The removal of wisdom teeth (or third molars) is one of the most common surgical procedures carried out in the UK. The wisdom teeth grow at the back of your gums and are the last teeth to come through. Most people have 4 wisdom teeth (1 in each corner). Wisdom teeth usually grow through the gums during the late teens or early twenties. By this time, the other 28 adult teeth are usually in place, so there isn’t always enough room in the mouth for the wisdom teeth to grow properly. Because of the lack of space, wisdom teeth can sometimes emerge at an angle or get stuck and only partially emerge. Wisdom teeth that grow through like this are known as impacted.

You should make an appointment to see your dentist if your wisdom teeth are causing severe pain. They’ll check your teeth and advise you whether they need to be removed. If your dentist thinks you may need to have your wisdom teeth removed, they’ll usually carry out an X-ray of your mouth. This gives them a clearer view of the position of your teeth. As with any teeth problems, it’s important to see your dentist as soon as possible, rather than waiting for your regular dental check-up. Find your local dentist

Your wisdom teeth don’t usually need to be removed if they’re impacted but aren’t causing any problems. This is because there’s no proven benefit of doing this and it carries the risk of complications. Sometimes, wisdom teeth that have become impacted or haven’t fully broken through the surface of the gum can cause dental problems. Food and bacteria can get trapped around the edge of the wisdom teeth, causing a build-up of plaque, which can lead to:

• tooth decay (dental caries)
• gum disease (also called gingivitis or periodontal disease)
• pericoronitis – when plaque causes an infection of the soft tissue that surrounds the tooth
• cellulitis – a bacterial infection in the cheek, tongue or throat
• abscess – a collection of pus in your wisdom teeth or the surrounding tissue as a result of a bacterial infection
• cysts and benign growths – very rarely, a wisdom tooth that hasn’t cut through the gum develops a cyst (a fluid-filled swelling)

Many of these problems can be treated with antibiotics and antiseptic mouthwash. Wisdom teeth removal is usually recommended when other treatments haven’t worked.

Your dentist may remove your wisdom teeth, or they may refer you to a specialist surgeon for hospital treatment. Before the operation, the procedure will usually be explained to you and you may be asked to sign a consent form. You’ll usually be given a local anaesthetic injection to numb the area around the tooth. You’ll feel some pressure just before the tooth is removed, as your dentist or oral surgeon needs to widen the tooth socket by rocking the tooth back and forth. A small cut in the gum is sometimes necessary, and the tooth may need to be cut into smaller pieces before it’s removed. It takes anything from a few minutes to 20 minutes, or sometimes even longer, to remove a wisdom tooth. After your wisdom teeth have been removed, you may have swelling and discomfort, both inside and outside your mouth. Occasionally, some mild bruising is also visible. This is usually worse for the first 3 days, but it can last for up to 2 weeks. Read more about how a wisdom tooth is removed and recovering from wisdom tooth removal.

As with all surgery, there are risks associated with removing a wisdom tooth. These include infection or delayed healing, both of which are more likely if you smoke during your recovery. Another possible complication is “dry socket”, which is a dull, aching sensation in your gum or jaw, and sometimes a bad smell or taste coming from the empty tooth socket. Dry socket is more likely if you don’t follow the after-care instructions given by your dentist. There’s also a small risk of nerve damage, which can cause a tingling or numb sensation in your tongue, lower lip, chin, teeth and gums. This is usually temporary, but in rare cases it can be permanent. Read more about the possible complications of wisdom tooth removal.

Dentists charge depending on the treatment required, unless you’re under 18 or otherwise exempt from NHS charges. If hospital treatment is required, it will be provided through the NHS free of charge. Read more about dental costs.

Wisdom tooth removal can be carried out by a dentist or a specialist surgeon working in a hospital. If your dentist recommends removing your wisdom teeth, they’ll take an X-ray of your mouth to help them determine who should carry out the procedure. Any charges and payment methods should be discussed before the procedure begins. Read more about NHS dental charges.

