An oral and maxillofacial surgeon or your dentist can remove (extract) a wisdom tooth. The procedure often can be done in the dentist’s or surgeon’s office. You may have the surgery in the hospital, especially if you are having all your wisdom teeth pulled at one time or if you are at high risk for complications.
Your dentist or oral surgeon may use one of three types of anesthesia, depending on the expected complexity of the wisdom tooth extraction and your comfort level. Options include:
dentist or oral surgeon administers local anesthesia with one or more
injections near the site of each extraction. Before you receive an injection,
your dentist or surgeon will likely apply a substance to your gums to numb
them. You’re awake during the tooth extraction. Although you’ll feel some
pressure and movement, you shouldn’t experience pain.
Sedation anesthesia. Your dentist or oral surgeon gives you sedation anesthesia through an intravenous (IV) line in your arm. Sedation anesthesia suppresses your consciousness during the procedure. You don’t feel any pain and will have limited memory of the procedure. You’ll also receive local anesthesia to numb your gums.
special situations, you may be offered general anesthesia. You may inhale
medication through your nose or have an IV line in your arm, or both. Then you
lose consciousness. Your surgical team closely monitors your medication,
breathing, temperature, fluids and blood pressure. You’ll experience no pain
and have no memory of the procedure. Local anesthesia is also given to help
with postoperative discomfort.
During wisdom tooth extraction, your dentist or oral surgeon:
- Makes an incision in the gum tissue to expose the tooth and bone
- Removes bone that blocks access to the tooth root
- Divides the tooth into sections if it’s easier to remove in pieces
- Removes the tooth
- Cleans the site of the removed tooth of any debris from the tooth or bone
- Stitches the wound closed to promote healing, though this isn’t always necessary
- Places gauze over the extraction site to control bleeding and to help a blood clot form
After the procedure
If you receive sedation anesthesia or general anesthesia, you’re taken to a recovery room after the procedure. If you have local anesthesia, your brief recovery time is likely in the dental chair.
As you heal from your surgery, follow your dentist’s instructions on:
Some oozing of blood may occur the first day after wisdom tooth removal. Try to avoid excessive spitting so that you don’t dislodge the blood clot from the socket. Replace gauze over the extraction site as directed by your dentist or oral surgeon.
You may be able to manage pain with an over-the-counter pain reliever, such as acetaminophen (Tylenol, others), or a prescription pain medication from your dentist or oral surgeon. Prescription pain medication may be especially helpful if bone has been removed during the procedure. Holding a cold pack against your jaw also may relieve pain.
Swelling and bruising
Use an ice pack as directed by your dentist or surgeon. Any swelling of your cheeks usually improves in two or three days. Bruising may take several more days to resolve.
After your surgery, plan to rest for the remainder of the day. Resume normal activities the next day, but for at least a week, avoid strenuous activity that might result in losing the blood clot from the socket.
Drink lots of water after the surgery. Don’t drink alcoholic, caffeinated, carbonated or hot beverages in the first 24 hours. Don’t drink with a straw for at least a week because the sucking action can dislodge the blood clot from the socket.
Eat only soft foods, such as yogurt or applesauce, for the first 24 hours. Start eating semisoft foods when you can tolerate them. Avoid hard, chewy, hot or spicy foods that might get stuck in the socket or irritate the wound.
Cleaning your mouth.
Don’t brush your teeth, rinse your mouth, spit or use mouthwash during the first 24 hours after surgery. Typically you’ll be told to resume brushing your teeth after the first 24 hours. Be particularly gentle near the surgical wound when brushing and gently rinse your mouth with warm salt water every two hours and after meals for a week.
If you smoke, don’t do so for at least 72 hours after surgery — and wait longer than that if possible. If you chew tobacco, don’t use it for at least a week. Using tobacco products after oral surgery can delay healing and increase the risk of complications.
You may have stitches that dissolve within a few weeks or no stitches at all. If your stitches need to be removed, schedule an appointment to have them taken out.
