Tooth Extractions Including Wisdom Tooth

As a general rule any time surgery is considered there has to be a relevant indication, i.e. whenever a tooth is to be extracted. Extracting a tooth without the relevant indication is unsound.

We always try our best to save the natural teeth but in some situations extracting a tooth is more advantageous than saving it.

For the following findings there is no sensible alternative treatment option:

  • teeth severely damaged by caries, retained roots
  • teeth severely damaged by periodontal disease
  • Teeth with peri-apical infections that can neither be preserved endodontically nor by surgery and have caused an extensive infection&/ inflammation.
  • Teeth extensively damaged by trauma.
  • Vertical fracture (splitting of tooth and root).
  • In case of crowding or impeded eruption, milk teeth and permanent teeth may need to be extracted for orthodontic reasons.
  • during prosthodontic treatment in order to maintain normal
  • While treating a jaw growth- tumor/malignancy.

Wisdom Teeth

Adults can have up to 32 teeth.  The wisdom teeth are the last to come through, right at the back.  They usually appear when you are between 17 and 25, although sometimes they appear many years later.

Nowadays people often have jaws that are too small for all 32 teeth – 28 is often the most we have room for.  So if all the other teeth are present and healthy there may not be enough space for the wisdom teeth to come through properly.

If there is enough room they will usually come through into a useful position and cause no more problems than any other tooth. Often there will be some slight discomfort as they come through, but this is only temporary and will disappear once the tooth is fully in position.

If there is not enough room, the wisdom tooth may try to come through, but will get stuck against the tooth in front of it.  The wisdom tooth will be at an angle, and will be described by the dentist as ‘impacted’.

If part of the wisdom tooth has appeared through the gum and part of it is still covered, the gum may become sore and perhaps swollen.  Food particles and bacteria can collect under the gum edge, and it will be difficult to clean the area effectively.

We can assess and then tell you whether this is a temporary problem that can be dealt with by using mouthwashes and special cleaning methods (and possibly antibiotics), or whether it is better to have the tooth removed.

If your gums are sore and swollen, use a mouthwash of medium hot water with a teaspoonful of salt. (Check that it is not too hot before using it.)  Swish the salt water around the tooth, trying to get into the areas your toothbrush cannot reach.  An antibacterial mouthwash can also reduce the inflammation.  Pain-relieving tablets such as paracetamol or aspirin can also be useful in the short term, but see your dentist if the pain continues.

If the pain does not go away or if you find it difficult to open your mouth, you should come and see us.  We  will be able to see the cause of the problem, and tell you what to do. It may help to clean around the tooth very thoroughly, and we may give you a prescription for an antibiotic. We  will usually take x-rays to see the position of the root, and to for the tooth to come through into a useful position.

Extracting a wisdom tooth is considered in following situations,

  • When it is clear that the wisdom teeth will not be able to come through into a useful position because there is not enough room, and they are also causing some pain or discomfort.
  • If they have only partly come through and are decayed (such teeth will often be more likely to decay) as it will be difficult to clean them as thoroughly as your other teeth.
  • If the wisdom tooth is causing a cleaning problem and has no real use.
  • If the wisdom tooth starts to ‘over-grow’. This often happens if the lower one has already been removed or is impacted and cannot come through, and the upper one has no tooth to bite against. The upper one will come down too far, to establish occlusion.
  • If they are painful.

The ease or difficulty of extracting a wisdom tooth depends on the position and the shape of the roots. We will tell you how easy or difficult each tooth will be to remove after looking at the x-rays.  Upper wisdom teeth are often easier to remove than lower ones, which are more likely to be impacted. We will say whether the tooth should be taken out at the dental practice, or whether you should be referred to a specialist (oral surgeon) at a hospital.  Very occasionally there is a possibility of some numbness of the lip after the removal of a lower tooth – your dentist will tell you if it is possible in your case.

You will probably have either a local anaesthetic – as you would have for a filling – or sedation.  You could also have a general anaesthetic in hospital.

Taking wisdom teeth out may cause some swelling for a few days.  But as soon as the area is healed, there will be no difference to your face or appearance.  Your mouth will feel more comfortable and less crowded, especially if the teeth were impacted.

