Impacted wisdom teeth
Dr. Dt. Kıvanç Türkoğlu, Specialist in Oral and Maxillofacial Surgery · Klinik 29, Altunizade, Üsküdar
01/ 10
Summary
- The wisdom tooth is the last molar to start erupting, at the very back of the mouth. When the jaw lacks space, it stays under the gum or bone.
- Being impacted is not a reason for removal on its own. Removal is considered with recurring gum infection, decay in the tooth in front, a cyst or pain.
- In the lower jaw the roots may sit near the canal of the nerve that supplies feeling to the lip. If this is unclear on the X-ray, cross-sectional imaging helps planning.
What symptoms does it cause?
Recurring swelling at the back, pain on biting, a bad taste and limited mouth opening are common. They usually appear once part of the tooth has broken through the gum.
Some teeth cause no symptoms and are found on a routine X-ray.
How is the decision made?
The clinician looks at the angle of the tooth, how deep it lies, the condition of the neighbouring tooth and your symptoms. Regular monitoring is a valid option for a healthy, trouble-free tooth.
If orthodontic or prosthetic treatment is planned, the decision is made together with that clinician.
Imaging
Assessment usually starts with a panoramic X-ray. If the roots appear to overlap the nerve canal and this would change the approach, a cone beam CT may be requested.
The scan does not remove the risk. It lets the surgeon know in advance where the root lies relative to the canal.
How does the procedure go?
The area is numbed with local anaesthesia. If the tooth is in bone, a small flap is raised and the bone covering the tooth is thinned.
When needed, the tooth is divided and removed in sections, which can reduce the amount of bone removed. The wound is closed with a few stitches.
Recovery
Bite on gauze for the first hours. On the first day, avoid vigorous rinsing and spitting to protect the clot. Intermittent cold packs limit swelling. Swelling usually peaks on day two or three and then subsides.
Lukewarm, soft food is best at first. Avoiding smoking for at least three days helps protect the clot. Non-dissolving stitches are removed at the follow-up visit.
Known risks
Dry socket, infection and bleeding can occur. In the lower jaw, numbness of the lip, chin or tongue may develop. It usually improves over time and is rarely permanent.
Contact your clinician if pain keeps increasing or you notice fever or a bad smell. If swallowing or breathing becomes difficult, seek emergency care without waiting.
Frequently asked
This information does not replace an examination and diagnosis. The diagnosis and treatment plan become clear after the examination and may change.
Does an impacted wisdom tooth always have to be removed?
Not every impacted tooth is removed. I recommend removal if there is recurring gum infection, decay in the tooth in front, a cyst or pain. For a tooth that looks healthy and causes no trouble, regular check-ups are also a valid option. The decision is based on the examination and the X-ray.
Why is an X-ray or CT scan requested before the extraction?
A panoramic X-ray shows the angle of the tooth and how deep it lies in the bone. In the lower jaw, if the roots appear over the nerve canal, I may request a CT scan. The scan does not remove the risk. It helps me know in advance where the roots lie relative to the canal.
Will I feel pain during the extraction?
I numb the area with local anaesthesia. Once the numbness is adequate, pain is not expected, but you may feel pressure and vibration. If you feel pain, tell me and I will give more anaesthetic. When needed, I divide the tooth and remove it in sections, which can reduce the amount of bone removed.
How long do swelling and pain last after the extraction?
In most people swelling peaks on the second or third day and then subsides. Intermittent cold packs limit swelling. In most people pain eases noticeably within the first week. The course varies from person to person. If pain keeps increasing as the days pass, or if you have a fever or a bad smell, let me know.
When can I go back to work after the extraction?
Many people with desk jobs go back to work within one to three days. If you do physical work or sport, you may need to wait a few more days. We estimate the time together, based on the extent of the procedure and the work you do.
How should I eat after the extraction, and what should I watch out for?
After the procedure, bite firmly on the gauze pack for as long as I tell you. If bleeding starts again, press firmly with clean gauze for twenty to thirty minutes without stopping. If it does not stop, contact me or a healthcare facility. On the first day, do not rinse your mouth vigorously or spit, and eat lukewarm, soft food. Do not smoke for at least the first three days. A longer break is better for healing.
What problems can occur after the extraction?
Dry socket, wound infection or bleeding can occur. Dry socket is a painful healing problem that occurs when the blood clot in the socket does not form properly or is lost early. It usually becomes noticeable after a few days and needs an examination. In the lower jaw, numbness of the lip, chin or tongue may develop. This loss of sensation usually improves over time and is rarely permanent.
I am having orthodontic treatment or planning a prosthesis. Do I need to have the impacted tooth removed?
This decision is not made on its own. We look together at the position of the tooth, the condition of the neighbouring tooth and your symptoms. If you have an orthodontic or prosthetic plan, I make the decision together with the clinician involved.
If my tooth is very close to the nerve, does it have to be removed completely?
The risk depends on the position of the tooth. In suitable patients, removing only the crown of the tooth and leaving the roots in place, called coronectomy, may be considered. This method also has its own risks and need for follow-up. We discuss which option suits you by looking at the CT scan.
How long does it take?
It depends on the angle and depth of the tooth. Some procedures are short, others take longer.
Why can numbness occur?
Because some lower roots lie next to the nerve that supplies the lip and chin. Numbness is usually temporary.
Sources
- Ghaeminia H, Nienhuijs ME, Toedtling V, et al. Surgical removal versus retention for the management of asymptomatic disease-free impacted wisdom teeth. Cochrane Database Syst Rev. 2020;5(5):CD003879. doi.org/10.1002/14651858.CD003879.pub5
- Hupp JR, Ellis E III, Tucker MR. Contemporary Oral and Maxillofacial Surgery. 7th ed. Philadelphia: Elsevier; 2019.
This treatment is carried out at Klinik 29 (Altunizade, Üsküdar). Klinik 29 website (English)
This information is for general guidance and does not replace an examination. Rapidly spreading facial swelling or difficulty swallowing or breathing is an emergency. Go to a hospital emergency department.
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