What You Need to Know About Wisdom Teeth, From Mahidol University-Trained Dentists

Wisdom Teeth

What to know before having a wisdom tooth removed by a specialist dentist.

Toothache from a wisdom tooth is one of the most common oral health problems, and in most cases the dentist ends up recommending that the tooth be surgically removed.

Many patients still have questions about it. How necessary is surgery? What should you do before and after the procedure? And what can you do when a wisdom tooth hurts? This article answers those questions.

What Is a Wisdom Tooth?

A wisdom tooth (impacted tooth) is a tooth that cannot come through into the mouth normally the way other teeth do. It may break through the gum only partly, and in some cases the whole tooth stays buried in the jawbone. This happens because wisdom teeth erupt later than the other teeth, so there is often no room left for them to come through.

There are 4 wisdom teeth in total, at the back of the mouth on the upper and lower jaws, left and right. They are most often found at the last molar position, the very back of the lower jaw.

What Causes Impacted Wisdom Teeth?

Wisdom teeth normally come in between about ages 16 and 25. They may grow in upright, tilted or lying flat, and they usually sit tight against the tooth next to them. An impacted wisdom tooth is a tooth that keeps trying to erupt. That pushing force can press against the neighboring tooth or keep the wisdom tooth growing inside the jaw.

This is what causes severe tooth pain and a lot of discomfort for patients. Besides the last lower molars, impacted teeth can also occur in other positions, such as the canines and premolars, but this is much less common.

Which Wisdom Teeth Need Surgery?

Two kinds of impacted wisdom teeth need surgery to prevent pain and infection in the future, such as limited mouth opening or a sore throat when swallowing.

• Soft tissue impaction: only gum tissue covers the wisdom tooth, and the tooth stands upright. It can be removed by opening the gum and extracting the tooth.
• Bony impaction: both gum and bone cover the wisdom tooth, and the tooth may sit in different positions, such as upright, tilted or lying flat. The dentist has to remove some bone and divide the tooth into sections to take it out.

What Are the Symptoms of an Impacted Wisdom Tooth?

A wisdom tooth that has not come up above the gum cannot be seen with the naked eye. It shows up only on an X-ray. People with an impacted wisdom tooth may have toothache, sometimes severe. There may also be inflamed gums around the tooth, a swollen cheek, difficulty opening the mouth or a sore throat when swallowing. In some patients, the swelling and infection spread to the face, cheek and neck.

Wisdom tooth pain usually comes from an infection of the tooth or the gum around it, which causes pain and swelling. The worse the infection, the worse the pain.

Patients who see a dentist regularly are often advised to have an X-ray at around age 17–18 to check the back teeth, whether a wisdom tooth is impacted and where it sits. If an impacted tooth is found, the dentist may recommend removing it before it starts to hurt, because leaving it in place can cause problems later on.

Severe Wisdom Tooth Pain: What Helps, and Do Painkillers Work?

Taking painkillers on their own only eases the symptoms. They do not treat the cause. If the problem is left alone, the pain can become severe, with swelling and infection that spread into the face and neck.

The dentist treats the cause by extracting or surgically removing the wisdom tooth right away and draining the infection to prevent complications. That is why it matters so much to see a dentist promptly.

Wisdom Tooth Pain Keeping You Awake: What Should You Do?

Wisdom tooth pain is often a sign of infection. Book a dental appointment as soon as you can, ideally the next morning, so the dentist can examine the tooth and treat the cause. Until then, a pain reliever can help ease the symptoms.

Why Remove an Impacted Wisdom Tooth?

As mentioned above, an impacted wisdom tooth cannot work like a normal tooth. In many cases, the dentist recommends removing it soon after it is found.

Impacted wisdom teeth can harm dental health in several ways.