The amount of discomfort will depend on how easy/difficult it was to take the tooth out.  There is usually some swelling and discomfort for a few days afterwards, and it is important to follow any advice you get about mouthwashes and so on, to help with the healing.  Usual painkillers such as paracetamol, aspirin or ibuprofen will usually deal with any pain.  It is best to stay fairly quiet and relaxed for 24 hours afterwards to make sure there are no bleeding problems.  There may be some stitches to help the gum heal over. We will probably want to see you again about a week later to check on the healing and to remove any stitches.

After getting a tooth pulled out these are few things which help in healing the wound better.

  • Take it easy for the rest of the day, rest as much as you can. Keep your head up to avoid any bleeding. Avoid hot food or drinks until the anaesthetic wears off. This is important as you cannot feel pain, may burn or scald your mouth.  Also be careful not to chew your cheek.  This is quite a common problem, which can happen when there is no feeling.
  • If you do rest, try to keep your head higher for the first night using an extra pillow if possible. It is also a good idea to use an old pillow cover, or put a towel on the pillow, in case you bleed a little.
  • Do not be tempted to rinse the area for the first 24 hours. It is important to allow the socket to heal, and you must be careful not to damage the blood clot by eating on that side or letting your tongue disturb it.  This can allow infection into the socket and affect healing.
  • Avoid alcohol for at least 24 hours, as this can encourage bleeding and delay healing. Eat and drink lukewarm food as normal but avoid chewing on that area of your mouth.
  • Keep your mouth clean after an extraction. However, you do need to be careful around the extraction site.
  • The first thing to remember is that there may be some slight bleeding for the first day or so. Many people are concerned about the amount of bleeding. This is due to the fact that a small amount of blood is mixed with a larger amount of saliva, which looks more dramatic than it is.
  • If you do notice bleeding, do not rinse out, but apply pressure to the socket. Bite firmly on a folded piece gauze we have given you. Make sure this is placed directly over the extraction site and that the pad is replaced if necessary.
  • If the bleeding has not stopped after an hour or two, contact your dentist.
  • It is important not to do anything which will increase your blood pressure, as this can lead to further bleeding. We recommend that you avoid smoking for as long as you can after an extraction, but this should be at least for next two to three days.

Different people heal at different speeds after an extraction.  It is important to keep your mouth and the extraction site as clean as possible, making sure that the socket is kept clear of all food and debris. Don’t rinse for the first 24 hours, and this will help your mouth to start healing.  After this time use a salt-water mouthwash, which helps to heal the socket.  A teaspoon of salt in a glass of warm water gently rinsed around the socket twice a day can help to clean and heal the area.  Keep this up for at least a week or for as long as your dentist tells you.

It is important to keep to a healthy diet; and take a Vitamin C supplement, which will help your mouth to heal.

There will usually be some tenderness in the area for the first few days, and in most cases some simple pain relief is enough to ease the discomfort.  What you would normally take for a headache should be enough.  However, always follow the manufacturer’s instructions and if in doubt check with your doctor first.  Do not take aspirin, as this will make your mouth bleed.

As we have said, it is important not to use anything containing aspirin as this can cause further bleeding.  This happens because aspirin can thin the blood slightly.  Asthma sufferers should avoid Ibuprofen-based pain relief.  Again check with your chemist or dentist if you are worried or feel you need something stronger.

Sometimes healing may not happen normally and can be very painful.  This happens when there is little or no blood clot in the tooth socket and the bony socket walls are exposed and become infected.  This is called a dry socket and in some cases is worse than the original toothache!  In this case, it is important to see your dentist, who may place a dressing in the socket and prescribe a course of antibiotics to help relieve the infection.  You may also feel the sharp edge of the socket with your tongue and sometimes small pieces of bone may work their way to the surface of the socket.  This is perfectly normal.

If it has been a particularly difficult extraction we will give you a follow-up appointment.  This could be to remove any stitches that were needed, or simply to check the area is healing well.

After the extraction we will discuss the options available to you for replacing your lost tooth.