Wisdom Tooth Extraction

Wisdom tooth extraction is a surgical procedure to remove one or more of the third molars (the last four teeth at the very back of your mouth), which typically appear in late adolescence or early adulthood.

Most people's jaws do not have enough space for wisdom teeth to grow in straight. When a tooth is blocked from fully breaking through the gum, it is called impacted. An impacted tooth can push against neighbouring teeth, damage the surrounding bone, or become a site for repeated infection. Removing the tooth stops these problems at their source. If the tooth has already come through fully but is causing decay or gum disease, it is taken out the same way a regular molar would be — by loosening it from its socket and lifting it free.

Wisdom teeth are removed when they are causing problems now or are very likely to cause problems in the future. Your oral surgeon or dentist will assess the position of the tooth using X-rays before recommending extraction.

• Impacted wisdom tooth — a tooth that is partially or fully trapped beneath the gum or bone.
• Pericoronitis — repeated infection or swelling of the gum flap that covers a partially erupted tooth.
• Dental caries (tooth decay) in the wisdom tooth itself that cannot be reliably filled or restored.
• Gum disease (periodontitis) around the wisdom tooth affecting the neighbouring molar.
• A cyst or benign tumour forming around an unerupted wisdom tooth.
• The wisdom tooth is crowding or damaging the tooth in front of it.
• Preparation for orthodontic treatment (braces) when the wisdom tooth would undo alignment work.

Extraction is generally not recommended when the wisdom tooth is fully erupted, sitting in a healthy position, easy to clean, and causing no pain, decay, or damage to surrounding teeth. Patients with certain blood-clotting disorders, uncontrolled diabetes, or who are currently undergoing radiotherapy (radiation treatment) to the jaw area may need specialist evaluation and extra precautions before the procedure can be carried out safely.

Wisdom tooth extraction is a very common procedure and is generally well tolerated, but like any surgical procedure it carries some recognised risks.

• Pain and swelling around the jaw and cheek for several days after the procedure — this is normal and expected.
• Dry socket (alveolar osteitis) — when the blood clot that forms in the empty socket is lost or dissolves too early, leaving the bone exposed and causing significant pain. This is the most common complication.
• Infection in the extraction site, which may require antibiotics.
• Bleeding that is heavier or lasts longer than usual.
• Temporary numbness or tingling in the lip, chin, tongue, or cheek, caused by proximity to the inferior alveolar nerve or lingual nerve (the nerves that run near the lower wisdom teeth).
• Permanent nerve damage — rare, but possible with deeply impacted lower wisdom teeth that lie very close to the nerve.
• Damage to a neighbouring tooth or its root during extraction.
• A small piece of tooth root left behind, which in most cases the body tolerates but may occasionally need to be removed.
• In upper wisdom teeth, accidental opening into the maxillary sinus (the air space above the upper back teeth) — usually heals on its own.
• Jaw stiffness (trismus) — difficulty opening the mouth fully for a period after surgery.
• Rare risks of the local anaesthetic (numbing injection), including allergy or temporary dizziness.

Preparation depends on whether you will have local anaesthesia (numbing injections only, while you are awake), sedation (a relaxing medicine given through a drip that keeps you drowsy), or general anaesthesia (fully asleep). Your surgeon will advise which is appropriate for your case.

If sedation or general anaesthesia is planned, you will usually be asked to fast — not eat or drink anything, including water — for a set number of hours beforehand. Your surgical team will give you the exact fasting instruction. For local anaesthesia alone, fasting is generally not required, but a light meal rather than a heavy one is advisable. Smoking should be avoided in the days before surgery, as it slows healing. Alcohol should also be avoided in the days before the procedure. Tell your doctor about all medicines you take; blood thinners, aspirin-containing products, and certain supplements may need to be paused under your doctor's guidance.

Before the procedure, the team typically carries out:

• Dental X-rays or a panoramic X-ray (OPG) — a wide image showing all teeth and their roots — to map the exact position and angle of the wisdom tooth.
• In complex cases, a cone beam CT scan (a 3-D dental X-ray) may be taken to see how close the tooth is to nerves and sinuses.
• A review of your medical history, current medications, and any known allergies.
• Blood tests if general anaesthesia or sedation is planned, or if you have an underlying health condition.

On the day, the procedure itself generally follows these steps:

• 1. You are seated in the dental or surgical chair and your blood pressure and pulse may be checked.
• 2. Local anaesthetic is injected around the tooth and the surrounding gum and bone. You will feel pressure but should not feel sharp pain. If sedation is used, it is given at this stage.
• 3. The surgeon makes a small cut in the gum tissue if the tooth is impacted or has not fully come through.
• 4. A small amount of bone covering the tooth may be carefully removed to give access.
• 5. The tooth is loosened using specialised instruments and, if needed, divided into sections to make removal easier.
• 6. The tooth (or its sections) is lifted out of the socket.
• 7. The socket is cleaned and any sharp bone edges are smoothed.
• 8. The gum is usually closed with stitches (sutures). Some sutures dissolve on their own; others need to be removed at a follow-up visit.
• 9. Gauze is placed over the socket and you are asked to bite down on it to encourage clot formation and control bleeding.

Most patients go home the same day. Recovery from a straightforward extraction usually takes a few days, while recovery from a surgical removal of a deeply impacted tooth can take one to two weeks or longer — your surgeon will give you a realistic estimate based on your specific case.

• Bleeding: Some oozing for the first few hours is normal. Biting firmly on clean gauze helps. Avoid spitting forcefully or using straws, as suction can dislodge the blood clot and cause dry socket.
• Pain and swelling: Swelling around the jaw and cheek typically peaks around the second or third day, then gradually improves. Cold packs applied to the outside of the face in the first 24 hours can help limit swelling. Pain relief medicine will be prescribed by your doctor.
• Diet: Stick to soft foods (such as porridge, yoghurt, mashed vegetables, or soup) for at least the first few days. Avoid hard, crunchy, or chewy foods that could disturb the healing socket. Avoid hot drinks immediately after the procedure.
• Mouth rinsing: Your doctor will usually advise gentle warm salt-water rinsing starting from the day after surgery — not before, so the initial clot is not disturbed. Do not use commercial mouthwash unless your doctor approves it.
• Stitches: If non-dissolving stitches were placed, a follow-up appointment is usually scheduled within about a week to have them removed.
• Smoking and alcohol: Both delay healing significantly and increase the risk of dry socket and infection. Most surgeons advise avoiding them for at least several days after the procedure.
• Activity: Rest on the day of surgery. Avoid strenuous exercise for a few days, as it can increase bleeding and swelling.
• Oral hygiene: Continue brushing your other teeth gently. Avoid brushing directly over the extraction site until your surgeon says it is safe.
• Warning signs to report: Increasing pain after the third day (possible dry socket), fever, pus or a bad smell from the socket, swelling that is getting worse rather than better, or difficulty swallowing or breathing — contact your surgical team promptly if any of these occur.
• Follow-up: A check-up is usually recommended to confirm the socket is healing well, even if you feel fine.