Wisdom tooth removal

Sometimes, a wisdom tooth does not come through properly into the mouth. It can become stuck, either under your gum or as it pushes through the gum.

We can remove wisdom teeth that cause problems. Some are simple to remove and this might only take a few minutes.

Other wisdom teeth can be more difficult to remove and this can take up to 40 minutes. You might have a general anaesthetic. This is a medicine that makes you sleep, so that you do not feel any pain. Your surgeon explains if your surgery is simple or complex.

If you have complex surgery to remove your wisdom tooth, the procedure might involve making a cut in the gum. This exposes the tooth.

The NHS website has more information about removing a wisdom tooth.

Guy’s Hospital is a teaching hospital where students get experience. If you need a simple wisdom tooth removal, students might treat you under the supervision of a qualified dental surgeon.

Types of anaesthetic

There are different types of anaesthetic. Your surgeon talks to you about which type of anaesthetic is most suitable for your treatment.

You do not need to stay overnight in hospital for wisdom tooth surgery. A responsible adult needs to take you home if you have sedation (a medicine to make you calm and sleepy) or a general anaesthetic.

Local anaesthetic

A local anaesthetic is an injection into the gum, as you would have for a filling. The injection takes a few minutes to make your jaw numb. This means that you do not feel any pain during the procedure.

Sedation and local anaesthetic

Sedation medicine helps you to feel relaxed and calm for your treatment. You might have sedation through a tube into a vein in your arm (intravenous sedation) before the local anaesthetic.

The sedative injection makes you feel relaxed and sleepy during the procedure. Most people do not remember anything afterwards.

General anaesthetic

If you have a general anaesthetic, you are asleep during your procedure. We usually only give you a general anaesthetic if you have complex wisdom tooth surgery. You can go home on the same day as your surgery.

Not everyone having a wisdom tooth removed needs, or can have, a general anaesthetic. When deciding the most suitable type of anaesthetic for you, we think about:

• how complex the surgery is
• if you have any medical conditions
• any other circumstances

Risks of wisdom tooth removal

Having a wisdom tooth removed is a very common and safe procedure. However, there are possible complications.

Your surgeon explains any possible risks and how these might affect you. You can talk to them about any questions or concerns that you have before treatment.

Dry socket

The tooth socket is the hole in the bone where we remove your tooth. After we remove the tooth, a blood clot forms in the socket to protect the bone and nerves underneath.

Dry socket is where a blood clot does not develop in the tooth socket or the blood clot disappears. This usually starts 3 to 5 days after treatment.

The bone and nerves are left exposed to air, food, fluid and anything else that enters the mouth. You might have increasing pain, a foul (unpleasant) taste and bad breath.

Dry socket is a common problem that affects 1 in 10 people. It is more likely if you:

• smoke
• take the contraceptive pill
• have lower wisdom teeth removed

Dry socket can be treated by carefully washing the area and putting on an antiseptic dressing. We can put on the dressing in the hospital or your local dentist can do this.

Dry socket is not an infection and antibiotics do not help.

Infection

There is a low risk of infection after dental surgery. Less than 1 in 100 people get an infection. It can happen 3 to 7 days after surgery.

If you have an infection, your pain and swelling might get worse. There might be a bad taste in your mouth and discharge from the wound. You might also feel unwell.

We do not routinely give antibiotics after wisdom tooth removal. This is because the risk of infection is low. If you are concerned, please contact the dental surgery department or your local dentist for more advice.

A tingling or numb feeling in the lower lip, chin and tongue

Wisdom teeth can be close to 2 nerves, which give you feeling (sensation) in the lower lip, chin, lower teeth, gums and tongue. These nerves can get damaged during lower wisdom tooth removal.

If these nerves are damaged, it can cause a different (altered) sensation in the lower lip, chin, lower teeth, gums around the lower teeth and the tongue. You might have a light feeling of ‘pins and needles’ or total numbness.

The tingling or numb feeling can affect a small area or the whole lip or tongue. This depends on which nerve is affected.

For most people, the risk of nerve injury is very small but for some the risk can be high. The nerve injury is usually temporary, but can be permanent. In our department:

• 6 in 1,000 operations result in temporary nerve injury
• 3 in 1,000 operations result in permanent nerve injury

You have a dental X-ray before surgery to check your risk of nerve injury. If the X-ray shows that you have a high risk, we might do a CT scan to check the risk more accurately. We can then confirm if the risk is high.

If you have a high risk of nerve injury, we might offer you a different treatment called a coronectomy. This involves removing the top part (crown) of the tooth only. We leave the roots of the tooth in place to reduce the risk of nerve injury.

If your surgeon thinks that you are at high risk of nerve injury, they will explain a coronectomy in more detail.

Damage to the next teeth

If the tooth next to the one being removed has a large filling or crown, it can get dislodged (knocked or forced out of position) during surgery. You then need to see your dentist for more treatment.

Jaw joint problems

If we remove any tooth in the lower jaw, this puts strain on the jaw joints (just in front of the ear). Although we try to reduce the strain when we remove teeth, some people get pain and stiffness in the jaw. This usually improves within a few weeks, but for some people jaw joint problems can last longer.

Sinus problems

Upper wisdom teeth can be close to the air sinus. This is a cavity (hole) in the top jaw. When we remove upper teeth, there is a very small risk that the air sinus can get punctured. If this happens, you might need more surgery to repair it.

Asking for your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to have wisdom tooth removal, we ask you to sign a consent form. This says that you agree to have the treatment and understand what it involves.

If you would like more information about our consent process, please speak to a member of staff caring for you.