Wisdom teeth might have a neat name, but given the problems they often cause, they don't seem all that wise. What do you need to know about these third molars and their removal?

So-called wisdom teeth or third molars would perhaps more aptly be called "trouble teeth" — we've all had problems with ours, known people who have, or have left a dentist appointment with a recommendation to get these teeth taken out. Usually appearing between the ages of 17 and 25, at the very back of the jaw, they're thought to have been important to our distant ancestors whose diets required an awful lot more chewing. For modern life, however, they're as pointless as male nipples — and they cause a lot more problems.  

Consider, for instance, that:

  • Some studies suggest that more than seven in 10 people have "impacted wisdom teeth" — wisdom teeth that failed to erupt properly, usually because of overcrowding. This means they're harder to keep clean, and prone to swelling, bleeding, and decay. 
  • Up to 60 percent of people who initially opt to retain their wisdom teeth need to have them removed later.
  • Around five million people have wisdom teeth removed each year in the United States alone, costing over $3 billion.

"Mother nature" might slowly be getting the message, as a quarter of people don't develop all four wisdom teeth while around four percent never get any at all. That won't help you any if you are currently dealing with a troublesome wisdom tooth, mind you. 

What can go wrong with wisdom teeth?

Impacted wisdom teeth are those that haven't had the space to erupt or develop the way they should, something that can result in numerous misalignment-related problems:

  • The tooth may be angled towards the back of the mouth — known as mesioangular impaction
  • The tooth may angle towards the back of the mouth — described as distoangular impaction
  • The tooth can come in "sideways" — called horizontal impaction, this rare phenomenon can cause the wisdom tooth to literally take root within the neighboring tooth

Vertical impaction, in which the wisdom tooth never completely erupts and is enveloped in gum tissue, is another frequently seen issue that allows for the easy entrapment of gunk, bacterial buildup, and a whole host of subsequent issues. Wherever wisdom teeth are misaligned, they can harm other teeth, hurt your jawbone, and even lead to nerve damage. 

Impacted wisdom teeth and the difficulties you have with keeping them clean result in a higher risk of:

  • Tooth decay — not only in wisdom teeth themselves, but also in neighboring teeth they're pressing into.
  • Gum disease (periodontal disease), a serious condition that manifests as bleeding and receding gums and that can eventually cause tooth and bone loss. 
  • Cysts and abscesses in wisdom teeth that have not completely erupted. 
  • Pericoronitis, a soft-tissue infection caused by plaque buildup. 

Nasty gnashers: Symptoms that should warn you it's time to see a dentist about your wisdom teeth

Everyone should ideally visit their dentist for a routine checkup twice a year — and your dentist should be able to spot signs of trouble before you even knew there was any.

People with wisdom teeth who notice the following symptoms would, however, "wise" to make an additional appointment, pronto:

  • Red, swollen, sore, or painful gums — in this case, around the general area of the wisdom tooth
  • Pain or swelling within your jaw
  • Pain around the tooth itself
  • Difficulty opening your mouth
  • In some cases, a sinus infection

When and why should wisdom teeth be removed?

There are, actually, different schools of thought on what circumstances call for the extraction of wisdom teeth — some dentists see them as inherently problematic and will suggest routine extractions even if the third molar erupted completely, at the right angle, and isn't currently causing any symptoms. 

More recent research suggests, on the other hand, that not all wisdom teeth that are extracted needed to be, and that's worth paying attention to, because not only do folks tend to feel rough right after the operation to remove these third molars, a significant portion develops permanent numbness of the lip, cheek, or tongue as their nerves are damaged during surgery. One study even referred to the routine extraction of otherwise normal wisdom teeth as a "public health hazard"!

You will, however, need to have your wisdom tooth or teeth extracted if:

  • You have an infection around the wisdom tooth or suffer from periodontal disease
  • Your wisdom tooth has, or wisdom teeth have, cavities
  • Your wisdom tooth has erupted only partially and gum tissue is covering part of it — this is a recipe for bacterial buildup that will later lead to decay and infection
  • Your wisdom tooth is damaging the surrounding teeth
  • You have a cyst of abscess

How are wisdom teeth removed?

That depends on the situation.

  • Completely erupted wisdom teeth can often be removed non-surgically — by means of extraction. Although your dentist will use different tools than they would for other teeth, the process is exactly the same from a patient's point of view. You'll receive local anesthesia, and may experience feelings of pressure but should not be in pain. 
  • Impacted wisdom teeth require surgical removal, which is carried out by an oral surgeon. The exact process depends on the way in which the tooth has been impacted — your surgeon may be working with only soft tissue (gums), or may have to remove the tooth from your jawbone, in which it may be encased completely or partially. Local anesthetic will suffice for soft-tissue impactions, while you may be sedated (with medications such as benzodiazepines — this is also called "twilight sedation", and you won't be able to remember the procedure afterwards) for bony impactions, and may even be offered general anesthesia. 

