Wisdom teeth removal

Adults have 4 wisdom teeth, one at the back of each quadrant of the mouth. These teeth usually come through (erupt) in early adulthood. 

However, sometimes wisdom teeth do not erupt properly and need to be removed. This involves cutting through the gum and removing the whole tooth either in one piece or 2–3 pieces. 

Signs of needing wisdom teeth removal 

As wisdom teeth are the last teeth to erupt, there is not always enough room left in the mouth for them. This can cause the teeth to come through at an angle or become stuck under the gums — these are impacted wisdom teeth. 

Impacted wisdom teeth can cause dental pain and increase your risk of other dental conditions. As a result, they may need to be removed surgically to improve your dental health and relieve any dental pain. 

Signs that you need a wisdom tooth removed include: 

• A dental cyst (a collection of fluid) around the impacted tooth
• An abscess (a collection of pus) around the impacted tooth
• Dental pain ie persistent toothaches
• Food becoming trapped around the impacted tooth despite regular cleaning
• Osteomyelitis — a bone infection
• Pericoronitis — repeated infection of the gum around the impacted tooth 

You may also need wisdom teeth removal if you are having teeth-straightening treatment (orthodontics).  

Is wisdom teeth removal right for you? 

An impacted wisdom tooth that is not causing any dental problems can usually be left in place and monitored at regular dental check-ups. 

If wisdom tooth removal is needed, you will need to have a dental X-ray to check the exact position of the tooth. If it is located too close to certain nerves, surgery to remove the whole tooth may not be suitable due to the risk of nerve damage. Instead, a coronectomy may be performed. 

Alternative treatments to wisdom teeth removal 

If wisdom teeth removal is not suitable due to the location of the impacted tooth, a coronectomy may be recommended. 

This involves removing only the part of the tooth above the gum line and is only suitable if the impacted wisdom tooth is not infected.

Wisdom teeth removal can be performed under a local or general anaesthetic. A cut will be made into your gum to access the impacted wisdom tooth.

In some cases, some of the bone surrounding the root of the tooth may also need to be removed. The tooth will then either be removed whole or be cut and removed in 2–3 pieces.

The gum will be stitched together using dissolvable stitches and gauze will be placed on top to reduce bleeding.

You will be taken to a recovery room where you will be monitored as the anaesthetic wears off.

How to prepare for wisdom teeth removal 

You will need to complete a pre-admission questionnaire, which will ask you questions about your medical history and the support you have at home for your recovery. 

Depending on the answers to this questionnaire, you may need to attend our pre-admission clinic to be assessed by a nurse. 

Before your procedure, an anaesthetist will discuss your options for anaesthesia. 

On the day of your procedure, a nurse will perform some simple tests to check your general health, such as checking your temperature and blood pressure. 

If you are having a local anaesthetic, you can eat and drink as normal before your surgery. However, if you are having a general anaesthetic, you will be asked to fast (ie not eat or drink anything other than water) for several hours preceding your surgery. Your care team will let you know exactly how long you need to fast for. 

Who will be involved? 

Your wisdom teeth removal will be performed by a dental surgeon. Your care team will also include an anaesthetist and a dental nurse. 

The operation 

How long does wisdom teeth removal take? 

Simple cases of wisdom teeth removal are usually completed within 30 minutes; however, more complex cases can take up to 45 minutes. 

Anaesthetic choices 

Before the day of your surgery, your anaesthetist will discuss your options for anaesthesia, namely local or general anaesthesia. 

Local anaesthetic is given as an injection into your gum. You will remain awake but not feel any pain. It can be provided alongside sedation, which is given via a thin tube (intravenous line) inserted into a vein in your arm. 

Sedation will make you feel relaxed and drowsy and usually prevents you from remembering the procedure. 

General anaesthetic is also given via an intravenous line inserted into a vein in your arm. It will make you fall asleep.

Pain during surgery and straight after surgery  

During surgery, you will not feel any pain due to the use of either a local or general anaesthetic. The effects of a local anaesthetic will take 2–4 hours to wear off, while the effects of a general anaesthetic will take up to 24 hours to wear off. 

You can then take over-the-counter painkillers, such as paracetamol and ibuprofen. 

If your pain gets worse as you recover, contact your care team as you may have developed an infection.

What happens straight after surgery 

You will be taken to a recovery room where you will be monitored by a nurse as the anaesthetic and sedation wear off. After about 15 minutes, the gauze placed in your mouth to reduce bleeding will be removed. 

Your hospital stay  

Wisdom teeth removal is usually performed as a day case. This means you can return home on the same day as your procedure. However, if you have a general anaesthetic, you will need to stay overnight in hospital.

Numbness, bleeding and swelling 

Immediately after wisdom teeth removal, you will experience some numbness, bleeding and swelling in your mouth. 

Numbness and bleeding should ease after several hours. Swelling, however, can persist for several days and, in rare cases, for up to 2 weeks. 

Oral hygiene 

You should not rinse or spit for the first 24 hours after your surgery as this can dislodge the blood clot forming over your wound site. 

After this time, you can brush your teeth as usual but should be careful around the site of your surgery. It can help to rinse with a mouthwash that does not contain alcohol during this time to reduce plaque build-up around the site of your surgery. 

Diet 

For the first few days after surgery, you will not be able to open your mouth as widely as usual. You should, therefore, eat soft foods and over the next 1–2 weeks gradually work your way up to your usual diet. 

Painkillers 

You can take over-the-counter painkillers, such as paracetamol and ibuprofen, as needed but do not exceed the dosage stated on the patient information leaflet provided with the painkillers. 

Wound care 

Your gums will be stitched with dissolvable stitches. These will naturally dissolve within 2 weeks. 

Smoking 

Avoid smoking for at least 48 hours after your surgery. This is because smoking significantly increases your risk of infection.

Driving 

You should not drive for at least 24 hours after having a general anaesthetic. You should only return to driving once you feel confident that you can perform the necessary movements, including an emergency stop, safely. 

Short-term side effects 

Wisdom teeth removal causes numbness for several hours and swelling for several days up to 2 weeks.

Recovery time 

You will most likely need to take 3–5 days off work after wisdom teeth removal. Complete recovery usually takes 2 weeks.

Infection 

A few cases in every 100 will develop an infection. Signs of infection include the gum around your surgical site becoming hot, swollen and painful. It may also release a strange-tasting discharge into your mouth.

Most infections can be treated with a course of antibiotics. However, if you develop a type of infection called dry socket, you will need to have the site washed and treated with a healing paste.

Dry socket occurs when the blood clot forming over your surgical site dislodges and saliva passes through and reaches the underlying bone. The bone then becomes inflamed and infected. 

Anaesthetic risks 

General anaesthesia is considered safe; however, it is common to experience the following side effects after having a general anaesthetic:

• Blurred vision
• Dizziness
• Headaches
• Memory loss of the time when the anaesthesia is still wearing off
• Nausea
• Vomiting 

Nerve damage 

A few cases in every 100 will develop numbness and/or tingling affecting the lower half of the face. This is most often temporary but can take up to 18 months to resolve. 

Excessive bleeding 

A few cases in every 100 will develop excessive bleeding. This is usually easily treated with new stitches or in rare cases, further surgery. 

Tooth damage 

Sometimes during a tooth extraction, a root of the tooth can break. Depending on how and where it breaks, your surgeon may either leave it in place or perform more extensive surgery to remove it.