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Department of Oral Surgery
Ipswich Hospital
Tel: 01473 703 200

Removal of Impacted Wisdom Teeth

This leaflet has been designed to improve your understanding of any forthcoming treatment, and contains answers to many commonly asked questions. If you have any other questions that this leaflet does not answer, or would like further explanation, please ask.

The problem

The wisdom teeth (or third molars) are usually the last teeth to erupt into the mouth and can come through at any time after about 16 years of age.

Often there is not enough room to accommodate wisdom teeth so they do not come into the mouth normally. When this happens, the wisdom teeth are said to be impacted.

Wisdom teeth are usually impacted either forwards into the tooth in front, or backwards into the jaw bone.

Why do I need treatment?

An impacted wisdom tooth can cause a number of problems that mean the tooth is best removed. Most commonly these are:

• repeated attacks of infection in the gum surrounding the tooth. This leads to pain and swelling
• food packing into the space between the wisdom tooth and the tooth in front which causes decay in one or both of these teeth, and
• cysts forming around the wisdom tooth if it does not come into the mouth properly. A cyst occurs when fluid fills the sac that normally surrounds a developing wisdom tooth

What does the treatment involve?

Because the wisdom tooth has not fully erupted into the mouth, it is often necessary to make a cut in the gum over the tooth.

Sometimes it is also necessary to remove some of the bone surrounding the crown of the wisdom tooth.

The tooth may need to be cut into two or three pieces to remove it. Once the wisdom tooth has been removed, the gum is put back into place with stitches. In the majority of cases these stitches are dissolvable and take around two weeks to disappear.

What type of anaesthetic is used?

A number of options are available and depend on how difficult the wisdom tooth is to remove:

• local anaesthetic. This is an injection into the gum surrounding the wisdom tooth, rather similar to that you may have had at your dentist for a filling. The injection takes a couple of minutes to numb the area and means that you will feel no pain while the wisdom tooth is removed. Patient’s views tell
  us this is the best option for wisdom teeth that are simple to remove.
• local anaesthetic and intravenous sedation. In addition to a local anaesthetic injection, you can also be given a sedative through a needle into a vein in your arm. This makes you feel relaxed and less aware of the procedure; or
• general anaesthetic. It is usually possible to remove wisdom teeth under a ‘day case’ general anaesthetic. This means that although you are put to sleep completely for the operation, you will be able to go home on the same day as your surgery

How long does it take to remove a wisdom tooth?

This is variable. Some wisdom teeth may only take a few minutes to remove. More difficult wisdom teeth that need to be cut into pieces to be removed can take around 20 minutes to extract.

Is there much pain or swelling after the removal of wisdom teeth?

It is likely that there will be some discomfort and swelling, both on the inside and outside of your mouth, after surgery. This is usually worse for the first three days, but it may take up to two weeks before all the soreness goes. You may also find that your jaw is stiff and has limited opening, and so you may need to eat a soft diet for a week or so.

If your mouth is likely to be very sore, you can take your usual pain relief medication, following the instructions on the packet. It may also be necessary for you to have a course of antibiotics after the extraction.

There may also be some bruising to the skin of your face that can take up to two weeks to fade away.

Depending on the position of the wisdom tooth you may experience some sensitivity to hot and cold from the tooth next to the wisdom tooth.

Is there anything else I need to do after the extraction?

It is important to keep the extraction site as clean as possible for the first few weeks after surgery. It may be difficult to clean your teeth around the site(s) of the extraction because it is sore and, if this is the case, it is best to keep the area free from food debris by gently rinsing with a mouth wash or warm salt water, made by dissolving a level teaspoon of kitchen salt in a cup of warm water, starting on the day after your surgery. Do not rinse your mouth on the day of your surgery.

Do I need to take any time off work?

Usually it will be necessary for you to take a few days off work and to avoid strenuous exercise for this time. You should not drive for 24 hours after intravenous sedation, or for 48 hours after a general anaesthetic.

Are there any possible problems?

Although there may be a little bleeding at the time of the extraction, this usually stops very quickly and is unlikely to be a problem if the wound is stitched. Should the area bleed again when you get home, this can usually be stopped by applying pressure over the area for at least 10 minutes with a clean, damp handkerchief or swab.

Infection is uncommon, particularly if antibiotics are taken.

There are two nerves that lie very close to the roots of wisdom teeth in the lower jaw. One of these nerves supplies feeling to your lower lip, chin and lower teeth. The other supplies feeling to your tongue and helps with taste. Sometimes these nerves may be bruised when a lower wisdom tooth is extracted. This can cause tingling or numbness in your lip, chin or tongue or, more rarely, altered taste. About one in 10 people will have some tingling or numbness that can last several weeks. Less than one in 100 people will have problems that last more than a year and can be permanent.

These risks may be higher if your tooth is in a difficult position. Your surgeon will tell you if you are considered to be at an increased risk.

If there is a large filling or crown on the tooth next to the wisdom tooth there is a small chance that could become damaged during surgery though we do our best to prevent this.

If the bleeding does not stop, please contact the Oral Surgery department on 01473 703 200 for advice during normal working hours.

Outside these hours please call the hospital switchboard on 01473 712 233 and ask for bleep 489.

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