Why do I need treatment?
An impacted wisdom tooth can cause a number of problems that mean the tooth
is best removed. Most commonly these are
• Repeated attacks of infection in the gum surrounding the tooth. This leads to
pain and swelling.
• Food packing which causes decay in either the wisdom tooth or the tooth in
• Cysts can form around the wisdom tooth if it does not come into the mouth
properly. A cyst occurs when fluid fills the sack that normally surrounds a
developing wisdom tooth. What does the treatment involve? Because
the wisdom tooth has not fully erupted into the mouth it is often necessary
to make a cut in the gum over the tooth. Sometimes it is also necessary to
remove some bone surrounding the crown (upper portion) of the wisdom
tooth. Not infrequently the tooth needs to be cut into 2 or 3 pieces to
remove it. Once the wisdom tooth has been removed the gum is put back
into place with stitches. In the majority of cases these stitches are
dissolvable and take around two weeks to disappear.
The technique of coronectomy is also practiced by some surgeons. In this
technique the upper portion of the wisdom tooth is removed (decoronation)
leaving some of the tooth roots behind in an attempt to minimise the risk of nerve
damage. Early studies suggest that there may be a reduced risk of inferior dental
nerve injury (the nerve giving sensation to the lower lip and skin over the chin)
using this technique. However, there can be up to a 15% complication rate due to
migration of the retained root or delayed healing, resulting in a need for further
What type of anaesthetic is used?
A number of options are available and depend on how difficult the wisdom tooth
is to remove
• Local anaesthetic - this is an injection into gum surrounding the wisdom tooth,
rather similar to that you may have had at your dentist for a filling. The
injection takes a couple of minutes to numb the area and means that you
will feel no pain while the wisdom tooth is removed.
• Local anaesthetic and intravenous sedation – in addition to a local
anaesthetic injection you can be given an injection into your arm. This
makes you feel relaxed and less aware of the procedure. You are awake
but patients frequently have little or no memory of the operation.
• General anaesthetic – it is usually possible to remove wisdom teeth under a
“day case” general anaesthetic, ie although you are put to sleep
completely you will be able to go home on the same day as surgery. How
long does it take to remove a wisdom tooth? This is a variable. Some
wisdom teeth may take only a few minutes to remove. More difficult
wisdom teeth that need to be cut into pieces to remove can take around
20 minutes to extract. Is there much pain or swelling after the removal
of wisdom teeth? It is likely that there will be some discomfort and
swelling both on the inside and outside of your mouth after surgery. This is
usually worse for the first three days but it may take up to two weeks
before all the soreness goes. You may also find that your jaw is stiff and
you may need to eat a soft diet for a week or so. If it is likely to be sore
your surgeon will arrange painkillers for you. It may also be necessary for
you to have a course of antibiotics after the extraction. There may be
some bruising of the skin of your face that can take up to a fortnight to
Is there anything else I need to do after the extractions?
It is important to keep the extraction sites as clean as possible for the first few
weeks after surgery. It may be difficult to clean your teeth around the sites of the
extraction because it is sore and if this is the case it is best to keep the area free
from food debris by gently rinsing with a mouthwash or warm salt water (dissolve
a flat teaspoon of kitchen salt in a cup of warm water) commencing on the day
after surgery. If possible, avoid smoking.
Do I need to take any time off work?
Usually it will be necessary to take a few days off work and avoid strenuous
exercise for this time. Depending on the type of anaesthetic used you may well
not be able to drive (24 hours after intravenous sedation and for 48 hours after a
What are the possible problems?
1. This is the most common side effect and usually lasts for up to 14 days. The
amount of swelling varies from patient to patient. In addition to this the
application of an ice pack during the first 24 hours post-operatively may help. Do
not apply the ice pack directly to your skin - wrap the ice pack in a towel first.
Restricted Mouth Opening
2. This is a consequence of the swelling and often settles once the swelling
disappears. During this time when your mouth opening is restricted you may
have to modify your diet, eating soft foods. There are however no hard and fast
rules about what you should eat. You must however keep your mouth as clean
as possible to reduce the risks of infection using regular mouthwashes.
3. Although there may be a little bleeding at the time of the extraction this usually
stops very quickly and is unlikely to be a problem if the wound is stitched. Should
the area bleed again when you get home this can usually be stopped by applying
pressure over the area for at least 10 minutes with a rolled up damp andkerchief
or swab. If the bleeding does not stop, please contact the department.
4. Two nerves lie in close proximity to impacted wisdom teeth. The lingual nerve
provides sensation in your tongue whilst the inferior alveolar nerve gives
sensation to the lower lip and skin overlying the chin. Occasionally these nerves
may be bruised during tooth removal. If this happens then you may have either
numbness or pins and needles in either the tongue, lower lip, skin over the chin
or any combination of these. Rarely taste can be affected. This however is
uncommon. Rarely the nerve damage can be permanent. Most of the time it is
temporary although it can take up to 18 months to recover. On occasions it may
not fully recover and on occasional patients may be left with patches of
5. An infection in the space left following wisdom tooth removal is often referred
to as a dry socket. The incidence of this happening is low being in the order of
2%. It can be minimised by adopting scrupulous oral hygiene during the recovery
phase. This usually encompasses normal tooth brushing with additional
mouthwashes as advised plus the avoidance of smoking.
Weakening of the Jaw
6. In exceptional cases wisdom tooth removal can cause significant weakening of
the jaw with the resultant possibility of jaw fracture. The incidence of this
happening is extremely low and is significantly less than 1% (less than 1 in 100].