Wisdom Teeth Removal – The Complete Guide Written By a Dentist

It is very among individuals in their late teens and early twenties to get a sudden sharp radiating pain from the back of your mouth. This is the sign of an erupting third molar, which is also called wisdom tooth. A wisdom tooth is mostly impacted and thus, it is advised to go for wisdom teeth removal as they can get painful, infected, or put pressure on the neighboring teeth.

To understand more about third molars, let us see in detail the types of third molar impactions, wisdom teeth removal procedure, and necessary precautions that you must take post third molar surgery.

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Evolutionary changes about wisdom teeth

100 million years ago, our jaws could comfortably accommodate all 32 teeth, including the third molars. Early man’s jaws were more extensive and more prominent because teeth played a vital role in survival. With the front appendages occupied with balance and running, teeth were prehistoric man’s means of catching and consuming prey.

Our ancestors subsisted on a chewy diet of leaves, roots, tubers, and raw meat. Having an enhanced chewing ability was a huge advantage at this point, and third molars might have played an essential backup role when other teeth were lost or worn down.

With evolution, men began walking upright, and arms took on a more significant role in obtaining food. The brains became larger while the jaws became smaller. In 2004, a team of researchers discovered a gene called MYH16, mutations in this gene lead to smaller jaws. This change in jaw dimensions lessened the amount of space available for wisdom teeth in the mouth (1).

As our diet became much more processed as compared to the roots and raw meat our ancestors ate. Thus, we have decreased our reliance upon the third molar. It is predicted that in the near future our third molar will go rudimentary.

When do third molars erupt?

Third molars typically erupt when you are between the ages of 17 and 25 (2). The eruption of our third molars marks a transitional period in our lives between adolescence and adulthood. Hence they are also called wisdom teeth.

The third molars can come in regularly and not cause concerns for many years. As it erupts, it creates pressure, sometimes pushing the other teeth to create space. Even if it manages to erupt normally, it can cause crowding and crumpling of the front teeth.

If you start experiencing pain during the eruption, the third molars can possess a risk, and it is best to go for wisdom teeth removal right away. Younger mouths are still settling into their adult shape, and they can recover from surgery faster.

Not everyone needs to get their third molars removed. The tooth can normally come and never be a cause for concern. You need to contact your dentist when you experience the following conditions.

Tooth damage

The pressure and irregular placement of impacted wisdom teeth can damage the teeth in front of them. Food lodgment can occur which irrevocably leads to tooth decay, gum disease, and even bone loss can occur (3).

Radiating pain

If a wisdom tooth comes in the wrong direction, it can quickly become inflamed. The lymph nodes become tender, and the pain from the eruption can radiate to your ears, temples, and neck.

Infection

Wisdom teeth erupt slowly, one part at a time. This leads to the creation of a flap over the tooth called an operculum. Food and bacteria can get trapped under this membrane, leading to tooth decay and infection.

Cysts

In some rare cases, impacted wisdom teeth can cause cysts or tumors in the surrounding tissue (4)

What are the types of wisdom tooth impaction?

Mesial impaction

Mesial impaction is the most common type of third molar impaction (5).  In this impaction, the wisdom tooth is tilted so that the crown portion of the tooth angles towards the front of the mouth and the roots away.

As the tooth tries to erupt, it presses against the nearby molar creating pressure and pain. It causes food entrapment and is the leading cause of the decay of the neighboring tooth.

Distal impaction

Distal impaction is the rarest type of third molar impaction. It is the opposite of mesial impaction, in this the crown of the tooth angles towards the back of the mouth and the roots align forward. As with mesial impaction, the angle of the tooth in distal impaction determines whether extraction is necessary (6).

Vertical impaction

Vertical impaction occurs when the third molar tooth is positioned straight but submerged below the bone level (7). The vertically impacted tooth rarely need extraction unless it pushes against the bottom of the molar in front of it.

Horizontal impaction

Horizontal impaction is one of the most painful types of impacted wisdom teeth. The tooth lies entirely flat and presses into the molar in front of it. The tooth is parallel to the jaw bone, and it exerts pressure entirely on the front tooth.

Things to know before surgery

Now that you have decided to get your wisdom tooth extracted, you need to consult a good oral surgeon.

