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Wisdom teeth removal

Wisdom teeth removal means having one or more of the third molars (your wisdom teeth) at the back of your mouth taken out. This can sometimes involve a surgical procedure.

Your wisdom teeth are the last four of the large grinding teeth (molars) at the back of your mouth to come through. You’re likely to have them by the time you reach your mid-twenties, though some people find they come through earlier or later than this.

Sometimes, your wisdom teeth don’t come through properly (they’re impacted). This can cause problems such as pain, swelling and infection. Having wisdom teeth taken out can ease these symptoms.

How a wisdom tooth is removed
Wisdom teeth can cause problems if there isn't enough space for them to grow at the back of your mouth

Why would I need to have my wisdom teeth removed?

Wisdom teeth don’t always need to be removed. For many people, they come through normally and don’t cause any problems. However, as your wisdom teeth are your last teeth to come through, there’s often not enough space in your mouth for them to grow properly. They can get partially stuck in your gums, or grow at an angle. This is called an impacted wisdom tooth. Even impacted wisdom teeth don’t always need to be taken out if they aren’t causing any symptoms.

Sometimes though, the way an impacted wisdom tooth is positioned can make it easy for food and bacteria to get trapped around the gum. This can lead to swollen and sore gums (pericoronitis), tooth decay and infection. If you’re having problems such as these, your dentist may recommend taking the impacted tooth out.

Having your wisdom teeth removed is one of the most common procedures done in the UK. It’s usually done in your late teens or twenties, when your wisdom teeth come through.

Preparing for wisdom teeth removal

Your dentist will ask you to have an X-ray before having a wisdom tooth removed, so they can see the exact position of the tooth in the gum. This will allow your dentist to work out the best way to remove the tooth. More often than not, wisdom tooth removal is a straightforward procedure that your dentist will be able to do at the dental practice, under local anaesthesia.

If your tooth looks like it will be more difficult to remove, your dentist may need to refer you to a specialist oral surgeon. You’ll need to have the procedure in hospital and you may be offered general anaesthesia. A general anaesthetic can make you sick, so if you’re having one, it's important not to eat or drink for six hours before your operation. Follow your dentist or surgeon’s advice.

Your nurse or surgeon will discuss with you what will happen before you have the procedure, including any pain you might have. If you’re unsure about anything, ask. No question is too small. Being fully informed will help you feel more at ease and will allow you to give your consent for the procedure to go ahead. You may be asked to do this by signing a consent form.

What are the alternatives to wisdom teeth removal?

If your wisdom teeth aren’t causing you any problems, even if they’re impacted, then you won’t need to have them taken out.

If your dentist thinks there’s a high risk of the nerves around your tooth being damaged, you may be offered a coronectomy. This is a procedure where the crown of the tooth is taken out but some of the root is left in place. This may help to reduce the chances of nerves around your tooth being damaged.

Talk to your dentist for more information about your choices.

What happens during wisdom teeth removal?

The procedure for removing your wisdom teeth will vary, depending on how difficult your teeth are to take out. Upper wisdom teeth are usually easier to remove than lower ones. Your dentist or oral surgeon can tell you exactly what to expect.

If you’re having your wisdom teeth removed at your dental practice, you’ll usually have it done under local anaesthesia. The local anaesthetic will completely block pain from your gums, but you will stay awake while your wisdom teeth are being removed. You may be offered sedation as well as local anaesthesia. This helps you to relax.

If you’re having your teeth taken out in hospital, you may be offered general anaesthesia. If you have a general anaesthetic, you’ll be asleep during the procedure.

Once the anaesthetic has taken effect, your dentist or surgeon will use special tools to gradually ease your tooth out, cutting into the gum if necessary. If your dentist or surgeon has cut into your gum, you may need dissolving stitches to close the wound.

What to expect afterwards

What happens after you have your wisdom teeth removed will depend on the type of anaesthesia you have. If you have general anaesthesia or sedation, make sure someone can take you home. And ask someone to stay with you for a day or so while the anaesthetic wears off.

