Wisdom tooth removal: what to expect
Wisdom teeth are among the most common reasons people are referred to me. Here's an honest guide to why they cause trouble, what happens during surgery and how to recover well.
Why wisdom teeth cause problems
Wisdom teeth are the third and last set of molars, and usually appear between your late teens and mid-twenties. By then there often isn't enough room at the back of the jaw, so they can come through at an angle, only partly erupt, or stay trapped (impacted) beneath the gum or bone.
That in itself isn't always a problem. But a partly erupted wisdom tooth can be hard to clean, which can lead to:
- Pericoronitis: painful infection of the gum around the tooth, often with swelling, a bad taste and difficulty opening your mouth.
- Decay in the wisdom tooth or the molar in front of it.
- Gum disease around the back teeth.
- Less commonly, cysts forming around an impacted tooth.
Do they always need taking out?
No. In the UK, NICE guidance advises that impacted wisdom teeth which are healthy and not causing problems shouldn't be removed just in case. Removal is recommended when there's a clear clinical reason, such as repeated or severe infections, decay that can't be repaired, damage to neighbouring teeth, or cysts.
The right decision is the one based on your X-rays, your symptoms and your history, not on a rule of thumb.
Your assessment
At your consultation I'll ask about your symptoms, examine your mouth and take an X-ray. Often this is a panoramic X-ray that shows the whole jaw. If the roots of a lower wisdom tooth sit close to the nerve that supplies feeling to your lip and chin, I may recommend a 3D (CBCT) scan to plan the safest approach.
We'll talk through the benefits and risks. As with any surgery, these include pain, swelling, bleeding and infection. For lower wisdom teeth there's also a small risk of altered sensation in the lip, chin or tongue. This is usually temporary, and I'll explain your individual risk based on your scans.
On the day
Most wisdom teeth are removed under local anaesthetic, so the area is completely numb. You'll feel pressure and movement, but you shouldn't feel pain. If you're anxious, conscious sedation may be an option.
Depending on the tooth, I may need to make a small opening in the gum, remove a little bone, or divide the tooth into sections so it can be taken out more gently. Dissolvable stitches are often placed at the end. Many procedures are completed well within an hour.
Recovery, day by day
| When | What's normal |
|---|---|
| First 24 hours | Some oozing of blood, numbness wearing off after a few hours, and soreness. Rest and take it easy. |
| Days 2 to 3 | Swelling and jaw stiffness are usually at their worst. Bruising on the cheek can appear. |
| Days 4 to 7 | Things steadily improve. Opening your mouth becomes easier. |
| Weeks 1 to 2 | Most people feel back to normal. Stitches dissolve on their own. |
Aftercare tips that make a difference
- Protect the blood clot. Don't rinse, spit forcefully or poke the socket for the first 24 hours.
- If it bleeds, fold a clean, damp gauze or handkerchief, place it over the socket and bite firmly for 20 to 30 minutes.
- From the next day, rinse gently with warm salty water (half a teaspoon of salt in a glass of warm water) after meals, for about a week.
- Don't smoke for as long as possible afterwards. Smoking significantly increases the risk of dry socket.
- Eat soft foods and chew on the other side. Avoid very hot drinks and alcohol for the first day or two.
- Manage pain with regular painkillers as advised, ideally starting before the anaesthetic wears off.
- Keep brushing your other teeth, taking care around the area.
- Sleep with your head raised on an extra pillow for the first couple of nights to help with swelling.
Dry socket: how to spot it
Dry socket happens when the blood clot in the socket is lost or breaks down, leaving the bone underneath exposed. It isn't common, but it's painful.
The tell-tale sign is pain that gets worse rather than better, usually starting two to four days after the extraction. It's often a deep, throbbing ache that can spread towards your ear, sometimes with a bad taste or smell. If this happens, contact the practice. A soothing dressing placed in the socket usually brings quick relief.