Adults normally have 32 teeth, and wisdom teeth (3rd molars) are the last to come through at the back of the mouth.
Normally there are 4 wisdom teeth, one on each side of the upper and lower jaw. If the jaws are too small to accommodate all the teeth, there may not be enough space for the wisdom teeth to come through properly and they become impacted (stuck), often causing problems.
Reasons for the removal of wisdom teeth
- The most common reason is a recurrent infection of the gum overlying a tooth that is partway through the gum (pericoronitis).
- Decay (caries) in the wisdom tooth, which your dentist cannot restore.
- Infection of the tooth (abscess) due to advanced dental decay.
- When the adjacent molar tooth is affected by gum (periodontal) disease or dental decay due to the impacted wisdom tooth.
- Progressive cystic (fluid-filled sac) formation around the tooth.
As part of other surgical procedures involving the jaw. There may be other less common reasons that your surgeon will discuss with you.
The removal of wisdom teeth
There is great variation in the difficulty of removing wisdom teeth. The procedure can be carried out under local anaesthesia (injection in the gum to numb the area), with or without intravenous sedation (injection in the arm or hand to reduce anxiety), or under general anaesthetic (completely asleep in a hospital). Your surgeon will discuss with you which method is most appropriate. The degree of difficulty of the surgery, any underlying medical conditions and other personal circumstances will be taken into account choosing the method. The procedure can involve an incision (cut) in the gum close to the tooth. Sometimes some jaw bone around the tooth is removed with a drill and also the procedure can be made easier by sectioning (cutting up) the tooth itself into smaller pieces.
What to expect after the operation
Swelling, bruising and difficulty opening the mouth can occur frequently. If initial swelling settles down and after a few days and a new swelling appears, it may indicate infection.
Most bleeding will have stopped shortly (within 30 minutes hour) of the operation finishing. Blood-stained saliva may be noticed for a day or two. More persistent bleeding may occur which should be dealt with by your surgeon/hospital. When an adjacent tooth has a large filling or crown it is possible that this can be dislodged during surgery.
There are two nerves in the vicinity of the lower wisdom tooth which may be slightly bruised during the operation. One of them is the lingual nerve supplying feeling to the tongue and lying closer to the gums of the lower wisdom tooth. The other nerve is called the inferior dental nerve which runs all along the lower jaw under the lower molar teeth. In less than 20% of patients, the nerves may not work well in the immediate post-operative phase leading to numbness of the lip and or tongue. Most of this loss of sensation returns within a few weeks to 3 months. Very rarely (less than 1%), it may persist longer or can be even permanent based on the specific risk factors discussed by your surgeon.
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