Wisdom Teeth: What They Are, When They Need to Be Removed, How the Extraction Process Works, Potential Risks, and Post-Surgery Care

What are wisdom teeth?

The wisdom teeth are the third set of molars to emerge from the mouth. These teeth generally erupt between the ages of 17 and 21 years.

Tooth Removal

Tooth Removal

Sometimes, because of a lack of space, an obstruction, or an improper position, wisdom teeth may become impacted. 

The National Institutes of Health Consensus Development Conference in 1979 settled on a variety of indications for extracting impacted third molars, including infection, nonrestorable carious lesions, cysts, tumors, and destruction of adjacent teeth and bone.

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How can I know if I have third molars?

Your dentist can check your mouth and verify that you have your third molars in each quadrant. However, third molars can be found below soft or hard tissues and require an x-ray to check their presence.

Moreover, the radiographic provides all of the details needed to schedule and prepare for the surgical removal of third molars. These details are the position, size, and shape of the third tooth, the depth in bone, and the relation between the tooth and other anatomical structures.

Why is it necessary to extract wisdom teeth?

The most common reasons for wisdom teeth extraction are a lack of space in the arch and pain. However, there are many other conditions for their extraction that are related to pathologies, such as:

    • Pericoronitis: This is a severe inflammation of the soft tissues around the partially impacted tooth. It manifests as intense pain in the affected tooth’s region, radiating to the jaw, temporomandibular joint, and posterior submandibular region. 
    • Cysts and tumors associated with the tooth: While odontogenic cysts and tumors are uncommon in patients with impacted third molars, they can appear.
    • Production of caries: Caries may develop on the posterior surface of the second molar as well as on the crown of the impacted tooth due to food particle entrapment and poor hygiene caused by the presence of the semi-impacted tooth.
    • Root resorption: Some studies have shown that leaving the third molar in place will induce resorption of the adjacent second molar’s posterior root.
    • Initiating or exacerbating orthodontic issues.

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What is Appropriate Timing for Removal of Impacted Teeth?

The removal of wisdom teeth is determined by three factors: the patient’s age, the formation of the root, and the position of the tooth.

The best time to do so is while the patient is young, preventing the potential risks and undesirable situations that may worsen over time. Furthermore, as compared to older patients, younger patients cope well with the overall surgical treatment and stress, and they have fewer complications and quicker post-surgical wound healing. 

Regarding root formation, the optimal moment to extract wisdom teeth is when one-third of the root has formed.

How is wisdom teeth extraction performed?

Your dentist may elect to extract your wisdom teeth or refer you to a specialist surgeon. 

The extraction procedure may differ based on the third molar’s position, size, and depth in the bone, as well as its connection to other structures.

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  • Your dentist or surgeon administers anesthesia which could be:
    • Local anesthesia: Local anesthesia is administered through one or more injections at the site of each extraction. 
    • Sedation anesthesia: An intravenous (IV) tube in your arm is used to administer sedation anesthesia. During the treatment, you will be unconscious due to the use of sedation anesthesia. In addition to sedation, local anesthesia is administered.
  • An incision is made in the gum tissue to expose the tooth and bone. However, there is no need to make an incision if the teeth have fully erupted and are out of the gum line.
  • If there is bone totally or partially covering the tooth, it is removed.
  • Wisdom teeth could be extracted whole or in fragments, depending on the location and how simple the extraction process is.
  • Extraction of the tooth
  • Some residue from the tooth or bone is removed from the extraction site.
  • The suture is used to seal the wound to promote healing, but this isn’t necessarily a requirement.
  • A gauze is placed over the extraction site to control bleeding and facilitate the formation of a blood clot.

What are the potential risks and complications of wisdom teeth extraction?

Wisdom tooth extraction, like every other form of procedure, has certain complications. 

Complications are classified as intraoperative (occurring during the procedure) or postoperative (occurring after the procedure).

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Intraoperative complications are: 

  • Nerve or blood vessel damage or injury.
  • Oroantral communication means communication between the maxillary sinus and the oral cavity.
  • Injury to adjacent teeth.
  • Hemorrhage. 
  • Mandibular fracture.

Postoperative complications are:

  • Dry socket 
  • Bleeding
  • Infection 
  • Pain, swelling, and stiffness in the jaw
  • Difficulty opening the mouth (trismus)
  • Unpleasant taste and odor in the mouth

What should I do after my wisdom teeth extractions?

Apply an ice pack on the side of your face in the surgery area to reduce swelling. Additionally, eat soft food and take your medicines as prescribed by your dentist.

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On the other hand, for the first days after your wisdom teeth extraction, you should avoid:

  • Drinking or eating hot meals
  • Spicy food
  • Drink with a straw
  • Smoking
  • Exercise
  • Mouthwashes
  • Spit
  • Touch the socket or surgical area
  • Chew on your cheeks or your tongue

When should you contact your dentist or surgeon?

