Wisdom Teeth

Why do we have wisdom teeth?

Adults can have a maximum of 32 teeth. The wisdom teeth are the last to come through, right at the back. They usually appear between the ages of 16 and 21.Although sometimes they may appear many years later. Nowadays people often have jaws that are too small for all 32 teeth – 28 are the most we have room for. So if all the other teeth are present and healthy there may not be enough space for the wisdom teeth to come through properly.

Do they always cause problems?

No. If there is enough room they will usually come through into useful position and cause no more problems than any other tooth. Often there will be a slight discomfort as they come through, but this is temporary and will disappear once the tooth is fully in position.

What is an impacted wisdom tooth?

If there is not enough room, the wisdom tooth may try to come through, but get stuck against the tooth in front of it. The wisdom tooth will be at an angle that will be described by the dentist as ‘impacted’.

What problems should I be prepared for?

If part of the wisdom tooth has appeared through the gum and part of it is still covered, the gum may become sore and perhaps swollen. Food particles and bacteria can collect under the gum edge, and it will be difficult to clean effectively. Your dentist may be able to advise you whether this is a temporary problem that can be dealt with by using mouthwashes and special cleaning methods (and possibly antibiotics), or whether it is better to have the tooth removed.

What can I do to help myself?

A mouthwash of hot water with a teaspoonful of salt will help to relieve gum soreness and Inflammation. (Check that it is not too hot before using it). Hold the solution around the tooth, letting the heat from the water do the work. An antibacterial mouthwash such as corsodyl can also be very useful to reduce the inflammation. Pain relieving tablets such as paracetamol and aspirin can be useful for short-term use, but consult your dentist if the pain continues.

What if it does not help?

If the pain does not go away or if you find it difficult to open your mouth, you should see a dentist. They will be able to see the cause of the problem, and advise you accordingly. It may be useful to clean around the tooth very thoroughly, and an antibiotic may be prescribed.

Are x-rays needed?

The dentist may need to take x-rays to see the position of the root and to ascertain whether there is room for the tooth to come through into a useful position.

What are the main reasons for taking wisdom teeth out?

  • When it is clear that the wisdom teeth will not be able to come through into a useful position because there is not enough room and when they are also causing pain or discomfort.
  • If they have only partially come through and are decayed -such teeth can often be susceptible to decay as it will be difficult to clean them as thoroughly as your other teeth.
  • If a wisdom tooth starts to ‘over-grow’. This often happens if the lower one has already been removed or is impacted and cannot come through. The upper one will come down too far looking for a tooth to make contact with.
  • If they are consistently painful over a period of time.
  • If, due to their position they cause a food trap, and hence a decay risk to the adjacent tooth.

Are wisdom teeth difficult to take out?

It all depends on the position and the shape of the roots. Your dentist will advise you as to how easy or difficult each tooth will be to remove after assessment, possibly with x-rays. Upper wisdom teeth are often more straightforward to remove than the lower ones, which are more likely to be impacted. Your dentist will advise whether you should be referred to a specialist (oral surgeon) at a hospital. Occasionally there is a possibility of some numbness of the lip after the removal of a lower tooth -your dentist will tell you if it is possible in your case.

Difficult wisdom teeth may require incising the gum to gain access and remove the bone around the tooth with handpiece drills. It is also possible the dentist may have to section or divide the tooth to remove it in separate pieces.

The nerve that supplies your tongue is protected but may become bruised. The socket is then cleaned with saline and sutures (stitches) are normally placed which need to be removed one week later. This procedure may be carried out at the surgery under a local anaesthetic (injection in the gum) or alternatively you may be referred to Loughborough General Hospital for an assessment. The tooth would eventually be extracted (taken out) at Leicester Royal Infirmary; there is a waiting list for this procedure on the NHS. However, if you would prefer to pay privately to avoid the NHS waiting list this can also be arranged through your dentist.

What should I expect after a wisdom tooth is taken out?

The amount of pain/discomfort will depend on how easy the removal of the tooth is. There is usually some swelling and discomfort for a few days afterwards, together with bruising over the cheeks. It is important to follow any advice you will be given about mouthwashes etc. to help with the healing.

Some people also find homeopathic remedies helpful in reducing discomfort such as arnica. Usual painkillers such as paracetamol, aspirin or ibuprofen will usually deal with any pain. It is best to stay fairly quiet and relaxed for 2 hours afterwards to make sure there are no bleeding problems. The dentist may use some stitches to help the gum heal over- they will then need to see you again about a week later to remove any stitches and to check on the healing. It may be difficult to open your mouth as wide as normal so it is advised to eat soft foods for a few days. The wound should not bleed, however, should you experience bleeding after the operation then follow the instructions given to you.

What does it cost?

At hospital treatment is free. In general practice it is free if you are under 18 or exempt from NHS charges, otherwise the cost depends on what is involved. It is important that you discuss costs and payment methods with your dentist before starting treatment.

What are the risks/complications?

Prolonged bleeding is very rare and only occurs in 0.6 -5% of patients. Occasionally 1-5% of patients may find their socket has become infected. To prevent this it is important to rinse your mouth with hot salt water, starting the day after the extraction, for at least a week frequently as instructed.

It is particularly important to refrain from smoking for a few days following the operation. If you should experience pain, typically a couple of days after the procedure, you may have an infected socket. Please contact the surgery for advice.

Nerve damage is a rare complication, leaving the lip or tongue feeling “tingly” or even numb, this occurs between 1 -1.6% of patients long term. The nerve usually recovers with time.There is sometimes a change in the way your teeth bite together, which feels different, initially, but usually reduces spontaneously.

Osteomyelitis (bone infection) occurs 0.0025% of patients.

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