ANAESTHESIA

Before having your wisdom teeth removed, you’ll be given an injection of local anaesthetic to numb the tooth and surrounding area. If you’re particularly anxious about the procedure, your dentist or surgeon may give you a sedative to help you relax. This will usually be an injection into your arm. General anaesthetic is rarely needed for wisdom tooth removal. It’s only occasionally used when the procedure is carried out in hospital. However, in this case, you should still be able to go home on the same day as the procedure.

REMOVING THE WISDOM TOOTH

If the tooth hasn’t come through the gum, a small cut (incision) will be made in the gum to access it. A small piece of the bone covering the tooth may also need to be removed. The tooth may be cut into smaller parts to make it easier to remove through the opening. There’s less need to make an incision if the tooth has broken through the gum. You’ll feel some pressure just before the tooth is removed, as your dentist or oral surgeon needs to widen the tooth socket by rocking the tooth back and forth before taking it out. You shouldn’t feel any pain as your wisdom teeth are removed because the area will be numb. However, if you do feel pain during the procedure, tell your dentist or oral surgeon so they can give you more anaesthetic. How long it takes to remove the tooth will vary. Simple procedures can take a few minutes, but it can take longer than 20 minutes if it’s more complicated.

AFTER SURGERY

If an incision has been made, dissolving stitches are used to seal the gum. Your dentist will tell you how long the stitches take to dissolve (usually 7 to 10 days). Your dentist may place gauze over the site of the extraction and ask you to keep pressure on it by biting your jaws together for up to an hour. This is to allow a blood clot to form in the empty tooth socket. Blood clots are part of the healing process, so try not to dislodge them. In some cases, antibiotics may be prescribed if you have an ongoing infection. For the 24 hours after removing your wisdom tooth, you should avoid:

• rinsing your mouth out with liquid
• drinking alcohol and smoking
• drinking hot liquids such as tea or soup
• strenuous physical activity

RECOVERY

As with any type of surgery, wisdom tooth removal carries some risks. However, these risks are usually small. Risks can include:

• dry socket – where a blood clot fails to develop in the tooth socket, or if the blood clot becomes dislodged
• nerve injury – this can cause temporary or permanent problems, such as tingling or numbness
• infection – signs include a high temperature, yellow or white discharge from the extraction site, and persistent pain and swelling
• bleeding

See your dentist if you have signs of infection after having your wisdom teeth removed, or if you’re bleeding heavily from the extraction site.

DRY SOCKET

Dry socket (alveolar osteitis) is one of the most common complications of wisdom tooth removal. It’s where a blood clot fails to develop in the tooth socket, or if the blood clot becomes dislodged or disappears. This can happen 3 to 5 days after surgery. The empty socket causes an ache or throbbing pain in your gum or jaw, which can be intense like a toothache. There may also be an unpleasant smell or taste from the empty tooth socket. If you look into the socket, you might be able to see exposed bone rather than a blood clot. You’re more at risk of developing dry socket if:

• you don’t follow your dentist’s instructions after the extraction
• you smoke
• you’ve had the condition before
• you’re over 25 years old
• the extraction was difficult or complicated

See your dentist or surgeon if you think you have dry socket. They can flush any debris out of the socket or cover it with a medicated dressing, which may be removed and replaced frequently until it heals.

NERVE INJURY

Although far less common than dry socket, injury to sections of a nerve called the trigeminal nerve is another possible complication of wisdom tooth removal. It can cause pain, a tingling sensation and numbness in your tongue, lower lip, chin, teeth and gums. The damage is usually temporary, lasting for a few weeks or months. However, it can be permanent if the nerve has been severely damaged. A nerve injury can interfere with your daily activities, making things such as eating and drinking difficult. However, a nerve injury will only cause sensation problems – it won’t cause any weakness to your lip or tongue. Your dentist or surgeon will try to minimise the possibility of nerve damage when removing your wisdom tooth, and they should tell you about the risk of complications before the procedure.

GENERAL ANAESTHETIC

General anaesthetic is occasionally needed for the removal of wisdom teeth. It carries some additional risks, but complications are very rare, occurring in less than 1 in every 10,000 cases.