Most people have four wisdom teeth, two in the upper jaw and two in the lower jaw. These teeth are commonly called wisdom teeth because they usually erupt between the ages of 16 to 21, known as the ‘age of wisdom’. A wisdom tooth is impacted when it is obstructed from erupting fully into the mouth by the tooth in front of it or the surrounding bone or gums.
Improperly erupted wisdom teeth are breeding grounds for bacteria and may cause tooth decay, sometimes even affecting the neighbouring teeth. Infection of the overlying gums can take place as well, resulting in pain and swelling.
More serious problems such as the formation of cysts or tumours around an impacted tooth can occur, leading to destruction of the surrounding jawbone and neighbouring teeth. These conditions may require complex and extensive treatment. As problems can develop silently, without your knowledge, a check-up with your dentist is thus advisable.
How Are Wisdom Teeth Removed?
The relative ease at which your dentist or oral surgeon can extract your wisdom teeth depends on their position and stage of development. Your oral health care provider will be able to give you an idea of what to expect during your pre-extraction exam. A wisdom tooth that is fully erupted through the gum can be extracted as easily as any other tooth. However, a wisdom tooth that is underneath the gums and embedded in the jawbone will require an incision into the gums and then removal of the portion of bone that lies over the tooth. Often, for a tooth in this situation, the tooth will be extracted in small sections rather than removed in one piece to minimize the amount of bone that needs to be removed to get the tooth out.
Check-up and consultation
Your initial visit to the dentist would include an examination of your mouth and X-rays to determine the position of the wisdom teeth, their condition and the status of the adjacent teeth and bone.
To prevent problems associated with impacted wisdom teeth, it is advisable to remove them early. The best time to remove them would be during the teenage years, before the roots of the teeth are fully formed and firmly embedded in the jawbone. Healing is also better during this period, with less risk of complications.
Wisdom tooth surgery
This is a minor surgical procedure that can usually be performed with little discomfort. The procedure can be performed under local anaesthesia (with or without sedation to control anxiety) or general anaesthesia. Your surgeon will advise you on the type most appropriate for your needs.
The surgery involves uncovering the tooth by lifting the overlying gums aside to expose the tooth and bone. The tooth may need to be sectioned in order to remove it. The gums are then stitched back.
After the surgery
What Does Recovery Involve After Wisdom Teeth Are Pulled?
After having your wisdom teeth removed, the speed of your recovery depends on the degree of difficulty of the extraction (a simple extraction of a fully erupted tooth versus a tooth impacted into the jawbone). In general, here’s what to expect.
During the first 24 hours
- Bleeding may occur for several hours after tooth extraction. To control it, position a piece of clean moist gauze over the empty tooth socket and bite down firmly. Apply constant pressure for about 45 minutes. A moistened tea bag is an effective alternative. The tannic acid in tea helps healing blood clots to form (blood clots function similarly to scab over an open wound). Repeat this process if a small degree of bleeding continues; if heavy bleeding continues to occur, contact your dentist or oral surgeon. Avoid rinsing or spitting for 24 hours after tooth extraction, avoid “sucking” actions (for example, don’t drink beverages through straws or smoke) and avoid hot liquids (such as coffee or soup). These activities can dislodge the clot, causing a dry socket (see below) to develop.
- Facial swelling in the area where the tooth was extracted typically occurs. To minimize swelling, place a piece of ice, wrapped in a cloth, on that area of your face on a schedule of 10 minutes on, followed by 20 minutes off. Repeat as necessary during this first 24-hour period.
- Pain medications, such as acetaminophen (Tylenol) or ibuprofen (Motrin or Advil), can be taken for minor pain. Your dentist or oral surgeon may prescribe more potent pain relievers, if necessary.
- Antibiotics that may have been prescribed prior to tooth extraction (to treat any active infection around the wisdom tooth to be extracted) should continue to be taken until the full prescription is gone.
- Foods should be restricted to a liquid diet until all the numbness from anesthesia has worn off. Eat soft foods for a few days. Also avoid alcohol if you’re also taking narcotic pain medication.
- Continue to brush your teeth, but avoid the teeth directly neighboring the extracted tooth during the first 24 hours. On day two, resume the gentle brushing of your teeth. Do not use commercial mouth rinses — these can irritate the extraction site.
After 24 hours
- Facial swelling in the area of the tooth extraction should be treated with heat after the first 24 hours of ice. Apply a moist warm towel to the area on a 20-minute on, 20-minute off schedule. Repeat as necessary.
- Rinse your mouth with warm salt water (1/2 teaspoon of salt in a cup of warm water) after meals and before bed. Do not use commercial mouth rinses.
- Stitches, if used and if not of the self-dissolving type, need to be removed by your oral health care provider in about 1 week. If you do require stitches, ask what type you have been given.
- Watch for signs of dry socket (described below). This condition requires treatment by your oral health care provider.
- Complete healing doesn’t occur for a few weeks to a few months following the extraction. However, usually within the first week or two, enough healing has taken place for use of your mouth to be reasonably comfortable in the area of the extraction. Your dentist will explain what to expect in your specific case.
What Are Potential Complications of Wisdom Tooth Removal?
Two of the more important complications after having your wisdom teeth removed include:
- Dry socket. Dry socket is a common complication that occurs when either a blood clot has failed to form in the extracted tooth socket or else the blood clot that did form has been dislodged. Without clot formation, healing will be delayed. When it happens, dry socket typically occurs 3 or 4 days following the extraction and is accompanied by pain (ranging from “dull” to moderate to severe) and a foul mouth odor. Your dentist or oral surgeon will treat the dry socket by placing medication in the socket.
- Parasthesia. Parasthesia is a rare complication of wisdom teeth extraction. Wisdom teeth entrapped in the jawbone are often close to nerves. Sometimes these nerves can be bruised or damaged during the tooth removal process. The result is a numbness (called a parasthesia) of the tongue, lip, or chin that can last a few days, weeks, months, or may even be permanent.