What is a wisdom tooth extraction?

Wisdom teeth are often the last teeth to appear although not in everyone. Some people never develop them whereas others have up to 4 teeth, at the end of the upper and lower jaws.

If you do get them then this is likely to be in your late teens or early 20’s. They are large molars used for grinding food that appear through the gums.

This is usually a straightforward affair but in some cases they can cause problems. A problem occurs when there are too many teeth in the jaw and so not enough room for the wisdom teeth. If there is not enough room at the rear of the mouth then they will appear at an angle. This condition is known as ‘impacted’ wisdom teeth.

Impacted wisdom teeth can result in swollen gums, bad breath, pain and infection.

There is more than one type of impacted wisdom tooth:

  • Vertical impaction: this is where a wisdom tooth grows straight down but is jammed up against other teeth.
  • Horizontal impaction: the wisdom tooth grows horizontally but jams up against other teeth.
  • Mesial impaction: this is the most common form of impaction. The wisdom tooth grows at an angle towards the front of the mouth.
  • Distal impaction: as the wisdom tooth grows it turns away from neighbouring teeth and becomes stuck in that position.

Not all wisdom teeth require treatment but some impacted teeth cause severe dental problems which require treatment.

Wisdom teeth can be impacted and can partially appear through the gum. Whilst many of them don’t require treatment they do become prone to a range of dental problems which include:

  • Gum disease: this includes gingivitis and periodontitis
  • Pericoronitis: this is an inflammation of the soft tissue around the tooth. It happens if plaque builds up between the gums and an impacted wisdom tooth.
  • Dental cavities: these happen as a result of a poor dental hygiene routine. Impacted wisdom teeth are difficult to clean which causes holes or cavities within the tooth.
  • Cysts and tumours: this is where the tissue around the wisdom tooth becomes infected which increases the risk of a cyst or tumour. Fortunately this is very rare.

What is the treatment?

Treatment is only undertaken if the impacted tooth (or teeth) is causing a severe dental problem. This can include antibiotics to ease any infection, extraction of the impacted tooth and trimming away surrounding gum tissue.

Note: The National Centre for Clinical Excellence (NICE) recommends that healthy, impacted wisdom teeth must not be removed.

Surgery must only be carried out if there is a recognisable need.

If your dentist feels that surgery is the only option then he or she will start by examining your teeth followed by an x-ray of your mouth. He/she will discuss the treatment with you, explaining the pros and the cons of the surgery.

You may be given a local or general anaesthetic. If you opt for a general anaesthetic then you will be admitted to hospital.

The dentist will make a small incision in the gum over the impacted tooth to fully access the tooth. He or she will remove any bone covering the tooth.

The tooth will then be broken down into small bits to aid with removal.

These fragments are removed through this incision.

The dentist will then close the incision with small stitches.

After wisdom tooth extraction surgery

If you have had a general anaesthetic then you will be advised to rest for 48 hours following surgery. Do not drink alcohol, operate machinery or do anything which requires your full concentration during this time. Get someone to drive you home after surgery.

You will be given painkillers to deal with any discomfort and antibiotics to control any infection. An antiseptic mouthwash can also help to prevent infection.

Take any medication as instructed by your dentist, apply a cold compress in case of swelling and avoid strenuous activity for a few days.

Other post-surgery advice includes eating soft foods for the first few days, avoiding spicy foods, alcohol and caffeine. Do not brush your teeth for the first 24 hours as this can dislodge any blood clots which help with healing. Dislodging these can result in a condition called ‘dry socket’.

Rinse out your mouth with warm salty water and place a piece of gauze over your gums if they are still bleeding.

Stitches: if you have the dissolvable type then these will disappear within 7 to 10 days. The non-dissolvable type will have to be removed a week after surgery.

You will have a series of aftercare visits which are designed to check on your progress. If in the meantime you notice anything untoward such as excessive bleeding, fever, difficulty breathing and facial swelling then contact your dentist immediately.

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