Wisdom Teeth Removal

Wisdom tooth removal — or wisdom tooth extraction — is a common oral surgery procedure. Dentists may recommend this treatment to preserve your oral health and protect your other teeth from possible issues in the future.

Your wisdom teeth — also called third molars — are in the very back of your mouth. Typically, they erupt (grow in) sometime between the ages of 17 and 25.

Scientists believe wisdom teeth are vestigial structures (parts of the human body that are no longer necessary). Our ancestors needed these teeth to crush and chew raw leaves, nuts, roots and meat. Today, we eat more cooked food and use forks and knives to cut our food into smaller pieces. As a result, we don’t really need wisdom teeth anymore.

Some people have all four wisdom teeth (one in each quadrant — the upper left, lower left, upper right and lower right). Others may have one, two, three or none at all. No matter how many wisdom teeth you do (or don’t) have, it doesn’t mean there’s something wrong. It’s just a variation of normal and a sign of the ever-changing evolutionary process.

Why is this done?

You might need wisdom teeth removed if you:

• Have one or more impacted wisdom teeth
• Have wisdom teeth that grow in crooked or sideways
• Develop pain near the back of your mouth
• Have food or debris trapped around your wisdom teeth
• Develop gum disease, particularly around your molars
• Have tooth decay (cavities) in a partially erupted wisdom tooth
• Develop a cyst (fluid-filled sac) around one or more wisdom teeth
• Have damage to nearby teeth or surrounding bone

In many cases, dentists recommend wisdom teeth extraction as a preventive measure. As a result, your dentist may suggest removing your wisdom teeth even if you don’t have any symptoms. This can help reduce your risk for future problems, including infection and tooth decay.

How should I prepare for wisdom teeth removal?

During a consultation with an oral surgeon, they’ll check the health of your wisdom teeth and take dental X-rays to see their exact location. This is a good time to tell them about any medications, vitamins or supplements you’re currently taking. Don’t stop taking medication before discussing it with your provider.

Your dental provider may discuss how they’ll manage your pain during your procedure. They may offer to give you a sedative to help you stay relaxed and comfortable. If you choose to have a sedative, be sure to ask them if you need to fast (not eat or drink) before the procedure. Typically, people fast for six to eight hours before their procedure.

If you receive a sedative, you won’t be able to drive for at least 24 hours. You should plan to have someone take you home after your procedure.

What happens during wisdom tooth extraction?

On the day of your procedure, your oral surgeon will:

1. Give you anesthesia to numb your teeth and gums and keep you comfortable. (If you choose sedation, they’ll give you sedative medications, as well.)
2. Make incisions (cuts) in your gums, if necessary, to expose teeth trapped in your gums or jawbone.
3. Carefully loosen your wisdom teeth and lift them from their socket. (Your provider may need to divide the tooth into sections for easier removal.)
4. Clean the area to make sure there’s no infection.
5. Place stitches to close the surgical site, if necessary.
6. Place gauze over the socket to slow bleeding.

How long does this procedure take?

Wisdom tooth extraction usually takes an hour or less. Complex cases may take longer.

What happens after wisdom teeth removal?

After wisdom teeth removal, you can expect some discomfort, slight bleeding and swelling. Your healthcare provider will give you instructions on managing your wisdom teeth to ease these side effects.

Dos and don’ts after wisdom tooth extraction

Your oral surgeon will give you postoperative guidelines specific to your situation. Following these instructions will help you manage bleeding, swelling and pain after your procedure. In the meantime, here are some general “dos and don’ts” after wisdom teeth removal:

DOS

• Do leave gauze in place for about 30 minutes after your surgery. Replace with clean gauze if necessary. Your oral surgeon will tell you when to stop using gauze after wisdom tooth extraction. But in general, you can take it out when the bleeding slows. It’s normal to have some oozing, but you shouldn’t have excessive bleeding.
• Do rest as much as you can. You should stay at home and recover for at least three to five days. If you have a physically demanding job, you might need to wait longer before returning to work.
• Do use an ice pack to help reduce swelling. Wrap the ice pack in a clean towel and place it on your face. Leave it on for 20 minutes and then take it off for 20 minutes. Repeat several times a day.
• Do keep extraction sites clean. Gently soak the surgical areas with alcohol-free antibacterial mouthwash. Don’t swish. Swishing can dislodge blood clots and cause dry socket, a painful condition that exposes the bone at your extraction site. Instead, lean your head to each side and let the mouthwash soak the areas.
• Do brush and floss the rest of your teeth every day. While you don’t want to brush over the extraction sites, you’ll still need to keep your other teeth clean during recovery. This reduces your risk for infection.
• Do take all medications as prescribed. Your provider will give you medications to keep you comfortable and reduce your risk of infection. Don’t stop taking these medications until your provider says it’s OK.

