Dental health and wisdom teeth

What are potential complications of wisdom tooth removal?

Two of the more important complications after having your wisdom teeth removed include:

• Dry socket. Dry socket is a common complication that occurs when either a blood clot has failed to form in the extracted tooth socket or else the blood clot that did form has been dislodged. Without clot formation, healing will be delayed. When it happens, dry socket typically occurs 3 or 4 days following the extraction and is accompanied by pain, ranging from "dull" to moderate to severe, and a foul mouth odour. Your dentist or oral surgeon will treat the dry socket by placing medication in the socket.
• Paresthesia. Paresthesia means numbness and is a less frequently occurring complication. Wisdom teeth entrapped in the jawbone are often close to nerves. Sometimes these nerves can be bruised or damaged during the tooth removal process. The result is a numbness of the tongue, lip or chin that can last a few days, weeks, months or may even be permanent.

How much does wisdom teeth extraction cost?

The cost of the extraction of a wisdom tooth varies considerably, as it depends on a series of factors like the difficulty of the procedure, whether it’s being carried out in a dental surgery or hospital and whether your dentist is NHS or private. Private prices start from around £179 per tooth and NHS prices are considerably less. It is always recommended that you get a written estimate before starting treatment and, if you have private health care, to check with your provider whether the extraction costs are covered by your plan.

Dental health and wisdom teeth

What happens during wisdom teeth removal?

Before your wisdom teeth are pulled, the teeth and the surrounding tissue will be numbed with a local anaesthetic which is the same injection with the same medication you would receive to numb a tooth prior to having a cavity filled. In addition to the local anaesthetic to numb the pain, you and your dentist or oral surgeon may decide that a sedative is desired to control any anxiety. Sedating medications that could be selected include: nitrous oxide (otherwise known as "laughing gas"), an oral sedative, or an intravenous sedative (administered via an injection into your veins). If nitrous oxide is given, you will be able to drive yourself home. If any of the other medications is selected, you will need someone to drive you both to and from the appointment.

What does recovery involve after wisdom teeth are pulled?

After having your wisdom teeth removed, the speed of your recovery depends on the degree of difficulty of the extraction (a simple extraction of a fully erupted tooth versus a tooth impacted into the jawbone). In general, here's what to expect.

During the first 24 hours

• Bleeding may occur for several hours after tooth extraction. To control it, position a piece of clean moist gauze over the empty tooth socket and bite down firmly. Apply constant pressure for about 45 minutes. A moistened tea bag is an effective alternative. The tannic acid in tea helps blood clots to form (blood clots function similarly to a scab over an open wound). Repeat this process if a small degree of bleeding continues; if heavy bleeding continues to occur, contact your dentist or oral surgeon. Avoid rinsing or spitting for 24 hours after tooth extraction, avoid "sucking" actions (for example, don't drink through straws or smoke) and avoid hot liquids such as coffee or tea. These activities can dislodge the clot, causing a dry socket to develop (see below).
• Facial swelling in the area where the tooth was extracted typically occurs. To minimise swelling, place a piece of ice, wrapped in a cloth, on that area of your face on a rotation of 10 minutes on, followed by 20 minutes off. Repeat as necessary during this first 24-hour period.
• Pain medications, such as paracetamol or ibuprofen can be taken for minor pain. Your dentist or oral surgeon may prescribe more potent pain relievers, such as opioid medication, if necessary.
• Antibiotics that may have been prescribed prior to tooth extraction and are being used to treat any active infection around the wisdom tooth to be extracted should continue to be taken until the full course is finished.
• Foods should be restricted to a liquid diet until all the numbness from the anaesthetic has worn off. Eat soft foods for a few days. Also avoid alcohol if you're taking opioid medication.
• Continue to brush your teeth, but avoid the teeth directly neighbouring the extracted tooth during the first 24 hours. On day two, resume the gentle brushing of all your teeth. Do not use commercial mouth rinses as these can irritate the extraction site.

After 24 hours

• Facial swelling in the area of the tooth extraction should be treated with heat after the first 24 hours of ice. Apply a moist warm flannel to the area on a 20 minute on, 20 minute off rotation. Repeat as necessary.
• Rinse your mouth with warm salt water (1/2 teaspoon of salt in a cup of warm water) after meals and before bed. Do not use commercial mouth rinses.
• Stitches, if used and if not of the self-dissolving type, need to be removed by your dentist or oral surgeon in about 1 week. If you do require stitches, ask what type you have been given.
• Watch for signs of dry socket (described below). This condition requires treatment by your dentist.
• Complete healing doesn't occur for a few weeks to a few months following the extraction. However, usually within the first week or two, enough healing has taken place for use of your mouth to be reasonably comfortable in the area of the extraction. Your dentist will explain what to expect in your specific case.

