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Surgical removal of wisdom teeth

Posted Jan 30 2012 6:47am

Problems with wisdom teeth are common and can be easily resolved through surgery. This article will be of help to anyone wanting to know how wisdom teeth are surgically removed and what the associated problems might be.

The wisdom tooth (or third molar) is the last tooth to erupt into the mouth and does so sometime after 16 years of age. Frequently there is not enough room to accommodate wisdom teeth and therefore they do not come through into the mouth normally. When this happens the wisdom teeth are said to be “impacted”. Wisdom teeth are usually either impacted forwards into the tooth in front or backwards into the jaw bone.

An impacted wisdom tooth can cause a number of problems that mean the tooth is best removed. Most commonly these are:

  • Repeated attacks of infectionInvasion by organisms that may be harmful, for example bacteria or parasites. in the gum surrounding the tooth, this leads to pain and swelling. Painkillers or antibioticsMedication to treat infections caused by microbes (organisms that can't be seen with the naked eye), such as bacteria. are often required.
  • Food packing which causes decay in either the wisdom tooth or the tooth in front
  • Cysts can form around the wisdom tooth if it does not come into the mouth properly. A cystA fluid-filled, enclosed pouch developing in a bodily structure as part of a disease process occurs when fluid fills the sack that normally surrounds a developing wisdom tooth.

The National Institute for Clinical Excellence (NICE) has published guidance on the extraction of wisdom teeth .

If a wisdom tooth has not fully erupted into the mouth then in order to remove it the first step is often to make a cut in the gum over the tooth. Sometimes it is also necessary to remove some bone surrounding the crown of the wisdom tooth. Rarely the tooth needs to be divided into two or three pieces to remove it. Once the wisdom tooth has been removed the gum is put back into the correct place with stitches. In the majority of cases these stitches are dissolvable and take around two weeks to fall out.

A number of options are available and depend on how difficult the wisdom tooth is to remove:

Local anaesthetic – this is an injection into the gum surrounding the wisdom tooth, rather similar to the one your dentist would give you 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. This is the best option for wisdom teeth that are simple to remove.

Local anaesthetic and intravenous sedation – in addition to a local anaesthetic injection you can be given an injection of sedative into your arm. This makes you feel relaxed and less aware of the procedure but you are still awake. You need to recover in hospital for a few hours after sedation and also will need to arrange for somebody to drive you home.

General anaesthetic – this is when you are put to sleep completely. It is usually possible to remove wisdom teeth under a “day case” general anaesthetic, i.e. although you are put to sleep you will be able to go home on the same day as the surgery. Again you will need to arrange a lift home.

This is variableLiable to vary or change.. Some wisdom teeth may take only a few minutes to remove. More difficult wisdom teeth that need to be divided before removal can take 20 minutes or longer to extract.

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 disappears. You may also find that your jaw is stiff and you may need to eat a soft diet for a week or so. If your mouth 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 around the time of the extraction. Rarely there may be some bruising on the skin of your face that can take up to a fortnight to fade away.

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 site of the extraction because it is sore. 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.

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 or operate machinery (for 24 hours after intravenous sedation and for 48 hours after a general anaesthetic).

  • 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 particularly 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 ten minutes with a rolled up handkerchief or swabAbsorbent material used to mop up bodily fluids, such as blood, for instance during an operation, or to take a sample for laboratory analysis. The term may also be used as a verb to mean the action of taking a swab.
  • Infection is uncommon particularly if antibiotics are used and you keep your mouth as clean as possible for the first week or so after surgery.
  • There are two nervesBundles of fibres that carry information in the form of electrical impulses. that lie close to the roots of lower wisdom teeth. One of these nerves supplies feeling to the lower lip, chin and lower teeth on the same side as the wisdom tooth. The other supplies feeling to your tongue and helps with taste, again on the side of the tooth in question. Sometimes these nerves may be bruised when a wisdom tooth is taken out. This can cause tingling or numbness in your lip, chin or tongue, and more rarely altered taste. About one in ten people will have some tingling or numbness that can last several weeks. Less than one in 100 people will have problems that last more than a year. These risks may be higher if your tooth is in a difficult position. The surgeon will discuss this with you if you are considered to be at an increased risk.
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