Impacted wisdom teeth and mouth surgery

What is a wisdom tooth, and why does it cause problems?

A wisdom tooth, or third molar, is the last tooth to come through. AAOMS writes that this is usually between seventeen and twenty-five. The NHS adds that problems can happen at any age.

When the jaw does not have enough room for these teeth, the tooth becomes “impacted”, meaning another tooth is blocking it, the gum covers part of it, or it is stuck in the bone. Impacted wisdom teeth are common, and the figures in different sources vary widely. Being impacted is not in itself a disease. The trouble starts when the tooth causes pain, swelling or gum infection (pericoronitis), food gets trapped under it, it damages the neighboring tooth and brings decay or gum disease, or it forms a cyst, meaning a fluid-filled sac, or an abscess around it.

Does it always have to come out?

No. Both sources say that if a wisdom tooth has no pain or disease and is kept clean, it can be kept and watched. The surgeon or dentist judges the position of the tooth from an X-ray. (To learn about the images, see the guide to jaw imaging.)

Removal is suggested when the tooth has caused one of these: pain, a hygiene problem that is hard to fix, infection, gum disease, decay, a cyst or tumor, or damage to the neighboring tooth. The final decision is the doctor’s after examination and X-rays, and you have a right to ask for the reason.

What is tooth removal like?

The NHS describes it:

• The gum is numbed with local anesthetic. If the tooth is harder to remove or the patient is anxious, sedation or a general anesthetic can also be used.
• The surgeon sometimes opens the gum, widens the socket a little and takes the tooth out whole or in two or three pieces. If stitches are needed, they usually dissolve by themselves.
• The work is usually short and, according to this service, does not take more than forty minutes. Most patients go home the same day, and after a general anesthetic may stay overnight.

After removal

• First day. The blood clot over the wound helps healing. Do not touch the wound, and follow the surgeon’s instructions on when and how to rinse your mouth.
• Pain and swelling. Usually ease after a day or two. For up to two weeks there may be bruising on the cheek, a stiff jaw and discomfort when chewing and swallowing.
• Food. Eat soft food or liquids and avoid hard, crumbly foods such as nuts and seeds that get into the wound. Do not have alcohol or very hot drinks. See the guide to eating after surgery.
• Smoking. Smoking raises the risk of infection and dry socket.
• Hygiene. Clean your other teeth carefully and keep away from the wound. The NHS finds gentle rinsing with salt water or mouthwash helpful. Make sure your own surgeon decides the timing and method.
• Bleeding. If it bleeds, press firmly with a clean cloth or gauze for at least ten minutes.
• Activity. The NHS says you might need one to three days off work. Do not drive for 48 hours after a general anesthetic and 24 hours after an injected sedative.

For more detail see the guide to care after surgery. Your own surgeon’s instructions always come before this list.

Possible complications

Most removals finish without a serious problem, but complications can happen:

• Dry socket. The clot does not form properly or comes away early, causing severe, lasting pain. The surgeon can look at the area and manage the pain.
• Infection. Sometimes the surgeon needs to give treatment with medicine.
• Nerve damage. Numbness or tingling of the tongue, lip and chin. It usually improves, but may last a few weeks or months and is rarely permanent.
• Bleeding. A little bruising and oozing of blood is normal, but bleeding that has not stopped needs a call.
• A link to the sinus. With an upper wisdom tooth, an opening sometimes forms between the mouth and the sinus. It usually closes by itself, but tell your surgeon about discharge or sinus pain.

If we do not remove the wisdom tooth

AAOMS lists the risks of keeping a problem impacted tooth like this: damage to the neighboring tooth, infection, decay and gum disease because it is hard to clean, and a cyst or tumor around the tooth that can damage the neighboring teeth and nearby structures. For this reason a wisdom tooth with symptoms should not be left alone for years.

A sore or swelling seen in the mouth does not always have to do with a wisdom tooth. The NHS says a mouth ulcer that lasts more than three weeks should be seen by a dentist or doctor.

When to act urgently

• The NHS says in these situations get an urgent dental appointment: bleeding that will not stop; severe or worsening pain and swelling that painkillers do not ease; pain with a bad taste in the mouth, fever or feeling unwell. Pain getting worse after a few days may be a sign of dry socket or infection.
• Tell your surgeon the same day about fever with spreading swelling, and if you cannot reach the surgeon, go to a hospital emergency room.
• Difficulty breathing or swallowing, swelling of the floor of the mouth, neck or around the eye, and a mouth that will not open and is getting worse with swelling or fever is an emergency. Call 115 and look at the list of urgent signs.

This page is for general information and does not replace an examination.