When to call your dentist or surgeon
Call your dentist or oral surgeon if you experience any of the following signs or symptoms, which could indicate an infection, nerve damage or other serious complication:
- Difficulty swallowing or breathing
- Excessive bleeding
- Severe pain not relieved by prescribed pain medications
- Swelling that worsens after two or three days
- A bad taste in your mouth not removed with saltwater rinsing
- Pus in or oozing from the socket
- Persistent numbness or loss of feeling
- Blood or pus in nasal discharge
If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or any other unfavorable reaction and contact our office immediately. Call the office if you have any questions.
Nausea and Vomiting
In most cases after anesthesia you will be prescribed an anti-nausea medication to help you get through any anticipated discomfort. In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour, including the prescribed medicine. You should then sip on coke, tea, or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine.
- If numbness of the lip, chin, or tongue occurs please notify our office.
- Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Ibuprofen should be taken to reduce the fever. Keep yourself hydrated.
- You should be careful going from the lying down position to standing. You could get light headed from low blood sugar or medications. Before standing up, you should sit for one minute before getting up.
- Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots; they are the bony walls which supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by Dr. Girdhar at the follow up visit.
- If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as Vaseline.
- Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days.
- Stiffness (Trimus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event which will resolve in time.
Why Do We Get Problems With Wisdom Teeth?
Wisdom teeth pain symptoms, caused by their ‘impaction’, are a common problem. These ‘third molars’ are the last teeth to erupt into the mouth. There are usually four, one in each corner of the mouth at the back. They most commonly appear between the ages of 17 and 24, but can also erupt much later. Symptoms are common here as they are the last molars to enter the mouth, there is often not enough space for them to fully come through.
Therefore they may only partially erupt into the mouth or not come through at all. “Graphic showing the cause of wisdom teeth pain i.e. pericoronitis” Graphic showing the cause of most problems pericoronitis When there is enough room, they will come through into the mouth normally and act as any other tooth.
There may be some problems including dental pain as they are growing in, (you may thus occasionally need some mild pain relief such as acetaminophen, paracetamol) but this will clear up once the tooth finds its final position. Pain and other symptoms can arise when there is not sufficient room in the mouth. The tooth may become impacted
What is an Impacted Wisdom Tooth?
A tooth is described as impacted if it is blocked from erupting into the mouth fully. Thus it will lie at an angle instead of being upright, remaining tipped against the tooth in front of it. Technically, any tooth can become impacted but it is wisdom teeth that are the most often affected, owing to their late eruption. Impacted teeth can cause a range of problems, but it should also be noted that they may cause no problems at all.
What Symptoms Might I Get?
When a wisdom tooth is problematic symptoms may include:
Pain and swelling of the gum overlying the impaction this is due either infection of this operculum or trauma from the tooth above hitting into it, or a combination of both. For example, a swelling that arises from infection may make the upper tooth impinge onto the gum traumatizing it more and causing a vicious cycle.
- Bad breath, due to infection and/or debris building up in the area.
- A bad taste in the mouth, for the same reasons.
- Pus coming out from the swollen gum area.
- Aches when you open your mouth, as you are stretching the inflamed tissues. Difficulty on opening your mouth.
- Tenderness when chewing or biting as this hurts the swollen gum area.
- Pain/ulcers on the inner cheek, where the pointy parts (cusps) of the impacted teeth may be digging into the soft tissues of the cheeks.
as pain can spread outward from the area.
The symptoms can occur for a few days and then clear up. It can then come back at any time, often with weeks or months between occurrences. More serious symptoms can develop: Watch out for these signs, and note that they may develop quite quickly:
Swollen glands under the chin (‘lymph nodes’). Swelling of the face and jaw, may indicate cellulitis. Muscle spasms in the jaw. Fever and general malaise. Such symptoms may indicate a severe, spreading infection which can be very serious if left untreated. Immediate advice should be sought from your dentist. The cause of these problems is that when a wisdom tooth is impacted, a flap of gum will lie over it. As it is difficult to clean effectively under the gum flap, bacteria will proliferate here and the gum will become inflamed. This inflammation is known as ‘pericoronitis’.