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Wisdom Tooth Extraction

The third (and final set) of molars many people get in their early twenties or late teens is called wisdom teeth. When properly aligned and healthy, the wisdom teeth can be a valuable addition. In many cases however, they are often misaligned and may require removal.

When misaligned, your wisdom teeth can be angled away or toward the second molars. They can also be angled outward or inward or may be positioned horizontally. Poor wisdom teeth alignment may crowd adjacent teeth and cause damage to the teeth, nerves, or jawbone.

Your wisdom teeth can also become impacted when they only partially erupt through the gum or when they are enclosed within the jawbone or soft tissue. Partial eruption of the wisdom teeth may provide an opening for bacteria and cause infection. This can result to swelling, jaw stiffness, and pain.

Wisdom teeth that are partially erupted are also more susceptible to gum diseases and tooth decay since their awkward positioning and hard-to-reach location makes flossing and brushing very difficult.

Do I have a wisdom tooth?

Visit your dentist and ask about the positioning of your wisdom teeth. To evaluate the presence and alignment of the wisdom teeth, an X-ray may be taken periodically. Your dentist will also be the one to decide if you need to visit an oral surgeon for further evaluation.

Your dentist can give recommendations if your wisdom teeth need extracting before any problems can develop. This is also done to help ensure a more complicated and painful extraction a few years down the road is avoided.

Wisdom teeth removal is often easier in young people since the bone is less dense and the roots are not fully developed yet. In older people, there is a tendency for the recovery and healing time to last longer.

When there is no sufficient room in your mouth to allow the third molars to fully erupt, multiple dental problems can occur. Ideally, impacted wisdom teeth should be extracted before the tooth structure develops fully.

In some patients, the wisdom teeth can emerge as early as 12 or 13 years old. In others, the wisdom teeth won’t appear until they are in their early twenties. Oftentimes, dental problems are likely to occur when the wisdom teeth emerge after the age of 30.

Some of the cases that might warrant removal of the wisdom teeth include:

  • One of the most frequent clinical problem related to wisdom teeth is localised gum infection or pericoronitis. Without ample room for total eruption to happen, the gum tissue surrounding the wisdom tooth can get infected and irritated. This can result in swelling, recurrent pain, and problems with swallowing or chewing.
  • Wisdom teeth that are impacted may result in crowding. There are numerous dental factors that can cause crowding and impacted wisdom teeth is considered one of the likely contributing factors. Removal of wisdom teeth is recommended to avoid any long-term damage to the gums, teeth, and jawbone.
  • Cyst Formation. Non-infectious diseases can occur as a result of impacted wisdom tooth. Cysts are fluid-filled “balloons” that develop inside the jawbone as a result of an impacted wisdom tooth and may slowly spread and destroy the adjacent jawbone. Dental treatment can become difficult when it is left unattended for many years. While rare, tumours are sometimes associated with delayed wisdom teeth removal as well, which is easily preventable with a dental treatment.

Adjacent Teeth Damage. If there is no adequate room to conduct a dental cleaning round the wisdom tooth, the adjacent tooth directly in front of it can be adversely affected and can result in decay, bone loss around the tooth, and gum disease.

The ease at which your dentist can remove your wisdom teeth will depend on two factors—your wisdom teeth’s stage of development and position. When extraction of your wisdom teeth is needed, your dentist will be able to give you an insight on what to expect before, during, and after the wisdom tooth procedure.

When your wisdom tooth has not fully erupted through your gums, it can be extracted as easily as any other tooth. However, if the wisdom tooth is situated underneath the gums and embedded in the jawbone, an incision into the gums and dental removal of the bone portion that lies over the tooth may be required.

In similar scenarios, the wisdom tooth will be extracted in small sections as opposed to remove in one piece. This is done to minimise the amount of bone that will be removed in order to get the tooth out.

After your wisdom teeth is removed, the speed of recovery will depend largely on the difficulty of the extraction. For instance, you can expect different recovery speeds between a tooth impacted into a jawbone versus a fully erupted tooth.

Generally, here’s what you can expect after the procedure:

The first 24 hours

Bleeding can occur several hours after the extraction of your wisdom tooth. To help minimise bleeding, you can position a clean moist gauze on the tooth socket and bite down firmly. Make sure constant pressure is applied for at least 45 minutes. The procedure is ideal for minimal bleeding. If heavy bleeding occurs after a wisdom tooth extraction, getting in touch with your dentist is recommended. Also, refrain from spitting or rinsing for 24 hours after your wisdom tooth has been removed. Sucking actions like smoking or drinking beverage using the straw should also be avoided. Activities mentioned earlier should be avoided for the time being as it can dislodge the clot, resulting to a dry socket.

