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What are they?

Wisdom teeth, also known as third molars, are the furthest teeth back in the mouth. There are two wisdom teeth in the upper jaw and two in the lower. Your wisdom teeth are the last to erupt and this usually occurs between the ages of 18-21.

Why extract wisdom teeth?

Wisdom teeth come in extremely variable shapes and sizes and can erupt at abnormal angles – known as impaction – often due to lack of space at the back of the mouth. Impaction or partial eruption of wisdom teeth through the gum can lead to food trapping and plaque accumulation causing problems requiring their removal, including:

Dental decay (caries) in either the wisdom tooth or in the molar directly in front of it. The decay can cause pain and may progress into more serious damage to the nerve if left untreated.

Pericoronitis, which is an infection of the soft tissue surrounding the tooth. This can be extremely sore and may limit mouth opening. If two or more of these infections occur in a year, your dentist may advise that the wisdom tooth is removed.

Cellulitis, a bacterial infection of, for example, the cheek or throat

Periodontal disease caused by bacteria leading to bone loss and tooth mobility

How wisdom teeth are extracted?

If your dentist recommends wisdom tooth removal, an x-ray will be needed so the anatomy of the tooth can be seen. It may be taken inside the mouth, however this can be uncomfortable as it is very far back. Another x-ray – an OPG – that goes around the jaw outside of the mouth may be preferable. The x-ray will show the number and shape of the roots as well as the position of the tooth in relation to nearby structures.

To take a tooth out, your dentist will numb the area so the entire procedure is painless – you may feel a pushing sensation but no sharp pain.
An upper wisdom tooth will require two injections: one by tooth on the side closest to the lip and one in the palate. A lower wisdom tooth will also require two injections: a block which numbs all the lower teeth on that side as well as the lip, skin of the chin and side of the tongue and then another injection closer to the tooth itself.

Your dentist will then loosen the tooth and gently ease it out if it is a conventional extraction. If, however, the tooth is partially erupted or below the gum, a small incision may have to be made in the gum in order to access the tooth. Your dentist will then move the gum out of the way to expose the tooth. Some bone may have to be carefully removed in order to get a good grip of the wisdom tooth, and the tooth may have to come out in sections depending on its angulation. Stitches will then be placed over this incision, which can either be dissolvable or require removal by your dentist at a follow up appointment.

Lower wisdom teeth can be slightly more complicated to extract as they may lie close to nerve that supplies sensation to lip, chin and teeth on that side. If in the original x-ray the roots appear very close to this nerve, your dentist may send you for an addition scan to get a 3D image. This will give a much clearer picture and minimize the chance of damaging the nerve. Damage to this nerve leading to temporary or permanent altered sensation to the lip and skin of the chin is a risk involved with removing lower wisdom teeth.

Post extraction advice

After an extraction you will remain numb for a few hours following the procedure. It is important not to eat or drink anything too hot as you may accidentally hurt yourself before regaining sensation.

If bleeding occurs from the socket, bite down on some gauze for 15 minutes. The pressure from this should stop the bleed.

Smoking should be avoided for at least 48 hours following the procedure as this can cause very painful complications such as dry socket (loss of the blood clot exposing the bone underneath).

Alcohol and heavy exercise should be avoided for the rest of the day following the extraction.

24hours following the extraction, hot salty water mouth rinses should be undertaken to keep the area clean.

It is normal to expect some swelling or soreness following the extraction. The usual painkillers you would take for a headache, for example, should be sufficient to manage this.

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