Prevention and essential care
Wisdom Tooth Removal
Wisdom teeth do not always need to come out. If one is healthy, fully through and not causing trouble, we simply keep an eye on it at your check-ups. When removal is the better option, we explain why, how it will be done and what the following days are likely to feel like before we begin.
- Assessment
- Examination and X-rays; 3D imaging if needed
- Anaesthetic
- Local anaesthetic
- Procedure
- Simple or surgical, depending on the position
- Recovery
- Most people feel better within about a week
What is it?
Wisdom teeth (third molars) are the last molars at the very back of the mouth, and they usually come through between the ages of about 17 and 25. If there is enough room in the jaw, they can come through without trouble and work like any other tooth. If there is not, they can stay partly or completely in the bone or under the gum. These are called impacted or partially erupted wisdom teeth.
When a tooth is only partly through, food and bacteria collect under the flap of gum that covers it. This can lead to pericoronitis, a gum infection that can be painful and cause swelling. Because the area is hard to clean, decay can develop in the wisdom tooth itself or in the second molar just in front of it. Less often, a cyst can form around an impacted tooth.
We do not routinely remove wisdom teeth that are healthy, fully through and causing no symptoms. Impacted teeth that are not causing problems are usually not removed just as a precaution either; instead they are monitored at check-ups, with X-rays when needed. Sometimes removal is considered as part of orthodontic treatment or a prosthetic plan. We make the decision together, based on the examination and X-rays, once we have talked through the options.
When can it be considered?
- Repeated pericoronitis (gum infection around a partly erupted tooth)
- An abscess or infection that is spreading
- Decay too advanced to repair
- Decay or damage to the second molar in front of it
- A cyst or other change around the tooth
- When an orthodontic or prosthetic plan calls for it
Examination and planning
At the examination we talk about your symptoms, your general health and any medication you take. Please tell us if you take blood thinners or have a long-term condition; if needed, we will ask for advice from the doctor who looks after you.
The position of the tooth, its roots and the surrounding bone are assessed on a panoramic X-ray. The roots of lower wisdom teeth can lie close to the canal that carries the nerve supplying feeling to the lower lip and chin. If the X-ray shows the roots very close to this canal, 3D imaging (cone-beam CT, CBCT) is requested when needed. Because it involves more radiation than routine X-rays, it is only used when the extra information is needed.
With this information we explain whether the tooth can be removed with a simple extraction or needs a surgical approach, roughly how long it will take and what the possible risks are. If the tooth is very deep or its relationship to the nerve needs a closer look, we will also talk about referral to an oral and maxillofacial surgeon. If you feel anxious, tell us at the start; we explain each step beforehand and can stop for breaks.
How the process works
Examination and imaging
We listen to your symptoms, examine your mouth and assess the position and roots of the tooth on an X-ray.
Plan and explanation
We explain why removal is advised, how it will be done, the possible risks and what recovery involves, and answer your questions.
Local anaesthetic
The area is numbed and we wait until it is fully numb.
Removal
A tooth that is fully through can usually be removed simply. For an impacted tooth, the gum is opened, a little bone may be removed and the tooth may be taken out in sections.
Stitches and first care
Stitches are placed if needed, you bite on a gauze pad, and we go through the aftercare advice with you.
Review
Healing is checked a few days to a week later; stitches that do not dissolve are usually removed at around one week.
Digital tools that may be used
- Digital X-rays
- We look at the position of the tooth, its roots and the surrounding structures together on screen, so you can see what we are describing.
- Intraoral photographs
- These record the gum flap, any inflammation and the neighbouring tooth, and help us compare at the healing review.
Aftercare
Recommended
- Bite firmly on the gauze for about 30–45 minutes; if it is still oozing, repeat with a clean pad
- On the first day, hold a cold compress against your cheek on and off, about 15–20 minutes at a time
- Stick to soft foods that are lukewarm or cool for the first few days, and chew on the other side
- After the first 24 hours, rinse gently with warm salt water, especially after meals
- Brush your other teeth as usual and take care around the extraction site
- Take any medication exactly as advised and for as long as advised
Best avoided
- Rinsing hard, spitting repeatedly or drinking through a straw in the first 24 hours
- Smoking and alcohol, especially in the first few days
- Very hot drinks and hard or crunchy food on the first day
- Touching the socket with your tongue or fingers
- Strenuous exercise and heavy physical work for the first few days
Whether a treatment suits you can only be decided after an examination. Timelines and stages vary from person to person.
Frequently asked questions
Do all wisdom teeth need to come out?
No. Wisdom teeth that are healthy, fully through and causing no problems can often stay. Impacted teeth that are not causing symptoms are not removed just as a precaution either; they are monitored at check-ups. Removal is advised when there is a reason, such as repeated infection, decay that cannot be repaired or damage to the neighbouring tooth.
What will I feel during the extraction?
The local anaesthetic numbs the area. Once it has taken effect you may still feel pressure and pushing, which is normal. If you feel anything sharp, just raise your hand. We will stop straight away and give more anaesthetic if needed.
How long does it take, and will I need stitches?
It depends on the position of the tooth. Removing a tooth that is fully through often takes only a few minutes; an impacted tooth can take longer. Stitches are usually placed after a surgical extraction. Dissolving stitches fall out on their own, and others are removed after about a week. Most people are back to normal activities the next day, although a day or two of rest can help after a more difficult removal.
How much swelling should I expect?
Some swelling and jaw stiffness are expected, especially after an impacted tooth has been removed. Swelling usually peaks on the second or third day and then starts to go down. Most people feel noticeably better within about a week, although the gum can take a few weeks to heal completely.
What is dry socket, and how would I know?
If the blood clot in the socket breaks down too early, a dry socket (alveolar osteitis) can develop. It usually shows up a few days after the extraction as pain that gets worse instead of better, often spreading towards the ear, together with a bad taste or smell. Smoking makes it more likely. If this happens, come back to us; the socket can be cleaned and a soothing dressing placed.
What if the numbness does not wear off?
The anaesthetic normally wears off within a few hours. The nerves that supply feeling to the lower lip, chin and tongue run close to the lower wisdom teeth, and occasionally numbness or tingling in these areas lasts longer after removal. This usually improves over weeks or months, and permanent numbness is uncommon. If you are still numb the next day, please let us know.
When should I call straight away?
Contact us without delay if bleeding does not stop despite pressing on a gauze pad, if you have a fever, if the swelling gets worse after the third day, if the pain keeps getting worse, or if you have difficulty swallowing or breathing.
Related treatments
All treatments- incisors, canines, premolars, molarsGum TreatmentStep-by-step care for inflamed gums and gum disease, from scaling and polishing to subgingival scaling and root planing, a deep clean of the root surfaces.
- incisors, canines, premolars, molarsOrthodontic TreatmentTreatment that gradually moves crowded or gapped teeth, or teeth that do not meet properly, into a better position with clear aligners or fixed braces, planned together with our specialist orthodontist team.
- incisors, canines, premolars, molarsRoot Canal TreatmentTreating an inflamed or infected tooth nerve (pulp) by cleaning and sealing the root canals so the natural tooth can be kept.
Questions about wisdom tooth removal?
You can send your questions on WhatsApp or reach the practice by phone.