Depending on the complexity of the removal, the procedure may take anywhere from a few minutes to more than half an hour, and may be carried out by your dentist or an oral surgeon. It is not uncommon to require stitches after the surgery is complete. 

How long does it take to recover from wisdom tooth removal — and what can you expect during recovery?

While you recover from the extraction of your wisdom tooth — a process that takes a week or so — you may experience some:

  • Pain or discomfort
  • Swelling
  • Bleeding
  • Difficulty opening your mouth, talking, or swallowing

Preventing excess bleeding and swelling

Bleeding and blood-streaked oozing immediately after the extraction isn't uncommon and doesn't necessarily pose a problem, but patients should know that:

  • It takes a while for blood clots to form — it is important not to rinse your mouth on the day of the surgery, as this only encourages further bleeding.
  • Should the bleeding be quite heavy, biting down on some cotton wool can help stem the flow. 
  • Always let your dentist or oral surgeon know if you're taking blood thinners — they'll probably ask you to stop taking them for a while. 
  • Avoid touching the area with your hands, or playing with it with your tongue — this can induce further bleeding.
  • Some dentists will even advise you to place a teabag on the area and bite down on it, as tea contains properties that aid blood clotting.
  • Steer clear of alcohol, which will worsen bleeding.

You can tackle your swelling by using an ice pack on the area, but be aware that you'll probably still look a bit puffy for a few days.

Medications to take after your wisdom tooth is removed

When it comes to pain, an over-the-counter NSAID like ibuprofen is usually a good option — don't choose Aspirin, which may make bleeding worse. If you're prescribed a course of antibiotics to fight infection, take them exactly as prescribed. 

Tips for the days after wisdom tooth removal

Starting the day after surgery, you can and should:

  • Rinse your mouth with a salt/water mix or an antiseptic mouthwash to help prevent infection
  • Brush your teeth, avoiding the area around the extraction site
  • Eat soft foods that don't require much — if any — chewing and that may damage the site of extraction. Banana milkshakes, mashed potatoes, soups, and soft eggs are all good choices. Don't skip meals, because your body needs the extra nutrients and energy to help you recover faster. 
  • Make sure to stay hydrated.
  • Take it easy if you feel rough. 
  • DO NOT SMOKE for at least five days after your wisdom tooth removal. This can lead to a nasty infection of the extraction site known as dry socket, something you really don't want. 

Your stitches, if you had any, may be self-dissolving. If they're not, you'll need to go back to have them removed about a week after the procedure. 

What if something goes wrong? Signs of complications after wisdom tooth removal

Call your dentist or oral surgeon immediately if you notice any of the following signs of infection or other trouble on the horizon:

  • Persistent, heavy, bleeding
  • Pus — yellowish thick liquid — oozing from the extraction site
  • A bad, "infected" taste in your mouth often goes along with pus; let your dentist know if you have a foul taste in your mouth that doesn't go away after you rinse it
  • Trouble swallowing (especially if it gets worse rather than better with time)
  • Trouble breathing
  • Swelling that gets worse rather than better
  • Pain that doesn't get better after taking painkillers
  • A fever
  • A numbness that lasts far longer than the anesthesia you were given and that may affect your tongue, cheeks, lips, or gums
  • Bloody or pussy nasal secretions, which got there from your tooth via the sinus route

These symptoms can be a sign of a number of possible complications after wisdom tooth removal. Let's take a closer look at them. 

Dry socket

The "socket", the empty space left behind after the tooth was removed, should begin to heal after a blood clot forms at the site. Dry socket can strike when the blood clot didn't develop as it should have, leaving the jaw bone and nerves exposed. Dry socket can lead to extreme pain, fever, and a rather foul smell emitting from your mouth. Smokers, people with poor oral health, those who rinse their mouths a lot after the extraction despite advice to the contrary, or who "irrigrate" the area by drinking through a straw, are at an increased risk, along with women who use hormonal birth control. 

Paresthesia

Paresthesia is a numb, tingling, or prickling sensation caused by nerve damage — this sometimes occurs after wisdom tooth removal and is often temporary, but can be permanent in rarer cases. This complication is rare if an experienced oral surgeon carries your wisdom tooth extraction out. 

Infection

Fever, pus, a foul smell and taste, increased rather than decreased swelling, and persistent pain are some of the signs that your extraction site may have become infected. You can play a role in preventing infection by keeping your mouth clean after having your wisdom tooth removed. 

Sinus damage

People who have their top wisdom teeth removed should be aware that these teeth are close to the sinuses and can cause sinus infection. While this isn't normally a problem, those people who had fully formed wisdom teeth (which weren't removed as they were developing) may sometimes suffer the formation of an opening that allows the mouth and sinuses to be directly in touch. Not blowing your nose — and thereby putting pressure on the area — after extraction can help prevent this. Should it be a problem, further surgery may be needed to close this space. 

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