  • When you meet your doctor, brief your current health condition and tell if you are on some medication.
  • If you have any questions about the surgery, ask now.
  • Wisdom teeth removal procedure varies with the condition of the tooth. Ask what is the condition of your teeth?
  • Ask whether you will be given anesthesia or sedation?
  • Know if you have to bring in someone who can drive you back home after wisdom teeth removal surgery.
  • Sometimes your face can swell and look puffy. Usually, the condition subsides within a few days. But it would be good to ask if some day off at home is required or not?

Things to know during third molar surgery

The total duration of the surgery will be between 40-60 minutes. You will be administered one of the below anesthesia or sedation. It would be good to discuss what kind of anesthesia will be given to you.

Local anesthesia

This anesthesia is administered locally near the wisdom tooth with the help of injections. You will be awake during the surgery but will not feel the pain. Since the anesthesia is locally injected, the recovery time is fast.

IV Sedation

Here the anesthesia is given via IV or injected through the vein in your arm. You will lose your consciousness and may or may not remember the procedure. Also, local anesthesia will be given for the local numbness of the area around the wisdom tooth.

Nitrous and local anesthesia

IV sedation takes more time to wear off completely. Your doctor can also go for a combination of nitrous and local anesthesia. Nitrous is equally effective and goes lighter on budget. Also, you may recover in minutes post-surgery since the nitrous effect goes quickly.

General anesthesia

General anesthesia is used for complicated situations. You will be completely out during the procedure. You will neither feel pain nor remember anything from the surgery. Again, local anesthesia is given around the tooth extraction site for numbness.

Wisdom teeth removal procedure

A tooth standing at 0-degrees from the neighboring tooth is correctly positioned, and would not require removal because it should erupt well. But if the tooth is at a 90-degree angle or nearly a 90-degree angle, it will not erupt through the gum properly. Such a poorly positioned tooth needs to be surgically removed.

The diagnosis of the position of the third molar is made by taking dental X-rays and OPGS. The procedure of wisdom teeth removal can be done under local anesthesia but for very conscious patients, sedation is also an option. The doctor would get blood work done determining your bleeding and clotting time. Prophylactic antibiotic coverage is given to rule out infection. A day of third molar surgery is established, and the procedure is performed.

An incision is made to reveal the tooth. The bone is shaved away until the tooth is exposed. Once exposed, the wisdom tooth can be elevated or is cut in half along the crown for easier removal.

The tooth can also be split into more pieces so they can be removed easily (8). After that, the area is sutured, and a gauze pack is placed on the extraction site. Depending on the type of impaction, the procedure can vary as mentioned below.

Soft Tissue Impaction

In this, the third molar is covered only by gum tissue. The thickness of the gum tissue is proving difficult for the tooth to erupt and hence it is called soft tissue impaction. A flap is raised during the wisdom teeth removal procedure, and the tooth is elevated and removed.

Partial Bony Impaction

The third molar is partially exposed and partly is trapped in the jaw bone. The flap is raised, and the bone is covering the tooth is shaved. The tooth is then elevated or split for extraction depending upon the scenario.

Complete bony impaction

The entire tooth is submerged in the socket, surrounded by bone on all sides. It requires raising the flap, guttering the bone, cutting the tooth in pieces, and extracting it.

Instructions post wisdom teeth removal surgery

  • The gauze pad placed after surgery acts as a protective dressing and should be left in place 2-3 hours with gentle pressure applied.
  • Use ice for the first 12 hours. Apply the ice pack to your cheeks for 20 minutes and removing it alternately.
  • Rinsing, spitting, and tooth brushing should be avoided on the day of third molar surgery.
  • It is recommended that prescription medications should be continued as directed by the dentist.
  • Activities for the first 24 hours post-surgery should be minimal.
  • Sleep with your head elevated.
  • Do not smoke for at least the next three days (9).
  • Pain in the ear, difficulty in swallowing, and difficulty in opening and closing mouth are symptoms that can occur with varying frequency post-surgery and usually recede on its own.

If the instructions are followed, the complete healing occurs in 7-14 days. In the case of spitting, smoking, or any other activity post-surgery a painful condition known as dry socket can develop (10). So always follow the instructions carefully.