DON’TS

• Don’t drink through a straw. This dislodges blood clots and causes dry sockets.
• Don’t exercise until your oral surgeon says it’s OK. Getting your heart rate up increases your risk of pain, bleeding and swelling. Most people can resume their fitness routines in about 48 to 72 hours.
• Don’t lift heavy things. Heavy lifting also increases your risk for postoperative complications like pain, bleeding and swelling.
• Don’t eat hard, crunchy or chewy foods. These can damage your healing gums and cause pain.
• Don’t drink carbonated beverages or beverages containing alcohol. These beverages can dislodge blood clots and cause dry sockets. Skip these drinks for at least five days.

What are the benefits of removing wisdom teeth?

Wisdom tooth removal can reduce your risk for future oral health problems, like:

• Gum disease
• Tooth decay
• Damage to neighboring teeth
• Bone loss
• Jaw damage

If you’ve already developed pain because of your wisdom teeth, extraction can often ease discomfort almost immediately and get you back on track to better oral health.

What are the risks or complications of extraction?

Wisdom teeth removal usually doesn’t result in long-term complications. In rare instances, people may develop:

• Infection (pus coming out of your socket or incisions)
• Dry sockets (loss of blood clot resulting in exposed bone)
• Damage to other oral structures, including your jawbone, nerves, sinuses or nearby teeth

How long does it take to recover after wisdom teeth removal?

Your recovery will be a marathon, not a sprint. It can be more than a month for your socket(s) to heal. The good news is side effects like bleeding, pain and swelling should ease within a week. Here’s what you can expect as you recover:

Days 1 to 3

Expect to have some light bleeding, swelling and pain during this time. Some suggestions that may help the healing process include:

• Pile extra pillows under your head when you’re resting. Keeping your head raised while you rest will help with swelling.
• Take prescription medication as recommended. Avoid aspirin if you use over-the-counter medication. Aspirin thins your blood, so the extraction site may continue bleeding.
• Use a cold compress to manage pain and reduce swelling.

Take care with what you eat and drink, too. Your provider will give you a list of soft foods that you can eat during the first three days. Drink lots of water, but don’t swish it around your mouth.

Days 4 to 7

You’ll probably have less pain, swelling and bleeding. Most people go back to their daily routine by day 5. You should:

• Start rinsing your mouth with warm salt water. This helps with healing. By now, it’s OK to spit.
• Be able to go back to light activities, but don't push yourself. Anything that raises your heart rate can cause bleeding, swelling and pain.

Contact your dentist if you have fever, severe pain or pus oozing from the socket. These could be infection symptoms.

Week 2

Your side effects may be gone, but your healing gums still need extra care. You should:

• Continue rinsing your mouth with warm salt water.
• Add new foods to your meals, as long as they're not crunchy or chewy foods that could hurt your tender gums.
• Keep on brushing and flossing while avoiding the socket. Good oral hygiene keeps your mouth clean and prevents infection.
• Have a follow-up appointment with your oral surgeon. Tell them about any ongoing pain, especially facial pain. This could be a symptom of a dry socket.

Weeks 3 to 4

Your gum tissue should begin to grow over and cover the socket. You can now:

• Very gently brush the new tissue coming in over your socket.
• Start eating your usual snacks and meals, including your favorite crunch or chewy foods.
• Be more active and do things that raise your heart rate.

When should I call my dentist or oral surgeon?

Call your healthcare provider if you develop:

• Swelling that gets worse after three days.
• A fever that’s higher than 102 degrees Fahrenheit (38.8 degrees Celsius).
• Pus coming from the incision site.
• Bleeding that doesn’t stop.
• Severe pain that doesn’t get better with medication.
• Difficulty breathing or swallowing.

What’s the average wisdom teeth removal age?

As long as you’re old enough to have wisdom teeth, you’re old enough for wisdom teeth extraction. There’s also no upper age limit. Many dentists recommend wisdom teeth removal in your late teens or early 20s. At this age, your wisdom teeth are still developing, so they may be easier to extract.