Dental health and wisdom teeth

Wisdom teeth are the third and final set of molars that most people get in their late teens or early twenties. Sometimes these teeth can be a valuable asset to the mouth when healthy and properly aligned, but more often than not, they are misaligned and require removal.

Wisdom teeth present potential problems when they are misaligned as they can position themselves horizontally, be angled toward or away from the second molars or be angled inward or outward. Poor alignment of wisdom teeth can crowd or damage adjacent teeth, the jawbone or nerves. Wisdom teeth that lean toward the second molars make those teeth more vulnerable to decay by entrapping plaque and debris. In addition, wisdom teeth can be entrapped completely within the soft tissue and/or the jawbone or only partially break through, or erupt, through the gum. Teeth that remain partially or completely entrapped within the soft tissue or the jawbone are termed "impacted". Wisdom teeth that only partially erupt allows for an opening for bacteria to enter around the tooth and cause an infection, which results in pain, swelling, jaw stiffness and general illness. Partially erupted teeth are also more prone to tooth decay and gum disease because their hard-to-reach location and awkward positioning makes brushing and flossing difficult.

How do I know if I have wisdom teeth?

Wisdom teeth present potential problems when they are misaligned as they can position themselves horizontally, be angled toward or away from the second molars or be angled inward or outward. Ask your dentist about the positioning of your wisdom teeth. He or she may take an X-ray periodically to evaluate the presence and alignment of your wisdom teeth. Your dentist may also decide to send you to an oral surgeon (also called an oral and maxillofacial surgeon) for further evaluation.

Your dentist or oral surgeon may recommend that your wisdom teeth be extracted even before problems develop. This is done to avoid a more painful or more complicated extraction that might have to be done a few years later. Removal is easier in young people, when the wisdom teeth roots are not yet fully developed and the bone is less dense. In older people, recovery and healing time tend to be longer.

How are wisdom teeth removed?

The relative ease at which your dentist or oral surgeon can extract your wisdom teeth depends on their position. Your dentist will be able to give you an idea of what to expect during your pre-extraction exam. A wisdom tooth that is fully erupted through the gum can be extracted as easily as any other tooth. However, a wisdom tooth that is underneath the gums and embedded in the jawbone will require an incision into the gums and then removal of the portion of bone that lies over the tooth. Often, for a tooth in this situation, the tooth will be extracted in small sections rather than removed in one piece to minimise the amount of bone that needs to be removed to get the tooth out.

Tooth extraction

What to tell your dentist before you have a tooth extracted

Although having a tooth out is usually very safe, the procedure can allow harmful bacteria into the bloodstream. Gum tissue is also at risk of infection. If you have a condition that puts you at high risk for developing a severe infection, you may need to take antibiotics before and after the extraction. Before having a tooth removed, let your dentist know your complete medical history, the medications and supplements you take, and if you have one of the following:

damaged or man-made heart valves

a congenital heart defect

an impaired immune system

liver disease (cirrhosis)

an artificial joint, such as a hip replacement

a history of bacterial endocarditis

After you've had a tooth extracted

Following an extraction, your dentist will send you home to recover. Recovery typically takes a few days. The following can help minimise discomfort, reduce the risk of infection and speed recovery.

Take painkillers as prescribed or over the counter products suggested by your dentist - such as ibuprofen, aspirin or paracetamol.

Bite firmly but gently on the gauze pad placed by your dentist to reduce bleeding and allow a clot to form in the tooth socket. Change gauze pads if they become soaked with blood Otherwise, leave the pad in place for three to four hours after the extraction.

Apply an ice bag to the affected area immediately after the procedure to keep down swelling. Apply ice for 10 minutes at a time.

Relax for at least 24 hours after the extraction. Limit activity for the next day or two.

Avoid rinsing or spitting for six hours after the extraction to avoid dislodging the clot that forms in the socket.

After six hours, gently rinse your mouth with a solution made of half a teaspoon of salt in a glass of warm water.

Do not drink from a straw for the first 24 hours.

Do not smoke, as it can inhibit healing.

Eat softer foods (such as soup or yoghurt) the day after the extraction. Gradually add solid foods to your diet as the extraction site heals.

When lying down, prop your head up with pillows. Lying flat may prolong bleeding.

Continue to brush and floss your teeth, and brush your tongue, but avoid the extraction site. Doing so will help prevent infection.

When to call the dentist

It is normal to feel some pain after the anaesthesia wears off. For 24 hours after having a tooth out, you should also expect some swelling and residual bleeding. However, if pain is severe or bleeding continues for more than four hours after the extraction, you should call your dentist. You should also call your dentist if you experience any of the following:

signs of infection, including fever and chills

nausea or vomiting

redness, swelling or excessive discharge from the affected area

cough, shortness of breath or chest pain

The initial healing period usually takes about one to two weeks. New bone and gum tissue will grow into the gap. Longer term, however, having a tooth (or teeth) missing can cause the remaining teeth to move, affecting your bite and making it difficult to chew. For that reason, your dentist may advise replacing the missing tooth or teeth with an implant, fixed bridge or denture.