FAQs for wisdom tooth removal

what to eat after wisdom teeth removal?

Usually, it is best to stay on a liquid diet for the first 24-48 hours after wisdom tooth removal. You can then start with a soft diet that does not involve aggressive jaw movement. Moreover, it helps to ease the pain. Some of these foods include –

  • Mashed potatoes
  • Smoothies
  • Pudding
  • Yogurt
  • Cheese
  • Icecream and applesauce

Avoid cold food such as nuts, chips, hard candy, and ice. These damages the adjacent teeth or cause pain and bleeding at the extraction site.

How much is wisdom teeth removal?

Typically, a simple wisdom tooth removal costs between $75 – $200 per tooth. Whereas, an impacted wisdom tooth removal costs between $225 – $600 per tooth.

How long can I eat after wisdom teeth removal?

Usually, the dentist advice to start a liquid diet after an hour or two of wisdom tooth removal. Sometimes, it is also advised to eat after the numbness has completely worn away. However, after three days of wisdom tooth removal, you can eat foods such as toast, oatmeal, and eggs.

How long does wisdom teeth removal take?

Most of the wisdom tooth removal procedures take around one to one and a half hours to complete the process. However, this time range depends on the severity of impaction and complications associated with the surgical procedure.

How are wisdom teeth removed?

Typically, the procedure for removal of wisdom tooth is performed in a stepwise manner as given below –

  • The oral surgeon determines the type of anesthesia suitable for a patient. Typically, local anesthesia or sedation is commonly used in most wisdom tooth removal procedures.
  • Once the anesthesia is administered, the patient may feel numbness around the gums and teeth of the extraction site. In sedation anesthesia, the patient may also feel drowsy due to suppression of consciousness.
  • The dentist then makes an incision in the gums to expose the tooth and the surrounding bone.
  • Bone is drilled to access the impacted tooth root.
  • In cases of curved root or difficult angulations of the tooth, the dentist may cut the tooth into two pieces to remove it easily
  • The tooth is finally removed from the socket.
  • After removal, the socket is disinfected and cleaned.
  • Sharp bony spicules are smoothened, and the gums are sutured back to promote healing
  • A gauze pack is placed on the extraction site to control bleeding and form a blood clot.

What to do after wisdom teeth removal?

After the removal of a wisdom tooth, the patient is given a set of instructions to maintain the health of the extraction site. Some of these instructions include –

  • Control of bleeding – the patient is advised to avoid excessive spitting or mouth rinsing to prevent dislodgement of the blood clot.
  • Analgesic medications such as ibuprofen or acetaminophen should be taken to relieve the pain after the effects of anesthesia wear away.
  • Cold compressions using an ice pack helps to reduce any swelling or bruising around the extraction site.
  • The patient must plan to rest for the rest of the day and avoid any type of physical activity that may strain the body.
  • A liquid diet is advised for the next 24-48 hours. The patient can then gradually switch to a soft diet and eventually eat hard foods.
  • Maintenance of good oral hygiene is crucial to allow proper healing of the extraction site.
  • Smoking and alcohol consumption is usually prohibited for at least three days post-surgery.
  • If sutures have been placed, the patient is advised to follow up after one week to remove the stitches and examine the healing site.

How long after wisdom teeth removal can I smoke?

Usually, it is advised to wait for a minimum of 72 hours or three days before you start smoking as it helps to provide adequate time for healing of the extraction site. Moreover, chewing tobacco is usually prohibited for a minimum of one week as it can lead to delayed healing.

How to sleep after wisdom teeth removal?

It is better to sleep sitting up by propping pillows on both sides to support the head and prevent it from rolling off. Lying down and sleeping may prolong the bleeding from the extraction site. Moreover, laying on one side can lead to an increase in swelling.

Usually, this sleeping pattern must be followed for at least 3-5 days post-surgery to reduce the risk of swelling and inflammation.

How long to recover from wisdom teeth removal?

