What are wisdom teeth?
Wisdom teeth, also known as third molars, are the last adult teeth to develop. Most people have up to four wisdom teeth, one at the back of each corner of the mouth.
They usually appear between the late teenage years and the mid-twenties, although they may emerge later or not at all.
Many wisdom teeth grow into a normal position and never cause any problems. Others do not have enough space to come through properly and may become trapped beneath the gum or against another tooth. These are known as impacted wisdom teeth.
Do wisdom teeth always need to be removed?
No. Many wisdom teeth can safely be left in place.
Wisdom teeth generally only need to be removed when they are causing problems or when there is a significant risk of future damage to the surrounding teeth or tissues.
Sometimes a wisdom tooth can be causing damage without producing any pain. For example, an impacted lower wisdom tooth may cause decay or gum disease affecting the molar immediately in front of it.
The decision to remove a wisdom tooth is therefore based on its position, any existing disease, the likelihood of future problems and the risks associated with surgery.
If your wisdom tooth is healthy and unlikely to cause problems, keeping it under review may be the best option.
Why might a wisdom tooth need treatment?
The most common reasons include:
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Repeated infections (pericoronitis): When a wisdom tooth only partially emerges, bacteria and food can collect beneath the surrounding gum, causing pain, swelling and infection.
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Tooth decay: Wisdom teeth can be difficult to clean, making them more vulnerable to decay.
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Damage to the neighbouring tooth: An impacted wisdom tooth can cause decay, gum disease or occasionally damage to the roots of the tooth immediately in front.
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Gum disease: Food and bacteria can collect around an impacted tooth, leading to inflammation and loss of supporting bone.
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Cysts: Occasionally, a fluid-filled cyst can develop around an unerupted wisdom tooth.
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Other planned treatment: Wisdom teeth sometimes need to be removed as part of jaw surgery or other surgical treatment.
A single mild episode of gum inflammation does not necessarily mean that a wisdom tooth needs to be removed. However, repeated infections or one particularly severe infection may make removal advisable.
What happens at my consultation with Mr Maini?
Your consultation will include a discussion of your symptoms, medical history and any previous problems with your wisdom teeth.
Your surgeon will examine your mouth and may recommend an X-ray, usually an orthopantomogram (OPG), which shows your teeth and jaws.
The X-ray helps establish the position of your wisdom teeth, whether they are affecting neighbouring teeth, and how close their roots are to important structures such as nerves.
Sometimes, a cone beam CT (CBCT) scan may be recommended to provide a more detailed three-dimensional view. This is particularly useful in selected cases where a lower wisdom tooth is close to the nerve supplying sensation to the lower lip and chin, and the additional information may influence treatment.
Not everyone needs a CBCT scan.
Following the assessment, your surgeon will explain whether treatment is recommended and discuss the available options, including leaving the tooth in place.
How are wisdom teeth removed?
The technique depends on the position of the tooth and whether it has fully emerged through the gum.
Some wisdom teeth can be removed relatively simply, in a similar way to other teeth.
Impacted wisdom teeth may require a surgical procedure. This can involve lifting the gum, removing a small amount of surrounding bone and dividing the tooth into sections to allow it to be removed safely. Dissolving stitches are usually used if needed.
Patients can go home on the same day.
What type of anaesthetic will I need?
Wisdom teeth can be removed under:
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Local anaesthetic: An injection numbs the area. You remain awake but should not feel sharp pain, although you may notice pressure and movement.
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Local anaesthetic with sedation: Medication helps you feel relaxed and less aware of the procedure.
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General anaesthetic: You are completely asleep throughout the procedure and will be unaware of what is happening.
The most appropriate option will depend on the complexity of the surgery, your medical history, your preferences and the number of teeth being removed.
What type of anaesthetic will I need?
What type of anaesthetic will I need?
What is a coronectomy?
In some patients, the roots of a lower wisdom tooth lie very close to the nerve supplying sensation to the lower lip and chin.
Removing the entire tooth may carry an increased risk of nerve injury.
In suitable cases, an alternative procedure called a coronectomy may be recommended.
During a coronectomy, the crown (top portion) of the wisdom tooth is removed while the roots are deliberately left in place.
This can reduce the risk of injury to the inferior alveolar nerve.
If the roots are found to be mobile during the coronectomy, they will be removed.
The retained roots will usually remain buried beneath the gum and cause no further problems. However, they can occasionally move towards the surface over time, become painful or infected, or require removal at a later date.
Coronectomy is not suitable for every patient or every wisdom tooth. Your surgeon will explain whether it is an appropriate option for you.
What are the risks of wisdom tooth surgery?
Wisdom tooth removal is a common and generally safe procedure. However, as with any operation, there are potential complications.
Your surgeon will explain the risks relevant to your particular wisdom tooth before you decide whether to proceed.
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Pain, swelling and bruising
Some discomfort, facial swelling and bruising are normal after surgery. Swelling is usually most noticeable and increases during the first two to three days and then gradually settles.
You may also experience temporary stiffness or difficulty opening your mouth.
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Infection
Occasionally, an infection can develop after surgery. This may require further assessment, cleaning of the area or antibiotics.
Dry socket
A dry socket occurs when the blood clot within the extraction socket breaks down or is lost before healing has progressed sufficiently.
It typically causes increasing pain a few days after the extraction, sometimes accompanied by an unpleasant taste or smell.
Although painful, a dry socket can usually be managed with appropriate treatment.
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Nerve injury
Two important nerves run close to lower wisdom teeth.
The inferior alveolar nerve supplies sensation to the lower lip and chin, while the lingual nerve supplies sensation to part of the tongue and contributes to taste sensation.
Occasionally, removal of a lower wisdom tooth can cause bruising or injury to one of these nerves, leading to numbness, tingling or altered sensation.
In most cases where this occurs, sensation improves over time. However, in a small number of patients, the changes may be long-lasting or permanent.
The risk varies considerably depending on the position of the tooth and its relationship to the nerves. Your surgeon will discuss your individual risk following assessment of your X-rays.
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Other possible complications
Less common complications include prolonged bleeding, damage to neighbouring teeth or restorations, and problems involving the sinus following removal of an upper wisdom tooth.
Very rarely, more significant complications can occur.
What should I expect after wisdom tooth surgery?
Most patients experience some discomfort, swelling and stiffness following wisdom tooth removal.
The amount of recovery time depends on the difficulty of the extraction, the number of teeth removed and the individual patient.
For the first few days, you should:
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Take the recommended pain relief as directed.
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Eat soft foods and drink plenty of fluids.
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Avoid vigorous exercise and strenuous activity.
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Avoid smoking or vaping, as this can interfere with healing.
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Avoid vigorous rinsing or spitting during the first 24 hours.
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Keep your mouth clean, following the instructions given by your surgeon.
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Begin gentle warm salt-water mouth rinses after the first 24 hours, if advised.
Most people can return to normal daily activities within a few days, although more difficult surgical extractions may require additional recovery time.
Complete healing of the extraction site takes longer.
Should I have wisdom tooth surgery now?
There is no single answer that is right for everyone.
In some patients, the risks of removal are low and early treatment may prevent damage to the neighbouring teeth. In others, particularly when an impacted tooth is deeply buried and close to a nerve, leaving it in place may be safer.
It is also important to recognise that wisdom tooth removal can become more difficult, and recovery may take longer, as we get older.
Your surgeon will consider your age, symptoms, X-rays, overall dental health and personal circumstances before advising you.
The aim is to recommend treatment only when the expected benefits outweigh the risks.