Wisdom teeth & complex extractions
Wisdom teeth that cannot come through properly (impacted) often cause no problems. When they do cause disease, removing them is usually a short day-case procedure. Dentoalveolar surgery, including wisdom teeth, is one of Will’s subspecialty interests.
Who it may help
- Repeated gum infections around a partly erupted tooth (pericoronitis)
- Decay that cannot be repaired, in the wisdom tooth or the tooth in front
- Cysts, abscesses or damage to neighbouring teeth
- Teeth that are in the way of other planned jaw surgery
Recovery
Swelling and jaw stiffness are worst at two to three days and usually settle within a week to ten days. Most people take a few days off work. Gentle salt-water rinses help the sockets heal.
What is involved
The tooth is removed under local anaesthetic, with sedation, or under general anaesthetic. A small cut is made in the gum, a little bone may be removed and the tooth is often divided into pieces to take it out gently. Dissolving stitches close the gum. Where X-rays or a CBCT scan show the roots are very close to the nerve, a coronectomy – removing only the crown and leaving the roots – may be safer.
Risks and side effects
All surgery carries some risk. The main ones for this treatment are listed below; your own risk depends on your health and the details of your operation.
- Pain, swelling, bruising and jaw stiffness
- Bleeding or infection
- Dry socket – delayed healing that causes pain a few days later
- Numbness or tingling of the lower lip, chin or tongue from nerve bruising – usually temporary; permanent numbness is rare
- Damage to a neighbouring tooth or filling – rare
Alternatives
A wisdom tooth that is healthy and not causing disease can be left and monitored. A single mild infection may settle with cleaning and mouthwash. Coronectomy is an option when the nerve is at risk.
Guidance and standards
NICE guidance is that wisdom teeth should not be removed routinely as a preventive measure, only where there is a clear clinical reason. GIRFT encourages simpler extractions to be carried out in the most appropriate setting, often as day cases.
Questions worth asking at your appointment
- Benefits – what will this treatment do for me?
- Risks – what could go wrong, and how likely is it for me?
- Alternatives – what other options are there?
- Nothing – what happens if I wait, or decide not to have treatment?
Based on the Choosing Wisely UK BRAN questions.