What is wisdom tooth extraction?

Wisdom teeth are the upper and lower third molars. These teeth are at the very back of your mouth. They are the last teeth to surface in the mouth. They are called wisdom teeth because they usually come in when a person is between 17 and 21 years old.

Some people have their wisdom teeth for their entire life. Other people choose to have their wisdom teeth removed. Some people have these teeth taken out before they break through the gums.

An oral surgeon or dentist can remove wisdom teeth. The procedure can be done in the dentist's or surgeon's office. You may have the procedure in the hospital, if you are having all your wisdom teeth pulled at one time.

Your dentist will open up the gum tissue over the tooth and take out any bone that is covering the tooth. The dentist will separate the tissue that connects the tooth to the bone. Then the dentist will remove the tooth. The tooth may be cut into smaller pieces to make it easier to remove.

After the tooth is removed, you may need stitches. Some stitches dissolve over time. Some stitches have to be removed after a few days. Your dentist will tell you if your stitches need to be removed.

Activity

• Relax after surgery. Physical activity may increase bleeding.
• Do not lie flat. This may prolong bleeding. Prop up your head with pillows.

Diet

• Eat soft foods, such as gelatin, pudding, or a thin soup. Gradually add solid foods to your diet as you heal.
• Do not use a straw for the first few days. Sucking on a straw can loosen the blood clot that forms at the surgery site. If this happens, it can delay healing.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also get instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.

Incision care

• Bite gently on the gauze pad periodically, and change pads as they become soaked with blood. Call your dentist or oral surgeon if you still have bleeding 24 hours after your surgery.
• While your mouth is numb, be careful not to bite the inside of your cheek or lip, or your tongue.
• After 24 hours, gently rinse your mouth with warm salt water several times a day to reduce swelling and relieve pain. Do not rinse hard. This can loosen the blood clot and delay healing.
• Avoid rubbing the area with your tongue or touching it with your fingers.
• Continue to brush your teeth and tongue carefully.

Ice and heat

• Try using an ice pack on the outside of your cheek for the first 24 hours. You can use moist heat—such as a washcloth soaked in warm water and wrung out—for the following 2 or 3 days.

Other instructions

• Do not smoke for at least 24 hours after your surgery. The sucking motion can loosen the clot and delay healing. In addition, smoking decreases the blood supply and can bring germs and contaminants to the surgery area.

Wisdom tooth removal usually is effective in preventing:

• Crowding of the back teeth.
• A wisdom tooth becoming stuck in the jaw (impacted) and never breaking through the gums.
• Red, swollen, and painful gums caused by a flap of skin around a wisdom tooth that has only partially come in.
• Gum disease and tooth decay in the wisdom tooth, which may be harder to clean than other teeth, or in the teeth and jaw in the area of the wisdom tooth.

Procedures can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for your procedure.

Preparing for the procedure

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what procedure is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your procedure. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your procedure. Your doctor will tell you if you should stop taking any of them before the procedure and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

After a wisdom tooth is removed, you may experience:

• Pain and swelling in your gums and tooth socket where the tooth was removed.
• Bleeding that won't stop for about 24 hours.
• Difficulty with or pain from opening your jaw (trismus).
• Slow-healing gums.
• Damage to existing dental work, such as crowns or bridges, or to roots of a nearby tooth.
• A painful inflammation called dry socket, which happens if the protective blood clot is lost too soon.
• Numbness in your mouth and lips after the local anesthetic wears off, due to injury or inflammation of nerves in the jaw.
• Rare side effects, including:
  • Numbness in the mouth or lips that does not go away.
  • A fractured jaw if the tooth was firmly attached to the jaw bone.
  • An opening into the sinus cavity when a wisdom tooth is removed from the upper jaw.

Dental surgery may cause bacteria in the mouth to enter the bloodstream and cause infections in other parts of the body. People who have certain health conditions may need to take antibiotics before dental surgery. Such people include those who have had a heart valve repaired or replaced or were born with heart defects.

Anesthetic (local and/or general) almost always is used during the extraction procedure. All surgeries, including oral surgery, that use general anesthetic have a small risk of death or other complications.

After your procedure, you may have some pain and swelling. You should feel better in a few days. Your doctor can give you medicine for pain. Your doctor will remove the stitches after a few days, if needed.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your procedure may be canceled. If your doctor told you to take your medicines on the day of the procedure, take them with only a sip of water.

At the hospital or surgery center

• Bring a picture ID.
• You will be kept comfortable and safe by your anesthesia provider. You may get medicine that relaxes you or puts you in a light sleep. The area being worked on will be numb.
• How long the procedure will take depends on how many teeth are removed.

A wisdom tooth is extracted to correct an actual problem or to prevent problems that may come up in the future. Some of the problems that can occur when wisdom teeth come in are:

• Your jaw may not be large enough for them, and they may become impacted and unable to break through your gums.
• Your wisdom teeth may break partway through your gums, causing a flap of gum tissue to grow over them. Food and germs can get trapped under the flap and cause your gums to become red, swollen, and painful. These are signs of infection.
• More serious problems can develop from impacted teeth, such as infection, damage to other teeth and bone, or a cyst.
• One or more of your wisdom teeth may come in at an awkward angle, with the top of the tooth facing forward, backward, or to either side.

The procedure often can be done in the dentist's or surgeon's office. You may have the surgery in the hospital. This is more likely if you are having all your wisdom teeth pulled at one time or if you are at high risk for complications.

If you have any infections, surgery will usually be delayed until the infection has cleared up. Your doctor or dentist may have you take antibiotics to help heal the infection.

Before removing a wisdom tooth, your dentist will give you a local anesthetic. It numbs the area where the tooth will be removed. A general anesthetic may be used, especially if several or all of your wisdom teeth will be removed at the same time. It prevents pain in the whole body. It causes you to sleep through the procedure. Your dentist will probably recommend that you don't eat or drink after midnight on the night before surgery so that you are prepared for the anesthetic.

To remove the wisdom tooth, your dentist will open up the gum tissue over the tooth and take out any bone that covers the tooth. The dentist will separate the tissue that connects the tooth to the bone and then remove the tooth. Sometimes the dentist will cut the tooth into smaller pieces to make it easier to remove.

After the tooth is removed, you may need stitches. Some stitches dissolve over time. Others have to be removed after a few days. Your dentist will tell you if your stitches need to be removed.