• Impacted wisdom teeth cause decay. When a wisdom tooth grows in at an awkward angle, it traps food very easily. Cleaning it fully is hard because it sits so far back near the throat, so the wisdom tooth decays and the decay often spreads to the tooth next to it. In some cases, the neighboring tooth also has to be extracted along with the wisdom tooth.
• Impacted wisdom teeth lead to gum inflammation. When a wisdom tooth only partly breaks through, gum tissue can cover part of it. Food gets trapped under the gum and cannot be cleaned out. Bacteria build up, and the gum becomes inflamed and painful, then swells with pus. The infection can spread to other areas. Some patients cannot swallow, and if the infection spreads down into the throat it can make breathing difficult. This needs urgent medical care.
• Impacted wisdom teeth can cause cysts. The tissue around an impacted wisdom tooth can develop into a cyst or growth. Because the tooth usually sits against the jaw, it keeps pressing on and eating into the jawbone. Over time this can change the shape of the face, put part of the jaw at risk and leave the jawbone more likely to break if it takes a knock.

Wisdom teeth are also removed for other reasons. Before orthodontic treatment, for example, the third molars may need to come out first so the other teeth can be moved more easily.

Leaving a Painful Wisdom Tooth in Place: Possible Complications

Leaving an impacted wisdom tooth in place for a long time can cause many oral health problems, for example:

• Gum inflammation
• Decay in the neighboring teeth
• Teeth shifting or becoming crooked
• Bad breath
• Bite problems
• Pressure from the wisdom tooth damaging the bone around its roots or the roots of the neighboring tooth, to the point of needing root canal treatment
• A risk of changes to the shape of the face
• Sinus problems, and infection of the gums, face and neck that can make breathing difficult

Wisdom Tooth Extraction and Surgery Steps

Once an X-ray shows where the wisdom tooth sits, the dentist plans the surgery. The procedure is straightforward and less frightening than many people expect. It is not very different from having any other tooth taken out.

The dentist numbs the area with a local anesthetic, then opens the gum to expose the wisdom tooth and uses a dental drill to section and remove it. The area is rinsed clean and then stitched closed. Wisdom tooth surgery does not need a recovery stay. Patients can go home once it is done, with no overnight stay in hospital.

Read more: How Much Does Wisdom Tooth Surgery Cost, Where Should You Have It Done and Is It Covered by Social Security?

Aftercare Following Wisdom Tooth Surgery

• After wisdom tooth surgery, do not spit out blood or saliva for the rest of that day, as this can keep the wound bleeding. Bite on gauze for 1–2 hours. You can swallow saliva normally.
• Hold an ice pack or cold pack against your cheek during the first 3 days to reduce swelling.
• After the day of surgery, the cheek on the treated side may feel tight. Practice opening your mouth to exercise the muscles.
• While the area is painful, you can take pain relievers and antibiotics as prescribed to ease symptoms and make eating easier.
• Stick to soft foods for about 1 week to avoid disturbing the wound.
• Keep brushing and cleaning your mouth as usual, and return to have the stitches removed 5–10 days after surgery.

What Can I Eat After Wisdom Tooth Surgery?

You can eat almost anything. For the first 5 days, though, choose soft foods that are not hard or chewy (so they do not irritate the wound), and have food and drinks that are cool (food that is too hot or spicy can sting the wound).

Foods to Avoid After Wisdom Tooth Surgery

• Avoid very spicy or very hot food.
• Sucking on ice and eating cold foods is fine.
• Avoid hard foods that could knock the teeth or the surgical wound.
• Do not smoke for at least the first 3 days. Smoking slows wound healing and makes the wound bleed more.

How to Relieve Pain After Wisdom Tooth Surgery

After wisdom tooth surgery, follow your dentist’s post-operative instructions closely to lower the risk of complications. If the area is still painful after surgery, pain relievers can be used. Your dentist will prescribe pain relievers if needed, and cold compresses help during the first 3 days.

Possible Complications After Wisdom Tooth Surgery

After wisdom tooth surgery, follow your dentist’s instructions closely. Otherwise the chance of complications goes up, for example:

• More bleeding from the wound than normal, which may come from bleeding not being controlled properly or from a condition that makes blood slow to clot
• Infection after surgery, which may come from not keeping the wound clean enough
• Inflammation after removal of a very deeply impacted tooth, where the tissue has been bruised
• Numbness of the face, lips or tongue, which may come from the anesthetic or from surgery affecting the sensory nerve in the lower jaw

If you notice any of these, contact your dentist promptly so the problem can be dealt with in time.