
- Wisdom teeth, lower third molars, lower back molars or number 8 teeth are your very back teeth. They erupt into your mouth usually between the ages of 17 and 25 but can be earlier or later. With regard to having wisdom teeth you will fall into one of the following categories
1. Wisdom teeth don't ever develop
2. Wisdom teeth develop but never erupt (enter) into your mouth (may cause pain or be unaware)
3. Wisdom teeth develop and partially erupt into your mouth (may cause pain or not)
4. wisdom teeth develop and fully erupt into your mouth (may cause pain or not)
- Quite often there is not enough room for the wisdom teeth to erupt fully into your mouth, in which case they may only partly erupt into your mouth and stay this way, or not erupt at all and stay hidden beneath the gum level.
- The lower wisdom teeth are more likely to cause problems than the upper wisdom teeth. They are also often more difficult to extract/remove when they do cause a problem than the upper wisdom teeth.
Impacted Wisdom Tooth
- This is where there is not enough room for your tooth to erupt fully. This is often the case for lower wisdom teeth. The lower wisdom tooth impaction is classified depending on the angle of the erupting wisdom tooth which can be anything from a normal angle (vertical impaction) to sideways (horizontal impaction) or even upside down!
- Impacted wisdom teeth may not cause any pain or problems at all and in these cases they can be left alone.
- Alternatively the impacted teeth may cause decay in themselves or the back of the teeth in front
- Pericoronitis - repeated inflammation of the gum still covering the partially erupted tooth which can cause repeated infections and pain in the area.
- Cellulitis - the infection as above that spreads in the tissues surrounding the wisdom tooth causing swelling, pain, limited mouth opening and systemic illness,
Wisdom Tooth Removal
Wisdom tooth extraction: Depending on difficulty and your level of anxiety this progressive scale explains the stages of treatment:
1. Straightforward local option of sedation
2. Raising gum flap and removal then suturing of gum flap with or without sedation
3. Raising gum flap and sectioning of tooth for removal in pieces then suturing gum flap into place
4. Raising gum flap, removing bone and removing tooth with or without sedation
5. Raising gum flap, removing bone and sectioning tooth for removal in pieces
1. Straightforward local option of sedation
2. Raising gum flap and removal then suturing of gum flap with or without sedation
3. Raising gum flap and sectioning of tooth for removal in pieces then suturing gum flap into place
4. Raising gum flap, removing bone and removing tooth with or without sedation
5. Raising gum flap, removing bone and sectioning tooth for removal in pieces
Wisdom Tooth Extraction Procedure
Procedure:
1. If having intravenous (IV) sedation see dental sedation section. This is where a cannula is inserted in the arm or back of the hand and a sedative drug is administered to sedate you.
2. Next whether having sedation or not, local anaesthetic is required. This is injected at the back of the mouth on the side of the extraction and also on the cheek side of the tooth to ensure the area is fully numb before starting
3. Raising gum flap - a cut is made into the gum and the gum is lifted to expose the underlying tooth and bone. You will be numb so will not feel this.
4. Bone removal - this is where special equipment is used to remove the smallest amount of bone possible in order to enable access to the tooth that needs removal.
5. The tooth is then taken out in one piece or sectioned into a number of pieces and then removed depending on its shape and location.
6. the remaining socket is cleaned and then the gum flap is placed back to where it was originally
7. A number of sutures (stitches) are then used to secure the gum back into place neatly and cover over the socket.
8. The sutures may dissolve or be removed 2/3 weeks later by your dentist/oral surgeon.
1. If having intravenous (IV) sedation see dental sedation section. This is where a cannula is inserted in the arm or back of the hand and a sedative drug is administered to sedate you.
2. Next whether having sedation or not, local anaesthetic is required. This is injected at the back of the mouth on the side of the extraction and also on the cheek side of the tooth to ensure the area is fully numb before starting
3. Raising gum flap - a cut is made into the gum and the gum is lifted to expose the underlying tooth and bone. You will be numb so will not feel this.
4. Bone removal - this is where special equipment is used to remove the smallest amount of bone possible in order to enable access to the tooth that needs removal.
5. The tooth is then taken out in one piece or sectioned into a number of pieces and then removed depending on its shape and location.
6. the remaining socket is cleaned and then the gum flap is placed back to where it was originally
7. A number of sutures (stitches) are then used to secure the gum back into place neatly and cover over the socket.
8. The sutures may dissolve or be removed 2/3 weeks later by your dentist/oral surgeon.
Pain Relief
1. Hot salty mouthwash (2 teaspoons salt dissolved in warm water) if mild discomfort
2. Corsodyl mouthwash if mild discomfort instead of the salt water mouthwash
3. Antibiotics if causing infection prescribed by your dentist or emergency dentist
4. Wisdom tooth removal if causing repeated infection
5. Removal of lower second molar (tooth in front of the wisdom tooth), if impacted wisdom tooth causing decay or resorption of this tooth.
