom teeth have been removed you may feel swelling and discomfort both inside and outside your mouth. Some mild bruising can also appear. This is usually worse for the first three days, but it can last for up to two weeks.
Possible complications
As with all surgery, there are risks associated with removing a wisdom tooth. These include infection or delayed healing, both of which are more likely if you smoke during your recovery.
Another possible complication is a dry socket — a dull, aching sensation in your gum or jaw, sometimes with a bad smell or taste coming from the empty tooth socket. It is more likely if you do not follow the aftercare instructions given by your dentist.
There is also a risk of minor nerve damage, which can cause a tingling or numb feeling in your tongue, lower lip, chin, teeth and gums. This is usually temporary, but in rare cases it can be permanent. If any of these symptoms appear, contact your dentist rather than trying to treat them yourself.
Frequently asked questions about wisdom tooth extraction
Do wisdom teeth always have to be removed?
No. If an impacted or partially erupted wisdom tooth causes no symptoms and is not damaging the neighbouring tooth, the gum or the jawbone, removal is usually not necessary. The decision is made by assessing factors such as pain, recurring gum infection (pericoronitis), decay, abscess, cyst formation or an orthodontic treatment plan. This assessment must be made by your dentist together with a panoramic X-ray.
What does the cost of wisdom tooth removal depend on?
The fee depends on how deeply the tooth is impacted, the shape of its roots and how close they are to neighbouring anatomical structures (the sinus, the nerve canal), the length of the procedure, the type of anaesthesia used and the imaging required. Removing a tooth that sits at the surface and upright is not the same procedure as the surgical removal of a tooth lying horizontally inside the bone. A realistic estimate can only be given after an examination and a radiographic assessment.
How long does it take, and is it painful?
The procedure usually takes between a few minutes and 30 minutes; for impacted teeth with separated roots it can extend to an hour. Because the area is numbed with local anaesthetic, pain is not expected during the extraction — what you feel is mostly pressure and a pulling sensation. Once the anaesthetic wears off, sensitivity lasting a few days is considered normal.
How does healing progress after the extraction?
Swelling and discomfort are usually most noticeable during the first three days, then gradually reduce and can continue for up to two weeks. Mild bruising may appear. The most important factors that delay healing are smoking and not following the aftercare instructions. On the first day, avoiding very hot food, not using a straw and not spitting help the blood clot to stay in place.
What is a dry socket, and how is it prevented?
A dry socket is inflammation of the empty socket after the blood clot that formed following the extraction becomes dislodged; it presents as throbbing pain and a bad taste in the mouth. It typically follows habits such as using a straw, smoking, rinsing vigorously or poking at the socket with a finger during the first days. If symptoms appear, contact your dentist rather than intervening yourself.
Do you have pain at the back of your mouth or a wisdom tooth question? Send us a message on WhatsApp — we reply in English.
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