The aim of this leaflet is to give a written overview of the management of wisdom teeth.
Why do some wisdom teeth need to be removed?
Wisdom teeth are our last adult teeth to emerge. In many circumstances, they will grow (erupt) into the mouth completely normally and function as a regular molar tooth.
However, in some cases, there is not enough room at the back of the mouth to allow these teeth to erupt into the correct position. In these instances, wisdom teeth can remain buried (unerupted) or can develop at unusual angles (impacted).
When wisdom teeth erupt into these abnormal positions, they can become more prone to dental diseases which then require the tooth to be removed.
Wisdom teeth might need treatment if:
- They have decay
- Severe and repeating pain
- Severe infection of the tissues surrounding the tooth
- Abscess of the tooth
- Cystic change surrounding the wisdom tooth
- Other evidence of disease as per the National Institute for Clinical Excellence (NICE) guidance on wisdom tooth removal.
What are the options for management of wisdom teeth?
- Active monitoring (your dentist might take x-rays periodically to monitor the tooth) and sometimes provide conservative treatment such as irrigation of the soft tissues and oral hygiene advice
- Extraction (whole tooth removed)
- Coronectomy (partial removal, roots left in-place)
What is the process of removing wisdom teeth?
Some wisdom teeth can be removed by conventional dental extraction but generally impacted and unerupted wisdom teeth require surgical removal.
To surgically remove a wisdom tooth, a small cut is made in the gum and sometimes bone is removed to expose the tooth. It is normal for the wisdom tooth to come out in several pieces. Your gum will then usually be stitched back together using some dissolvable stitches.
What benefits are associated with treatment of wisdom teeth?
- Management of dental decay, inflammation and infection
What problems are associated with removal of wisdom teeth?
Following your operation, you may have some of the following side effects:
Pain
It is common to have discomfort for the first 48-72 hours following removal of wisdom teeth and generally it will need to be controlled with painkilling medication.
The usual domestic headache remedies are generally sufficient, and the most appropriate type will be recommended for you.
Bleeding
It is normal to experience some blood-stained saliva after the wisdom tooth is removed. Instructions will be given to manage this if more severe.
Bruising
This is the result of slight bleeding into the soft tissue around the operation site. For lower wisdom teeth, this happens around the lower jaw and may spread into the upper part of the neck. For upper wisdom teeth the cheeks may be affected.
Swelling
Swelling of the face may occur, taking up to 48 hours to reach its maximum, gradually reducing back to normal over the following couple of weeks.
Stiffness of the jaw
As a result of the swelling and tightening of the surrounding muscles and this can last a couple of weeks. Pre-existing temporo-mandibular joint disorders (TMJD) issues may be made worse by the surgery.
Infection
Infections after treatment are rare. If you are at higher risk of infection your surgeon will inform you before the procedure.
Dry socket
Dry socket is a common complication following tooth removal. This increases the severity of the pain from the surgical area.
Temporary or permanent nerve damage
In certain circumstances, when lower wisdom teeth are removed, damage to two nerves can result in loss or altered sensation (sometimes painful) which can be temporary or permanent. This can affect the lower lip, skin of the chin, gums of the teeth, lower teeth and tongue (including taste).
If you are at an increased risk of this complication, your surgeon will discuss this and may discuss a procedure called a coronectomy with you (see below). If a close relationship is suspected between the tooth and the nerve, you may be offered a 3D x-ray called a CT scan to investigate this relationship further.
A communication between the mouth and the sinus
In some circumstances, where upper wisdom teeth roots lie within the maxillary sinus there is the risk that in removing that tooth will create an opening from the mouth to the sinus.
What is a coronectomy?
A coronectomy involves taking only the upper portion of the tooth and leaving the root in place. This may reduce the risk of a change in sensation but with the additional risk that the remaining root may erupt into the mouth in the future or need removal at a later date.
The procedure is similar to that of a surgical extraction with the risks including pain, swelling, bruising, bleeding and infection.
How will I feel after my operation?
Treatment of wisdom teeth is generally more complex than other dental extractions, so you should expect more symptoms. It is normal to have a period of discomfort, where you may feel unwell, particularly if you have had a general anaesthetic.
The removal of a set of wisdom teeth, or even the removal of one difficult tooth, can require a week or two for you to return to a comfortable state. You should not say that you will have your operation near to an important event and you should allow at least two weeks before an important commitment if possible. You may wish to consider taking time off work or get help in the home, especially if you have young children.
On the day of your operation
Please refer to your personal appointment letter for your specific details. Your treatment may be under local anaesthesia, sedation or general anaesthesia and this should have been clarified with you at your initial appointment.
After care
- After your operation you will be given verbal instructions, a written advice sheet, and if necessary, a follow-up appointment.
- You will be given advice regarding pain relief after surgery and with very difficult surgery, may be given a prescription of pain-killing tablets.
- In exceptional circumstances, you may be given a prescription for antibiotics, but these are rarely needed for routine wisdom tooth removal.
- It is important to keep your mouth very clean. You should clean your teeth with a toothbrush twice daily. After 24 hours, gently rinse your mouth with warm salt water (one teaspoon of salt in a glass of warm water) 3-4 times per day, always after meals.
- Smoking should be avoided for at least 5 days after surgery as this causes delay in the healing of mouth wounds and predisposes to post-operative infections.
- Alcohol should be avoided until your mouth has healed as it may provoke post-operative bleeding or produce a severe reaction with some drugs which may be prescribed.
If you are concerned following removal of your wisdom teeth, you should telephone the Help number which will be given to you on discharge.
Useful sources of further information and resources used to create this leaflet
NHS website for wisdom tooth removal NHS Patient Information Leaflet on Tooth removal Royal College of Surgeons Leaflet on Recovering from wisdom tooth surgery NICE Guidance on Removal of wisdom teeth
If you have any questions about the management of your wisdom teeth or if you have any doubts about your operation, please ask before your operation