The recovery period after a wisdom tooth removal is usually gradual. However, on average, it may take a week or two to heal completely from the post-surgical symptoms. Typically, the healing process of a wisdom tooth extraction can be described as follows –

  • Blood clot forms during the first 24 hours post-surgery
  • In the first two to three days, you might notice an improvement in the swelling around the mouth and cheeks.
  • Within seven days the dentist will recall you to remove the stitches
  • Jaw stiffness and soreness of the mouth gradually goes away within 7-10 days.
  • Any remaining bruises or swelling on the face heals entirely within two weeks.

How to feel better after getting wisdom teeth removed?

The best way to experience faster recovery and feel better after surgery is to plan ahead.

  • Talk to the oral surgeon about the post-operative guidelines well before getting the tooth removed.
  • Take a few days off of work to rest well
  • Watch what you eat for the next one-week post-surgery to avoid unnecessary pain and discomfort.
  • Take the prescribed medications regularly, as advised by the dentist.
  • Perform mouth opening exercises to get rid of jaw stiffness quickly
  • Rinse your mouth with warm saltwater. It helps to clean your mouth and aids in the healing of the extraction site.
  • Teabags and cold compressions are the best way to reduce swelling and pain—moreover, they providing a soothing effect to the jaw.
  • Keep in touch with your dentist and ask any doubts you have regarding the healing process.

What to eat after wisdom teeth removal day 2?

Usually, during day 2 of recovery from wisdom tooth removal, the patient is advised to switch to a soft diet, which is easy to chew and swallow. Moreover, it helps to avoid unnecessary exacerbation of pain and discomfort.

The foods that you can eat at this time usually include –

  • Yogurt and smoothies
  • Cheese
  • Applesauce
  • Mashed potatoes
  • Soft pasta
  • Cooked rice
  • Fruits like banana
  • Smooth soup
  • Cooked cereal
  • Pudding
  • Eggnog

how long does wisdom teeth removal pain last?

Usually, it is normal to feel some pain after the anesthetic effect wears away. Prescribed or over-the-counter pain medications can help to relieve the pain during this time. Some people also feel pain during the second-day post-surgery.

However, if the pain is continuous for more than three to four days, it might indicate a complication. Consult your dentist immediately to control the severity of the condition.

How to reduce swelling after wisdom teeth removal?

Usually, ice packs are efficient in controlling the swelling around the mouth and cheeks after wisdom tooth removal. Apply the ice pack to your jaw every 20 minutes and remove it for the next 20 minutes. Repeat this method several times in a day, especially during the first few hours post-surgery.

What to eat after wisdom teeth removal day 1?

Usually, the dentists advise patients to follow a liquid diet for the first 24-48 hours after wisdom tooth removal. This diet typically includes –

  • Smoothies or milkshakes
  • Protein shakes
  • Fresh fruit juice
  • Smooth soup
  • Soft ice cream
  • Broths

Avoid caffeine, tea, and acidic drinks for at least one week to allow proper healing.

Why experts now say not to remove your wisdom teeth?

Usually, the removal of wisdom tooth depends on a lot of factors which includes –

  • Active carious lesion
  • Pericoronitis
  • Gum disease
  • Impaction
  • The risk of infection spread to adjacent healthy teeth.

Not all wisdom teeth, mostly the healthy and fully erupted wisdom teeth, require removal. Tooth extraction is typically performed to remove damaged teeth.

How long do you wear gauze after wisdom teeth removal?

Typically, a gauze pack should be placed in the mouth for 30 minutes to one hour after the wisdom tooth removal. This helps to control the bleeding from the extraction site. After one hour, the patient is asked to remove the gauze with hands and throw it in a closed lid dustbin.

How to prepare for wisdom teeth removal?

Talk to your dentist or oral surgeon well before getting the tooth removed. Get post-operative instructions. Take off from work for at least two to three days so that you have time to rest well after the surgery.

Follow the post-operative instructions religiously to recover fast from. Keep in touch with your dentist to talk about any complications that you may experience during the healing process.

Who removes wisdom teeth?

Usually, an oral surgeon is the best dental professional to remove wisdom teeth as he is more experienced and trained as compared to a general dentist. However, simple tooth extractions can b performed by a general dentist as well.

Can you get your wisdom teeth removed while pregnant?

