Wisdom teeth removal

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.
If hospital treatment is required, it will be provided through the NHS free of charge. Dentists charge depending on the treatment that is required, unless you are under 18 years of age or otherwise exempt from NHS charges.
Discuss issues such as charges, payment methods and waiting times with your dentist before your treatment begins.

About wisdom teeth removal

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 but you could have up to four – one in each corner of your mouth.

For most people, wisdom teeth don’t cause any problems so 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 what is known as impacted wisdom teeth, and can cause pain, swelling and/or infection.
Having your impacted wisdom teeth surgically removed (extracted) can relieve your symptoms. It may be possible for your dentist to remove your wisdom teeth, or he or she may refer you to an oral surgeon.

What are the alternatives?

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 let you know 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 yourself by preparing 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 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. He or she will then move the tooth 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. He or she will 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 comes back into your jaw. Take special care not to chew on the area or have any food or drinks that are too hot, as these could burn the area.
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 you home. You should try to have a friend or relative stay with you for the first 24 hours.
Your dentist or oral surgeon will give you some advice about looking after your teeth and gums before you go home. 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.

Recovering from wisdom teeth removal

If you need them, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Follow the instructions in the patient information leaflet that comes with your medicine and ask your pharmacist for advice. Don’t take aspirin because this can make bleeding worse.
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, you can rinse gently with warm salt water (half a teaspoon of table salt dissolved in a glass of water).
You should 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.

Eating and drinking

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

Bleeding

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

• 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 the unwanted, but 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

This is when problems occur during or after the operation. Most people aren’t affected. The possible complications of any operation 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 have not included statistics here. Ask your dentist or oral surgeon to explain how these risks apply to you.