Wisdom teeth do not always need to be removed. Extraction is recommended when they cause pain, infection, decay in the neighbouring tooth, pressure or difficulty with cleaning, or when they are impacted. The decision is made after a clinical and X-ray examination.
What wisdom teeth are
Wisdom teeth are the third molars, the last teeth at the back of each jaw. They usually come through in late adolescence or in the early twenties, although the timing varies greatly. Because there is often not enough room in the jaw, they may come through only partly, at an angle, or stay inside the bone. When a tooth fails to come through properly, it is called impacted (if it remains completely within the bone or gum) or partially impacted (if it has only partly erupted).
Symptoms that need examination
- pain or pressure at the back of the jaw,
- swelling and tenderness of the gums around the tooth (known as pericoronitis, i.e. inflammation of the gum around a partially impacted tooth),
- bad breath or a bad taste,
- difficulty opening the mouth or chewing,
- decay in the wisdom tooth or the neighbouring tooth, because the area is difficult to clean,
- pressure on the neighbouring teeth.
A wisdom tooth may also cause no symptoms and be discovered on an X-ray. In that case, the dentist decides whether monitoring is enough.
When they should be removed
Extraction may be needed when the wisdom tooth:
- it causes recurrent infections or pain,
- it causes decay in itself or in the neighbouring tooth,
- is impacted or partially impacted and causes a problem for the gum or bone,
- it presses on the neighbouring teeth,
- it is associated with a cyst or other lesion in the bone,
- cannot be cleaned adequately.
By contrast, a wisdom tooth that has fully erupted, is healthy, functional and easy to clean can be kept.
How the extraction is done, step by step
1. Examination and X-ray
The X-ray shows the position of the tooth, the shape of the roots and their relationship to neighbouring structures, such as the nerve of the lower jaw. Your medical history and the medication you take are also assessed.
2. Local anaesthesia
The area is numbed so that you feel no pain; you may feel pressure or movement.
3. Removal
If the wisdom tooth has erupted, the extraction may be simple. If it is impacted or partially impacted, a surgical extraction is carried out: the gum is opened, as much bone as necessary is removed and, if needed, the tooth is divided into sections so that it comes out more gently.
4. Stitching and instructions
The gum is stitched when needed and you are given written instructions for the following days.
Duration and recovery
Recovery depends on the case, the position and the difficulty of each tooth; in general, 2 to 3 days are needed for any swelling to subside. During this time, swelling, tenderness and slight bleeding are normal, while surgical extractions may take longer. The following help:
- pressure with gauze to stop the bleeding,
- cold applied externally for the first few hours,
- soft, not hot foods,
- avoiding rinsing, smoking and drinking through a straw in the first few days, so that the clot in the socket is not disturbed,
- taking the medication you are given correctly.
Risks and when to contact the dentist
Possible complications include prolonged bleeding, infection, painful dry socket (when the clot is lost) and, rarely, temporary or permanent altered sensation of the lip or tongue, mainly with lower wisdom teeth. For the lower jaw, assessing the position of the nerve on the X-ray is important. Contact the practice if the pain increases after the first 2 to 3 days, if bleeding does not stop, if there is fever or increasing swelling, or if you have difficulty opening your mouth.
How to prepare
Tell the dentist about every medication you take, especially anticoagulants or antiplatelet drugs, and about conditions such as diabetes or heart disease. Do not stop medication on your own. Eat lightly before the appointment and make sure you have soft foods at home. If the extraction involves more than one wisdom tooth, the dentist may suggest doing them in separate sessions.
Alternatives
When the wisdom tooth causes no problem, monitoring with regular check-ups and X-rays may be chosen. In mild inflammation, cleaning the area and antisepsis may help temporarily, but without resolving the cause if the tooth has no room. Extraction remains the definitive solution when problems keep recurring.
Frequently asked questions
When should wisdom teeth be removed?
Not always. Extraction may be needed when they cause pain, infection, decay in the neighbouring tooth, pressure, impaction or difficulty with cleaning.
When should a tooth be extracted in general?
When it cannot be preserved, because of extensive destruction, advanced periodontitis, a fracture or infection. Before extraction, alternative ways of keeping the tooth are considered wherever possible.
What is a surgical extraction?
This is the removal of a tooth that cannot be extracted simply, such as impacted wisdom teeth, broken teeth or roots. It is carried out under local anaesthesia, with appropriate instructions for healing.
What is an apicoectomy?
This is a minor surgical procedure at the tip of a tooth's root, performed when there is persistent inflammation that cannot be adequately treated by root canal treatment alone. The aim is to preserve the natural tooth wherever possible.
Book an appointment
If a wisdom tooth is bothering you, or you want to check whether it needs to be removed, book an appointment at our practice in Thessaloniki for a clinical and X-ray examination.
Every mouth is different. The appropriate treatment is recommended after a clinical examination.