After local anaesthesia, it may take several hours before the feeling comes back into your face and jaw. Take special care not to bump or knock the area. Don’t eat or drink anything for the first six hours after the procedure. You might have some discomfort as the anaesthetic wears off. But you'll be offered pain relief as you need it. You will be able to go home when you feel ready.

Your dentist or oral surgeon should give you some advice about looking after your teeth and gums before you go home. You may be given painkillers and mouthwash to use at home. You may also be prescribed a course of antibiotics to take, if there are signs that you have an infection when your tooth is taken out.

Recovering from wisdom teeth removal

Pain relief

It may take a few days to feel completely better after wisdom teeth removal. You’re likely to have some pain and discomfort after the procedure. This is usually worse for the first couple of days. You can take over-the-counter painkillers such as paracetamol or ibuprofen. Your dentist or surgeon may suggest you take both medicines because they can work well together to reduce pain. Follow the instructions in the patient information leaflet that comes with your medicine and ask your pharmacist if you need any advice.

As well as some pain, you may also have some swelling and stiffness in your jaw for a couple of days. This can make it difficult to open your mouth. Using an ice pack wrapped in a towel can help to reduce this.

Keeping the wound clean

Rinsing out your mouth will keep the wound clean and help it to heal. Do this very gently during the first 24 hours. If you rinse too forcefully, it can move the blood clots that have developed over the wound, and this can cause bleeding. Rinse after you have eaten with an antimicrobial mouthwash or salt water. This helps to get rid of bits of food.

Brush your teeth as usual, as best you can, gradually getting closer to the wound over a few days. After three or four days, you should be able to gently brush away any dissolving stitches you may have had.

If your wound starts to bleed after the procedure, you can bite down on a piece of gauze or a handkerchief for five minutes to stop it. Don’t eat very hot or cold food if your wound is bleeding, as this can make it start again.

Eating and drinking

You shouldn’t eat or drink at all for the first few hours after the operation. Then, for the first few days, stick to soft or liquid foods only. You can gradually return to your usual diet, but to begin with, try not to chew on the areas of your mouth that are healing. It’s best if you avoid alcohol or very hot or cold drinks for the first 24 hours.

Side-effects of wisdom teeth removal

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. The main side-effects from wisdom teeth removal include:

  • pain, swelling and bruising around your jaw
  • difficulty opening your mouth
  • bad breath
  • tiredness
  • sensitive teeth around where the tooth was removed

Any side-effects should get better within two to three days after your wisdom teeth are removed.

Complications of wisdom teeth removal

Complications are when problems occur during or after the procedure. These may include the following.

  • Infection of the tissues around the area where your wisdom tooth was removed.
  • Accidental damage to teeth nearby.
  • Dry socket. This is when the blood clot comes off your wound exposing the bone and nerves underneath. It can be painful and cause bad breath too. See FAQs for more information.
  • Damage to nerves. This can cause pain, tingling, pins and needles and numbness. This can affect your lips, tongue, gums and teeth. It’s usually temporary, but there is a small chance it could be permanent.
  • A broken jaw, though this is extremely rare.

Most people don't have any problems after having their wisdom teeth removed. But you should get medical advice if you have symptoms of any of the complications listed above.

The exact risks are specific to you and will differ for every person, so we haven’t included statistics here. Ask your dentist or oral surgeon to explain how these risks apply to you.

FAQ: Do I need time off work after wisdom teeth removal?

Wisdom teeth removal is a relatively minor procedure – you won’t need to take a lot of time off work. The time you need depends on what your job is, the type of anaesthetic you had and how quickly you recover.

If you have a job where you’re relatively inactive, then you should be back to work a day of two after the procedure. If you have a job where you’re physically active or doing heavy manual work, you may need to take a bit longer off.

It’s good to get back to your normal routine as soon as possible. You don’t need permission from your dentist or surgeon to go back to work – you can go when you feel ready.