If you see any of the following signs or symptoms, which might signal an infection, nerve damage, or other significant problem, contact your dentist or oral surgeon right away:

  • Excessive bleeding.
  • Numbness or a loss of sensation that persists.
  • Fever.
  • Pain that is unbearable despite the use of prescribed pain relievers.
  • Swelling that becomes worse after a few days.
  • Pus in the socket or exude from it.
  • Nasal discharge with blood or pus.

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FAQ: Wisdom Teeth and Their Extraction

  1. What are wisdom teeth?
    Wisdom teeth are the third set of molars that typically emerge between the ages of 17 and 21.
  2. Why do some people not have wisdom teeth?
    Some individuals never develop wisdom teeth due to genetics, while others may have them but never experience eruption.
  3. How can I tell if I have wisdom teeth?
    A dentist can check your mouth, but an X-ray is needed to confirm their presence if they are still beneath the gums or bone.
  4. What happens if wisdom teeth don’t come in properly?
    If wisdom teeth are impacted or misaligned, they can cause pain, infections, cysts, or damage to nearby teeth and bone.
  5. Do all wisdom teeth need to be removed?
    No, if they emerge properly and do not cause issues, they may not require extraction. Removal is recommended only when they pose a risk.
  6. Why do some wisdom teeth cause pain?
    Pain can result from impaction, infection, gum inflammation, cyst formation, cavities, or pressure on adjacent teeth.
  7. At what age should wisdom teeth be removed?
    The best time for extraction is when the roots are about one-third formed, typically in the late teens or early twenties, to minimize complications.
  8. What problems can wisdom teeth cause if left untreated?
    They can lead to infections, gum disease, cysts, tumors, tooth decay, root resorption, and alignment issues in surrounding teeth.
  9. Can wisdom teeth cause headaches or jaw pain?
    Yes, impacted wisdom teeth can put pressure on the jaw and surrounding nerves, leading to headaches, earaches, and jaw pain.
  10. Can wisdom teeth affect orthodontic treatment?
    Yes, they can shift teeth, cause crowding, and interfere with braces or other orthodontic work.
  11. How is wisdom teeth extraction performed?
    The procedure varies but usually involves local or sedation anesthesia, a gum incision, possible bone removal, tooth extraction in one piece or fragments, and sutures if needed.
  12. Is wisdom teeth removal painful?
    Anesthesia prevents pain during the procedure, but some discomfort, swelling, and stiffness are common after surgery.
  13. How long does wisdom teeth removal take?
    The procedure typically lasts 30-60 minutes, but complex extractions may take longer.
  14. What type of anesthesia is used for wisdom teeth removal?
    Local anesthesia numbs the area, while sedation or general anesthesia can be used for a more comfortable experience, especially for multiple extractions.
  15. What are the risks of wisdom teeth extraction?
    Potential complications include nerve damage, bleeding, infection, dry socket, swelling, difficulty opening the mouth, and jaw stiffness.
  16. What is dry socket?
    Dry socket occurs when the blood clot at the extraction site is dislodged or dissolves, exposing the bone and causing severe pain.
  17. How do I prevent dry socket?
    Avoid smoking, drinking through a straw, spitting forcefully, or eating hard foods that may disturb the blood clot.
  18. How long does it take to recover from wisdom teeth removal?
    Most people recover in about a week, though full healing can take a few weeks. Swelling and pain typically peak in the first three days.
  19. What foods can I eat after wisdom teeth extraction?
    Stick to soft foods like yogurt, mashed potatoes, applesauce, smoothies, and soups. Avoid hot, spicy, crunchy, or chewy foods.
  20. What should I avoid after wisdom teeth removal?
    Do not smoke, drink through a straw, rinse forcefully, spit, eat hard foods, or engage in strenuous activity for a few days.
  21. How do I reduce swelling after wisdom teeth removal?
    Apply ice packs to your face for 20-minute intervals during the first 24 hours to minimize swelling.
  22. How long will bleeding last after wisdom teeth removal?
    Mild bleeding is normal for the first 24 hours. Biting down on gauze and avoiding excessive movement can help control it.
  23. Can I brush my teeth after wisdom teeth removal?
    Yes, but avoid brushing near the extraction site for the first 24 hours to prevent dislodging the blood clot.
  24. When can I return to normal activities after wisdom teeth removal?
    Most people can return to daily activities in 2-3 days, but strenuous exercise should be avoided for at least a week.
  25. When should I contact my dentist after surgery?
    Seek medical attention if you have excessive bleeding, fever, worsening pain, persistent numbness, pus, or a foul taste or odor in your mouth.

References

Santosh, P. (2015). Impacted mandibular third molars: Review of literature and a proposal of a combined clinical and radiological classification. Annals of Medical and Health Sciences Research, 5(4), 229-234. https://pubmed.ncbi.nlm.nih.gov/26229709/

Wisdom tooth removal. (2021). Retrieved 23 January 2025, from https://www.nhs.uk/conditions/wisdom-tooth-removal/

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