Wisdom tooth extraction: procedure, recovery, and complications

The mouth is generally quite small. We have room for about twenty-eight teeth. That is the amount we have before third molars come in. You could say they are additional dentition that doesn’t actually serve a purpose.

The wisdom teeth should arrive when you’re about 18. They are usually all there before you turn 25. You can expect some pain when they start to grow. Wisdom teeth are known for being problematic in terms of the direction of growth and shape.

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How do you know if your wisdom teeth need to be pulled?

There are five main indications for extraction:

  • the tooth is growing at a wrong angle,
  • there is no room for the tooth,
  • the growth of the tooth is causing crowding,
  • caries or gum disease are present (it’s hard to clean the area), or
  • the tooth is impacted.

About 85% of all wisdom teeth will eventually have to be extracted. Unfortunately, there isn’t much you can do about it, especially if you have already started feeling discomfort. What’s more, the older you are, the more challenging it may be to pull them. Your best bet is to do it as soon as possible.

If you don’t have them removed you can possibly expect:

  • considerable swelling, tenderness, and pain,
  • bad breath or bad taste,
  • cysts, especially with impacted teeth, and
  • damage of neighboring gums, teeth, and bone.

What does “impaction” mean?

When a tooth is impacted it means it can’t freely break through to show up in the mouth. We differentiate four states of wisdom teeth:

Erupted

The tooth is not impacted at all. It has broken through the gums and is fully visible. This is a pretty straight-forward case, similar to a regular extraction.

Soft-tissue impacted

In this case, the tooth is stuck under the gum only. The soft tissue will have to be cut open.

Partially-bony impacted

This means that the tooth is partially locked in the jaw. Some of the bone will have to be removed.

Fully-bony impacted

When the tooth is completely stuck in the jaw the process of removing it is necessary. Unfortunately, this is also the most complicated situation.

The state of the tooth indicates how invasive the procedure will be and how much you will have to spend on it. The cost of a simple wisdom tooth extraction will be a lot lower than the price for dealing with an impaction.

If the tooth is erupted the procedure will be very similar to a regular tooth extraction. Otherwise surgery might be necessary.

How to prepare for wisdom tooth extraction

There are a couple of things you will need to do before the surgery. First of all, you will need to make sure you have a way of getting back home. Certain types of anesthesia make you drowsy and it could be unsafe to drive.

Ask your dentist beforehand what type of sedation he or she plans to use. If necessary, get in touch with somebody who could assist you since you might not be able to drive home on your own.

Depending on the type of anesthesia, you might also have to fast for some time before your procedure to avoid nausea. You might even have to stop eating the day before. Also, make sure to ask your dentist whether you should continue taking your regular medication if you do take any.

The procedure of wisdom tooth removal

The process of removing a wisdom tooth has five main steps and usually takes no more than 45 minutes. Depending on whether you have this done at a dentist’s or at a surgeons office they may differ a little.

Anesthesia

Your mouth will be numbed. If your tooth is impacted you might be sedated, too. There are different methods, depending on how deep the anesthesia needs to be. If you are going to be completely under, an anesthesiologist will have to perform this step.

Incision

If the tooth hasn’t erupted the dental professional will make an incision in your gum. If the tooth is also stuck under the bone a small piece might also be removed.

Disintegration of the tooth

The tooth may be cut up into smaller parts, especially if it’s in an unorthodox position. This also allows the hole in the gum and bone to be smaller.

Extraction

The tooth or the parts will be removed. You might feel slight pressure, as the tooth is rocked back and forth in the socket. This widens it and allows the roots to slide out.

Stitching

Your gums might need to be stitched back up. You will get a gauze pad to press into the swollen area. You will experience some bleeding.

It is very important to follow your dentist’s instructions after the procedure for a complication-free recovery.

Risks and complications

Wisdom tooth extraction can be complicated. Sometimes things go wrong. In such cases, you might have to seek emergency dentistry. Ignoring worrisome symptoms of a wisdom tooth could lead to complicated repercussions.

Below we have described a few of the most common cases linked to third molar extraction.

Alveolar osteitis (dry socket)

Those who are smokers, have experienced dry socket before, or who are over the age of twenty-five are at a higher risk of developing this condition. It is also likely if the extraction was complicated.

Dry socket means that the blood clots which are supposed to form in the place where the tooth was have become dislodged or disintegrated. The bone might become exposed. This can put you in danger of infection.

The symptoms include a dull or throbbing pain in the gum or jaw, a bad smell or taste, and numbness on the side of the face. You might not feel anything immediately after the extraction. The discomfort will develop over three to five days.

If this happens make sure to go back to your dentist. They will cover the hole with a medicated dressing.

Infection

An infection happens when bacteria have gotten inside the wound. It is rare, but can happen on occasion.

What you can do to prevent this is refrain from eating, drinking, and talking for at least two hours after the surgery. If your dentist suspects an infection is likely he or she will prescribe an antibiotic. Take it with adherence to their instructions.

Paresthesia (temporary or permanent nerve damage)

Those who are over thirty-five are more likely to develop this condition. It usually happens with lower wisdom teeth that are positioned very close to the nerve in your jaw.