FAQ: Can I have wisdom teeth taken out while I’m pregnant?

You can have an anaesthetic to have wisdom teeth taken out when you’re pregnant. However, your dentist or surgeon will only advise having the procedure if it can’t wait until after your baby is born. This is to reduce the risk of any problems for you and your baby. If your wisdom teeth need to be removed, the second trimester is the best time for this to happen. Your dentist or oral surgeon will discuss your options with you.

FAQ: What is dry socket?

Dry socket is when the blood clot that develops in the hole where your tooth was, gets dislodged. This leaves the bone underneath exposed and it can be quite painful. Dry socket can also cause bad breath.

Around five in every 100 people who have a wisdom tooth removed develop dry socket. You’re more likely to get it if you’re a woman, and if you have teeth removed from your lower jaw, rather than the upper one.

The main symptom is pain, which starts two to three days after the tooth is taken out and which gradually gets worse. The pain can spread to your ear and neck and can be severe. The pain and other symptoms can last for up to 10 days after your procedure.

Mouthwashes containing the antiseptic chlorhexidine can help stop you getting dry socket. Your dentist or surgeon may prescribe this for you.

If you have severe pain and normal painkillers aren’t helping, you should visit your dentist immediately. Treatments for dry socket include painkillers, rinsing out the socket to clean it, and packing the socket with a dressing soaked in painkillers and antiseptic.

Details

  • Wisdom teeth treatment

    Our Bupa Dental Centres offer a range of routine, specialist and cosmetic treatments including wisdom teeth removal. Find out more.

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Wisdom teeth. Oral Health Foundation, www.dentalhealth.org, accessed 23 August 2017
    • Removal of impacted wisdom teeth. British Association of Oral and Maxillofacial Surgeons.  www.baoms.org.uk, accessed 23 August 2017
    • Hollins C. Levison’s textbook for dental nurses. 11th ed. Wiley Blackwell; 2013
    • Dodson TB, Susarla SM. Impacted wisdom teeth. BMJ Clinical Evidence 2014:1302
    • Oral surgery. Oxford handbook of clinical dentistry. oxfordmedicine.com, published August 2014
    • Guidance on the extraction of wisdom teeth. National Institute for Health and Care Excellence (NICE), 2000. www.nice.org.uk
    • Get Well Soon. Helping you to make a speedy recovery after removal of wisdom teeth. Royal College of Surgeons. www.rcseng.ac.uk, accessed 7 July 2017
    • Ghaeminia H, Perry J, Nienhuijs MEL, et al. Surgical removal versus retention for the management of asymptomatic disease-free impacted wisdom teeth. Cochrane Database of Systematic Reviews 2016, Issue 8. DOI:10.1002/14651858.CD003879.pub4
    • Pogrel AM, Lee JS, Muff DF. Coronectomy: a technique to protect the inferior alveolar nerve. J Oral Maxillofac Surg 2004; 62:1447–52
    • Oral and maxillofacial surgery. Oxford handbook of operative surgery (online). Oxford Medicine Online. oxfordmedicine.com, published June 2017
    • Tooth extraction. Medscape. emedicine.medscape.com, updated April 2015
    • Bailey E, Worthington HV, van Wijk A, et al. Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth. Cochrane Database of Systematic Reviews 2013, Issue 12. DOI:10.1002/14651858.CD004624.pub2
    • Coulthard P, Bailey E, Esposito M, et al. Surgical techniques for the removal of mandibular wisdom teeth. Cochrane Database of Systematic Reviews 2014, Issue 7. DOI:10.1002/14651858.CD004345.pub2
    • Daly B, Sharif MO, Newton T, et al. Local interventions for the management of alveolar osteitis (dry socket). Cochrane Database of Systematic Reviews 2012, Issue 12. DOI:10.1002/14651858.CD006968.pub2
    • Nejdlova M, Johnson T. Anaesthesia for non-obstetric procedures during pregnancy. BJA Education. 2012;12(4):203–06
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