Wisdom tooth removals can be performed during pregnancy, usually during the second trimester. However, proper radiographic precautions must be taken, such as the use of protective lead aprons and thyroid collars to take radiographs during the procedure.

How much is wisdom teeth removal without insurance?

Usually, dental insurance does cover the cost of wisdom tooth removal. However, without dental insurance, a patient may have to pay around $80 – $300 per tooth for a simple wisdom tooth removal. Moreover, a complicated surgical extraction may cost about $100 – $400 per tooth without insurance.

What to eat after wisdom teeth removal day 3?

During day 3 of recovery from wisdom tooth removal, the patient can start eating the following foods –

  • Macaroni
  • Cooked noodles
  • Boiled eggs or scrambled eggs
  • Soft sandwiches

However, avoid eating spicy and crunchy food at this stage, such as pizza, popcorn, and chips.

How long after wisdom teeth removal can i drink alcohol?

Usually, it is advised to wait for 48 – 72 hours or three days after wisdom tooth removal to be able to drink alcohol. It is best if it can be avoided for the first one week as it helps in speedy recovery of the extraction site.

How to stop bleeding after wisdom teeth removal?

You can stop the bleeding by placing a gauze pack or cotton on the extraction site. Bite on the gauze gently or apply light pressure for at least 20-30 minutes and remove the gauze piece.

What happens if you don t remove your wisdom teeth?

Usually, a partially erupted wisdom tooth can cause bacterial infection in the gums called pericoronitis. A wisdom tooth that doesn’t erupt can lead to the development of a cyst, which can damage the surrounding bone and gum tissue. A partially erupted wisdom tooth can also risk the health of the adjacent teeth.

How long does numbness last after wisdom teeth removal?

Usually, the numbness lasts for two to three hours after removal of wisdom tooth. During this time, it is essential not to chew anything as it can lead to the formation of ulcers on the lips and inner cheeks. As the numbness starts to wear away, the patient may experience some pain around the extraction site.

What not to do after wisdom teeth removal?

Some of the things that you must avoid after wisdom tooth removal is as follows –

  • Avoid cold foods, crunchy or spicy foods
  • Avoid drinking hot and acidic beverages
  • Avoid sleeping in lying down position as it may prolong bleeding
  • Avoid frequent spitting of saliva or rigorous mouth rinsing
  • Avoid smoking or alcohol consumption for the next three days

how bad does wisdom teeth removal hurt?

Typically, a patient doe not feel pain during wisdom tooth removal as the procedure is performed under anesthesia. However, the patient may feel some pressure that is used to luxate the tooth in the socket.

How long does bleeding last after wisdom teeth removal?

Usually, a patient may experience some bleeding during the first 24-48 hours. Be aware that the bleeding may mix with the saliva giving an impression of blood oozing out of the socket. However, you can stop the mild bleeding by placing a gauze pack on the extraction site.

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How long does jaw stiffness last after wisdom teeth removal?

It may take around a week or more for jaw stiffness to heal completely. Mouth opening exercises usually help to recover quickly and reduce the period of the stiffness of the jaw.

How to brush your teeth after wisdom teeth removal?

You can follow regular tooth brushing after wisdom tooth removal. However, pay attention that the brush does not irritate the gums around the extraction site. Rinse your mouth gently and use warm salt water to clean the mouth.

You can also use a finger to brush the teeth adjacent to the extraction site for the first 3-4 days.

How to remove wisdom teeth at home?

Wisdom teeth cannot be removed by oneself at home. It requires surgical treatment to pull the tooth from the surrounding bone and gums. However, you can relieve wisdom tooth pain by using the following –

  • Clove oil
  • Teabags
  • Numbing gels
  • Over-the-counter pain medications
  • Ice pack
  • Saltwater rinse

Consult your dentist to check the dental condition and schedule a wisdom tooth removal appointment to avoid further complications.

Final words on wisdom teeth removal

You must go for wisdom teeth removal when you are young since with time an impacted third molar can get infected and cause more complications. Third molars also exert pressure, leading to crowding of the front tooth and can be removed as prophylaxis to avoid malalignment of teeth.

The surgery involved in wisdom teeth removal is a very routine daytime procedure. Post-surgery, take a day rest and thereafter you can go back to your routine life with ease.

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