  • Swelling in the facial area where the wisdom tooth was extracted can occur. To minimise the swelling, wrap a piece of ice in a clean cloth and place it on the affected area of the face for at least 10 minutes. A 20-minute rinse off should follow each time. Repeat as needed during the first 24- hour period.
  • Pain medications like ibuprofen or acetaminophen may be prescribed to ease minor pain. However, your dentist may prescribe a more powerful pain reliever when the need calls for it.
  • You need to continue taking antibiotics that have been prescribed prior to the wisdom tooth extraction. In some cases, antibiotics are prescribed prior to wisdom tooth extraction to treat any active infection around the tooth to be extracted. The antibiotics should be taken continuously until the full prescription has been consumed.
  • You are restricted to a liquid diet the first 24 hours.A liquid diet is recommended within the first 24 hours after the wisdom tooth procedure or after the anaesthesia has worn off. You might also be advised to eat soft foods, at least for the first few days after the dental procedure.
  • You can still brush your teeth.However, you need to avoid brushing the teeth directly adjacent to the wisdom tooth that has been extracted during the first 24 hours. Mouth rinses need to also be avoided for the time being until the site has healed fully.

Frequently Asked Questions

Does everyone have wisdom teeth?
Not everyone will have wisdom teeth. While many will have all 4 wisdom teeth, some will only have three or two. Others will only have one.
When there is no adequate room after the second molar for the wisdom tooth to develop and emerge normally, it is considered impacted.
Ideally, it is considered best to have wisdom teeth removed before the roots have been formed fully. When the roots have been fully formed, extraction can become more difficult. Also, when the surgery is done before the root has fully developed, surgery is easier and recovery time is faster.
Wisdom teeth that does not grow properly can pose some dental risks including infected/inflamed gum tissues, cavities, damage to surrounding teeth, cyst growth, sinus issues, and alignment problems.
Oftentimes, wisdom teeth does not grow in like the other teeth. If they are impacted, they are more angled and will have to be sectioned into pieces before it can be extracted. In addition, the wisdom teeth’s root anatomy needs to be taken into account. Wisdom teeth can have multiple roots and can be shaped in a variety of ways. It can also be fused together or it can grow separately. When the wisdom teeth has an irregularly shaped roots, extraction can become more difficult.
After the wisdom teeth is removed, there will be a hole in the bone. That hole is called a socket. A blood clot will form in the area in order to protect the nerves and bone underneath. If the clot becomes aggravated or dislodged, the nerve and the bone becomes exposed to fluids, air, and food. This exposure can sometimes result to an infection or a dry socket.
Typically, dry sockets occur at least 3 to 4 days after wisdom teeth extraction. Symptoms that point to dry socket include pain that radiates to the ear, pain that is not alleviated even after taking medications, and unpleasant smell or taste in the mouth.
After wisdom teeth removal, it is considered normal to experience bruising and swelling. In most cases, the swelling will improve in a few days while it may take a while longer for the bruising to clear up.
Gargling the first 24 hours after the procedure should be avoided. Following that, a light swish with mouth wash or warm salt water can be done. However, gargling vigorously is not recommended until your dentist has given you the go signal.
Ideally, waiting for 3 to 4 days after wisdom teeth removal is needed before resuming exercise or participating in other vigorous activities. Exercising prematurely may aggravate the blood clot, cause discomfort, and lengthen time needed for recovery.
Typically, the procedure can take up to an hour and half. At least 2 or 3 days of swelling and discomfort can also be expected. Post-operative healing time can also vary from one patient to another and can range from a couple of days to at least a week.
You should not feel any pain during the procedure because the area will be numbed using an anaesthetic. However, if you do feel any pain during the procedure, it is recommended that you tell your dentist about it immediately.
Getting the wisdom teeth extracted is not necessary if they are positioned correctly and does not cause any dental problems or pain. If they cause crowding or are impacted, having them removed is often the recommended solution.
Unfortunately, problems related to the wisdom teeth are inevitable. The good thing is, wisdom teeth problems can be minimised by predicting their eruption. This can be done using panoramic radiograph and by evaluating certain factors like the formation of the roots, the size of the teeth, the space available, the direction of the eruption, etc.
Removing wisdom teeth can cause swelling for a few days. However, as soon as the area has been healed, you will not notice any difference in your face, mouth, or appearance. If anything, your mouth will feel less crowded and more comfortable especially if you were dealing with an impacted wisdom tooth.