If your nerve is damaged during the procedure you might feel significant numbness. The areas affected can include the tongue, lip, and jaw. It will probably not affect your movement or cause speech or facial deformity.

It can last for a few days, weeks, or even months. In the worst-case scenarios, it is permanent, but it can possibly be repaired via surgery. You should contact your doctor if you suspect nerve damage.

Hemorrhage (heavy bleeding)

You should expect some bleeding after an extraction. It is unavoidable, as the tissue is disrupted. The “normal” bleeding should stop around forty-eight hours after the surgery. After that, it could be a cause for concern.

Try to sit upright and avoid physical activity on the day of your procedure. You can use a moistened tea bag to “cushion” the extraction site. That makes some people feel less discomfort and the tannic acid helps constrict blood vessels.

Do not use a straw. Any suction can make the bleeding worse, this includes smoking as well. If you experience significant bleeding after two days consult with your dentist, as your stitches might have opened or ripped.

Sinus cavity perforation

Your skull has a few hollow spaces called sinuses. Two of them are right above your upper teeth. As you age, roots of the upper molars can sometimes grow so long, they touch or even break through into those spaces.

When the tooth is removed this can create a hole. It will feel like liquids are going into your nose when drinking. It is usually not painful, but can be uncomfortable.

Most often, this hole will heal on its own. If, however, it is large, if you are a smoker, or if you drink through a straw, you might need surgery. This will involve transplanting tissue from somewhere else in your mouth.

The key factor that lowers the risk of complications is strict adherence to dentist’s instructions before, during, and after surgery.

Wisdom tooth extraction recovery

When you leave the office keep slight pressure on the gauze pad. If you only had a local anesthetic you might be able to return to work or your daily activities. Make sure to eat soft foods, or even maintain a liquid diet that day.

There are a few things you can do to prevent infection and any other complications:

Dos

  • Put ice on your gums if they are swollen
  • Bite down on gauze for two hours, changing it every thirty minutes
  • If bleeding persists, bite down on a teabag
  • Exercise your jaw lightly
  • Eat soft foods or liquids
  • Drink plenty of fluids
  • Rinse your mouth with antiseptic mouthwash
  • Brushing is not prohibited, but avoid the affected area
  • Take medication as advised by the dentist
  • Return to the office or call your doctor if you feel significant pain
  • You can eat ice cream or frozen yoghurt to numb the pain

Don’ts

  • Don’t drink through a straw to avoid loosening blood clots
  • Don’t brush the area for at least 24 hours
  • Don’t eat hard or sticky foods
  • Don’t smoke or drink alcohol

If your procedure went well and there were no complications it should take a few days to feel normal again. Stitches are usually self-dissolving. This means you won’t have to return to the office to have them taken out.

Dr. Peter March
Mouthwash should only be used if prescribed. Rinsing with warm salt water is recommended.

The area might feel weird and there might be some swelling for up to three days. You might also experience some bleeding. After that, you will have a post-surgical appointment to make sure everything is going okay.

FAQ

Is wisdom tooth removal painful?

Wisdom tooth removal is considered to be one of the more unpleasant dental procedures. You will most definitely get a local injection to numb pain in the extraction site and might get a deeper form of sedation if you have low pain tolerance or dental anxiety.

Nonetheless, you are likely going to need OTC painkillers to decrease post-op discomfort. Your dentist will provide you with instructions as per how to take them

Should I get 2 or 4 wisdom teeth removed?

Even if wisdom teeth are not impacted or infected, your dentist might still recommend extracting all 4. That is what is most often advised, especially if you have the funds for it. It is common to have two procedures and have two teeth removed at a time.

The first to go should, of course, be the more problematic teeth, but there is no one-fits-all solution. Consult with a professional to find out what is best for your mouth.

How long does it take to recover from wisdom tooth extraction?

It won’t take longer than a few days up to a week to feel normal, provided that there are no complications. Slight bleeding and swelling for up to three days are completely fine.

If you did not have self-dissolving stitches applied, you will have to return to the office to have them taken out. Otherwise there will be a check-up appointment scheduled to make sure everything is okay.

Is the third day the worst after wisdom teeth removal?

Symptoms like bleeding and swelling can build up until the third day. It is likely that you will experience more discomfort then than during the days immediately following surgery.

At the same time, by then you should be nearing the end of any unpleasantness and can start introducing more solid foods into your diet.

What happens if I don't get my wisdom teeth pulled?

Roughly 85% of wisdom teeth should be extracted to avoid complications. Those include significant swelling and pain, bad breath and taste, damage to other teeth, and accesses.

It’s best to remove troublesome teeth as soon as they start acting up. This can make the process easier. What’s more, the older you are, the more complicated the procedure might be.

Does removing wisdom teeth change the face shape?

It is very rare for wisdom tooth removal to alter someone’s appearance. Even if the dentition is protruding or impacted, it is unlikely that it will change your face shape.

If you have multiple molar teeth removed, your face might begin to look “sunken in”. This can be fixed by restorations such as crowns or implants.