Tooth extraction

When you were six, losing a tooth was a rite of passage, perhaps achieved by incessant tooth jiggling, biting into a crisp apple or tying a string around the tooth and giving it a pull. As an adult, tooth loss is hardly cause for celebration, yet having a tooth out is sometimes necessary.

Reasons for extracting teeth

Although permanent teeth were meant to last a lifetime, there are a number of reasons why tooth extraction may be needed. The most common is a tooth that is too badly damaged, from trauma or decay, to be repaired. Other reasons include:

A crowded mouth. Sometimes dentists extract teeth to prepare the mouth for orthodontics. The goal of orthodontics is to properly align the teeth, which may not be possible if your teeth are too big for your mouth. Likewise, if a tooth cannot break through the gum (erupt) because there is not room in the mouth for it, your dentist may recommend extraction.

Infection. If tooth decay or damage extends to the pulp -- the centre of the tooth containing nerves and blood vessels -- bacteria in the mouth can enter the pulp, leading to infection. If infection is so severe that antibiotics do not cure it, extraction may be needed to prevent the spread of infection.

Risk of infection. If your immune system is compromised (for example, if you are receiving chemotherapy or are having an organ transplant) even the risk of infection in a particular tooth may be reason to remove the tooth.

Gum Disease. If periodontal disease -- an infection of the tissues and bones that surround and support the teeth -- have caused loosening of the teeth, it may be necessary to extract the tooth or teeth.

What to expect with tooth extraction

Dentists and oral surgeons (dentists with special training to perform surgery) perform tooth extractions. Before removing the tooth, your dentist will give you an injection of a local anaesthetic to numb the area where the tooth will be removed. If you are having more than one tooth extracted or a tooth is impacted, your dentist may use a general anaesthetic. This will prevent pain throughout your body and make you sleep through the procedure.

If the tooth is impacted, the dentist will cut away gum and bone tissue that cover the tooth and then, using forceps, grasp the tooth and gently rock it back and forth to loosen it from the jaw bone and ligaments that hold it in place. Sometimes, a tooth that is difficult to remove must be taken out in pieces.

Once the tooth has been extracted, a blood clot usually forms in the socket. The dentist will pack a gauze pad into the socket and get you to bite down on it to help stop the bleeding. Sometimes the dentist will place a few stitches -- usually self-dissolving -- to close the gum edges over the extraction site.

Sometimes, the blood clot in the socket breaks loose, exposing the socket -- a painful condition called dry socket. If this happens, your dentist will probably place a sedative dressing over the socket for a few days to protect it as a new clot forms.

Toothache treatment

Self-care at home

For toothaches:

Over-the-counter pain medications such as paracetamol or ibuprofen may be used. Take these as directed on the package while you arrange a dental appointment.

Avoid very cold or hot foods as they may make the pain worse.

Relief may be obtained by biting on some cotton wool soaked in oil of cloves. Oil of cloves is available at most pharmacies.

For jaw pain:

Aspirin may be helpful for problems in the joint of the jaw - the temporomandibular joint (TMJ) - in adults. Paracetamol (not aspirin) should be used for children and teenagers.

If pain occurs every time you open your mouth widely, the TMJ may be the source of the pain. Yawning or taking a large bite of food may intensify the pain. An appointment with your doctor or dentist will help to determine the cause.

Dental health: Teeth and gum care

Tips for eating sensibly

Eat a variety of foods but realise that foods containing sugars and starches produce the most acids and stay longest in the mouth. Hard sweets are especially harmful because of the time they stay in the mouth.

Choose your snacks carefully because most people don't brush after snacks. Starchy food, like crisps, stick to the teeth. Avoid snacking on:

• Sweets, cakes and pies
• Sugary gum
• Crackers, breadsticks and crisps
• Dried fruits and raisins

Dental check-ups

Visit your dentist and hygienist at least once every six months. To maintain healthy teeth and gums, it's important to have regular check-ups and professional cleaning. You should also visit the dentist if you feel pain in your teeth or mouth or if you experience bleeding or swollen gum.

You can also ask your dentist about dental sealants, which are materials used to coat the top, chewing surfaces of the teeth. This coating protects the tooth from decay and usually lasts a long time.

Further Reading:

Gum problem basics: Sore, swollen and bleeding gums

The health perils of gum disease

Dental care: Caring for teeth & gums

Oral Health: Mouth-Body Connection

Oral cancer

Slideshow: Most common problems in your mouth

The health perils of gum disease