6. Removal of upper wisdom tooth that is causing pain from biting on gum covering lower wisdom tooth as is a much easier procedure and less chance of complications than removal of the lower wisdom tooth.
2. Corsodyl mouthwash if mild discomfort instead of the salt water mouthwash
3. Antibiotics if causing infection prescribed by your dentist or emergency dentist
4. Wisdom tooth removal if causing repeated infection
5. Removal of lower second molar (tooth in front of the wisdom tooth), if impacted wisdom tooth causing decay or resorption of this tooth.
6. Removal of upper wisdom tooth that is causing pain from biting on gum covering lower wisdom tooth as is a much easier procedure and less chance of complications than removal of the lower wisdom tooth.
X rays required?
An Orthopantogram (OPG) or half OPG is needed to assess type of impaction. This is a large X ray that is taken by standing in a machine and having the x ray film rotate around your head. This is necessary for almost all wisdom tooth extractions unless your dentist is happy with the information from an intra-oral (in mouth) x ray.
The X ray shows
1. Likelihood of difficult extraction and what will be required with regard to planning treatment
2. Location of surrounding nerves and any increased risk of nerve damage
3. Extent of any decay in wisdom tooth or surrounding teeth
4. Extent of any infection and/or bone loss around the wisdom tooth.
The X ray shows
1. Likelihood of difficult extraction and what will be required with regard to planning treatment
2. Location of surrounding nerves and any increased risk of nerve damage
3. Extent of any decay in wisdom tooth or surrounding teeth
4. Extent of any infection and/or bone loss around the wisdom tooth.
Wisdom tooth Removal - Aftercare
- Day of treatment: Just ibuprofen, soft diet, avoid alcohol, avoid smoking, avoid very hot food and drink. You can take paracetamol if you are unable to take ibuprofen.
- 2 to 5 days after - painkillers, Gentle hot salty mouthwash, soft diet and as above
- 2 weeks - Return for suture removal at 2 weeks or sometimes sutures will dissolve - your dentist will tell you which
- After Wisdom tooth extraction:
- Pain, swelling, bleeding, bruising and soreness is to be expected following wisdom tooth extraction. - Nerve pain, numbness or altered sensation may occur and any increased risk of this is discussed with you prior to treatment based on your X rays.
Wisdom tooth pain and Complications
- Infection - in socket following extraction. This will be sore underneath the jaw, swollen, painful after extraction and will require antibiotics to treat
- Dry socket - loss of blood clot early from socket leading to very painful bone inflammation. will usually occur after 3 days where day 1 and day 2 the pain was relieving and then gets progressively worse.
- Nerve damage - Numbness to lower lip and gum on the side of extraction. This is usually temporary but there is a small risk of permanent in the region of 1%. Alternatively or as well you may get numbness of the tongue on the affected side. Again, there is a small risk of permanent damage but it would usually be temporary.
Wisdom tooth Removal - Charges
1. May be removed by your own dentist in UK under a band 2 dental charge which is around £55
2. Referral to oral surgeon in UK, NHS, there is a waiting list and charge will be around £55 and you may or may not have sedation
3. Privately - £100-£500 depending on location, may have sedation also at additional charge
4. Northern Ireland - simple wisdom tooth extraction around £15, medium difficulty extracted by own dentist will cost around £40, referral to an NHS oral surgeon is about £60 with awaiting list or private referral as privately above and without the waiting list.
2. Referral to oral surgeon in UK, NHS, there is a waiting list and charge will be around £55 and you may or may not have sedation
3. Privately - £100-£500 depending on location, may have sedation also at additional charge
4. Northern Ireland - simple wisdom tooth extraction around £15, medium difficulty extracted by own dentist will cost around £40, referral to an NHS oral surgeon is about £60 with awaiting list or private referral as privately above and without the waiting list.
- So charges are dependent on the difficulty of the extraction and whether it requires referral to a specialist or hospital. Whether you are happy to wait on an NHS list to be seen or pay pirvately to be seen much sooner. Whether you would like sedation for the treatment or not and whether you live in Northern Ireland or the rest of UK.
We hope you have learnt from this article and now feel more informed with regard to your wisdom tooth extraction or wisdom tooth pain. Any Further questions please ask our dentists below: