Wisdom Tooth Extraction

This page contains information about wisdom tooth removal surgery. It is important to read this prior to your procedure so that you know what to expect during and after. Your dentist will discuss this information at your consultation also.

What are wisdom teeth?

Wisdom teeth are the last teeth to erupt into the mouth and are also called the third molar teeth. People can develop four wisdom teeth: two on each side of the mouth, one on the bottom jaw and one on the top jaw. Normally these teeth come through between the ages of 18 and 24, but can erupt later in life also.

What problems can wisdom teeth cause?

Because wisdom teeth grow at the back of the mouth, they can become stuck  (impacted) and fail to come through properly. These teeth can be impacted on the gum, bone or the tooth in front of it. The can be difficult to keep clean and this leads to a number of problems. The most common problems are:

• Infection of the gum (pericoronitis) around the wisdom tooth. This is the most common reason to remove a wisdom tooth and this infection can potentially be severe, but often the symptoms are mild.

• Tooth decay (dental caries) can occur in the wisdom tooth or the tooth in front. We see this in 25-30% patients. This can lead to needing extensive treatment on the tooth in front.

• Wisdom teeth can be affected by gum disease (periodontal disease) or contribute to gum disease on the tooth in front (5-10% of patients that we see). Patients may get no symptoms at all from this, but it can still cause problems.

• Cyst formation around the wisdom tooth. All teeth form within a sack and occasionally this sack can expand like a balloon. This is called a cyst. Over time this can become larger and cause pain and infection. This is rare.

How we assess wisdom teeth

We can make a partial assessment about the position of the wisdom teeth clinically during a general check up. A full jaw x-ray called an OPG is required for a full assessment. This x-ray will show us the position of the wisdom teeth in relation to the adjacent teeth and also the nerve the runs through the jaw bone. This is a very important piece of information that we need to have to appropriately plan your treatment. There is an additional cost if we take the OPG to assess your wisdom teeth. Your dentist will discuss this with you at your appointment.

What is wisdom tooth surgery?

There can be differences in the complexity of wisdom tooth removal. Some wisdom teeth are very simple to remove and may take only a few minutes to do; others can be more complex and may take up to 30-40 minutes.

For more complex wisdom teeth, the procedure may involve an incision (cut) into the gum to expose the tooth. A dental drill may then be used to remove bone from around the tooth to loosen it from the jaw. On occasions the tooth may then be cut up into smaller pieces; this makes it easier to remove the tooth. Once the wisdom tooth has been removed the gum is put back together with stitches. Sometimes a wisdom tooth can be removed easily and simply without the need for cutting the gum or for drilling.

There are two main options for anaesthetic that we offer at Gentle Dental. We will advise you which of these options is suitable for your treatment.

1. Local anaesthetic. This is an injection placed in the gum around the wisdom tooth that numbs the area so that you wont feel any pain during the procedure. There are no restrictions around driving home or going back to work after this.

2. IV sedation. This is a treatment that is generally used for more anxious patients and/or harder wisdom tooth surgery. We place the sedative through a vein in your arm and often you don’t remember having the treatment completed.

Not all patient are suitable for the above options and if the surgery if potentially very complex or you are not medically suitable for sedation, then we will refer you to a specialist for a general anaesthetic.

What can I expect after surgery?

Every patient and surgery is different and there is a lot of variation in what you will experience following the procedure. Generally, the more complex the tooth surgery, the longer it can take to heal. The average recovery time is between 3 and 7 days.

Pain: Pain is normal after wisdom tooth surgery and you should expect the area to be painful for 3 to 7 days. We will discuss the best pain relief regimen for you and give you a prescription for pain killers if necessary.

Swelling: Swelling is common and tends to get worse on the second and third day after surgery. It should begin to get better after day 3 but can take about a week to settle fully.

Bruising: Because of the blood vessels and nature of the procedure, you can experience bruising around the cheek and potentially the upper part of the neck. Sometime even a more simple tooth removal can lead to bruising.

Bleeding: We will ensure that the bleeding stops when we finish the procedure. You can, however, experience blood stained saliva for a day or two afterwards and this is normal. We will give you advice about how to manage any bleeding that does occur.

Jaw pain/Restriction: It can be uncomfortable to open wide and chew for 3 to 4 days following the surgery. The jaw joint has many muscles that help it to work and if you have swelling as your mouth heals, this can lead to pain and stiffness in the joint. Try a soft diet to help the jaw joint to rest and as the area heals, the jaw should feel better, but it can sometime last for a few weeks.

Tooth sensitivity: Often the wisdom teeth are touching the adjacent teeth and it is common to have some sensitivity in these teeth once the wisdom tooth is removed. Good oral hygiene will help the socket to heal well and keep the adjacent tooth healthy.

Bad breath: you can experience bad breath for a few days, particularly if we place stitches in the gum. This is should improve once the stitches either dissolve or are removed after a week.

Risks of Wisdom Tooth Removal

Removal of wisdom teeth is a very common and safe procedure but there are risks involved as with any operation. The pain risks involved are:

• Dry Socket. This is pain that begins approximately 2 to 4 days after the surgery and is due to breakdown of the clot that forms in the socket. It is not an infection but is a constant pain and is treated in the surgery by cleaning the wound and placing a dressing to help the healing.
• Infection. This in uncommon, but can happen 3 to 7 days after the surgery. Unlike dry socket, pain is accompanied by a bad taste and discharge from the wound. It requires treatment with antibiotics.
• Nerve damage. Our assessment of your x-ray will allow us to see how close the the wisdom tooth lies to two nerves. One nerve lies underneath the tooth and this supplies the sensation to the chin lip and lower teeth. The other nerve supplies sensation to the tongue. For most patients, there is a very small risk to the nerve. Nerve injury is usually temporary if it happens at all, but very rarely can be permanent. Injury to these nerves can cause altered sensation on the lower lip, chin, tongue and lower teeth. Altered sensation can range from pins and needles, numbness or neuralgia (nerve pain). If we consider you to be of high risk of nerve injury, we may refer you on to have a CT scan to further assess the nerve. This is a 3D scan that can show us precisely the position of the nerve and how to plan our treatment accordingly.
• Damage to the adjacent teeth. If the tooth next to the wisdom tooth has a large    filling or crown, it could potentially be moved during the procedure.
• Jaw problems.  Following removal of a lower tooth the jaw joint and surrounding muscles can be sore. This should improve in the weeks after the procedure.
• Sinus problems. Upper wisdom teeth lie close to an air sinus that is a hollow cavity. When these upper wisdom teeth are removed, there is a very small risk that the air sinus can become punctured. If this occurs, we occasionally have to repair it surgically at the time, or sometimes at a later date.

Will I have a follow up appointment?

If you have a procedure that doesn’t require any stitches to be removed, then you won’t need a follow up appointment. If you have non-dissolvable stitches, then we will arrange a follow up appointment 7-10 days after the procedure.

If you have any questions about anything in this leaflet, please don’t hesitate to ask at your consultation or contact us at the surgery.