When should wisdom teeth be removed?

In our latest article, leading consultant oral and maxillofacial surgeon, Professor Andrew Sidebottom, provides a comprehensive, detailed, and expert overview of when wisdom teeth need to be removed, as well as telling us what exactly a wisdom tooth removal entails.

What are wisdom teeth?

Wisdom teeth are the last teeth at the back of your mouth (the third molar teeth). They tend to come through (erupt) in the late teens or twenties, and provide an extra tooth to bite with. Some wisdom teeth do not come through fully (partly erupt) and get stuck against nearby teeth or bone. This often leaves a flap of gum over your tooth.

Why do wisdom teeth need to be removed?

A wisdom tooth may need to be removed for one or more of the following reasons:

• serious infection of the gum that partly covers your tooth (pericoronitis)

• tooth decay

• if you require jaw alignment surgery

• gum disease around the tooth

• the tooth may grow a cyst around it

• the tooth may in be the line of a fracture

Wisdom teeth in your lower jaw take longer to come through and are more often impacted, making repeated infections more likely.

Are there any alternatives to removing a wisdom tooth?

Simple painkillers such as paracetamol can help control mild pain caused by wisdom teeth. Antibiotics, as well as rinsing with hot, salty water or chlorhexidine mouthwash, can help greatly when the area around the wisdom tooth is infected.

These measures, however, do unfortunately only give temporary relief from symptoms and do not treat the underlying cause. Removing the gum lying over your tooth (operculectomy) may be possible in certain cases if a wisdom tooth has partly erupted.

An infection can be made worse if you have an upper wisdom tooth that bites down on the flap of the gum covering the partly-erupted lower wisdom tooth. For this reason, removing an upper wisdom tooth can sometimes cure the problem, delaying, or even avoiding the need to remove the lower wisdom tooth.

If the root of your tooth lies close to the nerve that supplies feeling to your lower lip, it is possible to remove just the crown of your tooth. This procedure is medically labelled a coronectomy. In the majority of cases, however, the wisdom tooth requires removal.

What does wisdom tooth removal involve exactly?

You may be given antibiotics before the operation, or may be asked to rinse your mouth with chlorhexidine mouthwash to reduce the risk of infection. The majority of upper wisdom teeth can be removed easily under a local anaesthetic.

Lower wisdom teeth can be more difficult to remove, though, and the surgeon will discuss whether a general anaesthetic is appropriate. The operation usually takes between 10 minutes to an hour, depending on how many wisdom teeth need to be removed and how difficult they are to remove.

Removing a wisdom tooth can typically involve cutting the gum to uncover your tooth, removing bone around your tooth, and dividing your tooth with a drill. If the root of your tooth lies close to the nerve that supplies feeling to your lower lip, it may be possible to remove just part of the tooth.

The gum will be closed with stitches which are dissolvable. Your surgeon may also place a pack made of gauze on the wisdom-tooth socket and ask you to bite on it for about 10 minutes in order to stop any bleeding.

What happens after a wisdom tooth removal procedure?

After the wisdom tooth removal operation, your surgeon will make sure that any bleeding has stopped. You should be able to go home the same day if you have had a GA (third molars) or within 30 minutes of LA. A responsible adult should take you home in a car or taxi and stay with you for at least 24 hours if you have had a GA. You will be advised to be near a telephone in case of an emergency.

What does aftercare involve, and what should patients be aware of?

If your wound starts to bleed, bite for 20 minutes on a pack made of gauze, or on a clean handkerchief rolled into a small knot. Do not smoke, and keep your mouth as clean as possible to reduce the risk of infection.

Try to leave your wound alone for one to two days. After around two days, rinse your mouth gently with hot, salty water four times a day for the following two days. For at least the next week, rinse your mouth with chlorhexidine mouthwash twice a day to help keep your remaining teeth clean until you can comfortably brush them again. It can take up to between two to three weeks for your wound to close, so make sure to gently rinse your mouth after meals to keep your wound clean.

To reduce the risk of bleeding, swelling and bruising, do not exercise, drink alcohol, nor have a hot bath for at least one week. Simple painkillers such as paracetamol and anti-inflammatory painkillers such as ibuprofen should relieve any discomfort.

Eat only soft foods for one to two days, gradually moving on to solid food only when you can chew comfortably. Avoid small, sharp food such as crisps and rice that may get stuck in the socket. Try to chew using the other side of your mouth. You may need to take up to a week off work. You should be able to return to normal activities within a week.

What are the main potential complications following a wisdom tooth removal?

There are a handful of potential rare complications following a wisdom tooth removal. These include the following:

• damage to nearby teeth

• damage to nerves of lower lip and tongue

• sinus problems

• broken jaw

• not being able to open your mouth fully (trismus), and jaw stiffness

Also, a dull throbbing pain can potentially come on after a couple of days. The risk of these will be discussed by your surgeon.

Professor Andrew Sidebottom is a highly experienced and exceptionally proficient consultant oral and maxillofacial surgeon who can provide you with the advice you need regarding your wisdom teeth. Consult with him by visiting his Top Doctors profile.