Wisdom Tooth Removal: When It Is Needed and Aftercare

Do wisdom teeth always need to come out?

No. Many clinical guidelines advise against removing healthy wisdom teeth that cause no problems, and simply monitoring them at routine check-ups. Extraction is a surgical procedure with recovery time and possible complications, so it is done only when the benefit is greater.

The problem is that the jaw often has too little room for this tooth, so it comes through partly or at an angle, creating an area that is hard to clean where bacteria collect.

When does a wisdom tooth need removing?

Your dentist decides after an examination and X-ray. Common reasons include:

• Repeated gum infection over a partly erupted tooth, with pain, swelling and sometimes difficulty opening the mouth.
• Decay in the wisdom tooth that cannot easily be treated.
• Decay or damage to the neighbouring molar because the wisdom tooth leans against it.
• A cyst forming around an impacted tooth.
• Gum disease at the back of the mouth.
• Sometimes for reasons advised by an orthodontist or before certain other treatments.

What is an impacted tooth, and why is an X-ray essential?

An impacted tooth is one that could not fully come through, staying wholly or partly under the gum or in the bone. It may tilt towards the neighbouring molar or lie on its side.

A panoramic X-ray shows the tooth's position, the shape of its roots, and its relation to nearby teeth and to the nerve that runs through the lower jaw. In some cases, particularly when the roots are close to the nerve, your dentist may request a 3D cone beam scan (CBCT) to plan the extraction more precisely.

How is a wisdom tooth removed?

Extraction is usually done under local anaesthetic, so you feel pressure and movement but not sharp pain. An erupted tooth may be removed much like any other molar. An impacted one needs a small opening in the gum; a little bone may be removed or the tooth divided into pieces to ease it out, and the gum is then stitched.

It can take from a few minutes to around an hour depending on difficulty. For complex cases or very anxious patients, sedation or general anaesthesia may be discussed. Tell your dentist beforehand about any chronic conditions or medicines, especially blood thinners. If you are pregnant, non-urgent extraction is usually postponed.

Aftercare day by day

Recovery varies from person to person, but it usually goes like this:

• Day one: bite on the gauze for 30 to 45 minutes, and do not spit, rinse hard or use a straw. Apply cold packs to the cheek on and off, eat soft lukewarm food, and sleep with your head raised on an extra pillow.
• Days two and three: swelling usually peaks, which is expected. Start gentle warm salt-water rinses after 24 hours, especially after eating.
• Days four to seven: swelling and pain gradually ease, and you can slowly return to normal food while avoiding chewing on the extraction site.
• After about one to two weeks: stitches are removed if they are not dissolvable, while full bone healing continues for weeks.
• Throughout recovery: take painkillers or other medicines only as your dentist prescribed, and avoid smoking of any kind.

Signs of dry socket

Dry socket happens when the blood clot protecting the extraction site breaks down or comes out too early, exposing the bone. It is one of the more common complications, and it is more likely in smokers and after difficult lower extractions. Signs include:

• Pain that gets worse instead of better two to four days after the extraction.
• Pain spreading towards the ear or temple on the same side.
• A bad taste or smell from the socket.
• The socket looks empty instead of holding a dark clot.