Treatment
Wisdom teeth: when they need to come out, and when they do not
The most damaging thing a wisdom tooth usually does is destroy the healthy tooth in front of it, quietly, in a spot no toothbrush reaches. That, not the wisdom tooth itself, is often the real argument for removal.
Third molars, the wisdom teeth, arrive somewhere between seventeen and twenty-five, long after the rest of the dentition has settled. Human jaws have grown shorter over evolutionary time while the number of teeth has stayed the same, so for a large share of people there is simply not enough room at the back of the arch. What happens next varies enormously, and so does whether anything needs doing about it.
Impaction is a description, not a diagnosis
A wisdom tooth is impacted when it cannot fully erupt into a normal position. Depending on the angle it is lying at, it may be described as mesioangular, tilted forward into the tooth in front, vertical, distoangular, tilted backward, or horizontal, lying on its side. It may be entirely buried in bone, partly through the gum, or fully erupted but unopposed.
None of those descriptions is by itself a reason for surgery. A fully buried wisdom tooth, sealed under bone with no communication to the mouth and causing no problem, is often best left exactly where it is and simply observed.
The reasons that do justify removal
Recurrent pericoronitis
A partially erupted wisdom tooth has a flap of gum over part of it called an operculum. Food and plaque get underneath, nothing can clean it out, and the tissue becomes acutely infected: swelling, pain on biting, difficulty opening the mouth, sometimes a foul taste. One episode may be treated and monitored. Repeated episodes are a clear indication for removal, because the anatomy causing them will not change.
Decay in the wisdom tooth, or worse, in the tooth in front
This is the one that costs people a good tooth. A mesioangular wisdom tooth leans against the back surface of the second molar, creating a contact area that no brush and no floss can reach. Decay develops on the back of that second molar, hidden, and often is not found until it is deep. The second molar is a functionally important tooth. Losing it to protect a wisdom tooth that was never going to be useful is a bad trade, and it is a common one.
Other clear indications
- A cyst or other pathology developing around the crown of an unerupted tooth.
- A deep periodontal pocket on the back of the second molar caused by the wisdom tooth's position.
- The wisdom tooth is unrestorable, or repeatedly traumatises the cheek because it has drifted or over-erupted.
- It sits in the way of planned orthodontic or prosthetic treatment, or in the line of a jaw fracture.
- Resorption of the root of the second molar caused by the wisdom tooth pressing against it.
What the surgery involves, and its risks
A radiograph is always taken first, and for lower wisdom teeth it is doing a specific job: showing the relationship between the roots and the inferior alveolar nerve, which runs through the jaw and supplies sensation to the lower lip and chin. When the radiograph suggests they are close, a three-dimensional CBCT scan is sometimes taken to see the relationship properly before deciding on the approach.
Removal is done under local anaesthetic, sometimes with sedation. A buried tooth requires raising the gum, removing a small amount of bone, and usually sectioning the tooth so it can come out in pieces through a smaller opening. That last step sounds worse than it is, and it is what protects the surrounding bone.
- Swelling and limited mouth opening for a few days, peaking around day two or three. Expected, not a complication.
- Dry socket, where the blood clot is lost and the bone is exposed. Painful, more common in smokers, and treatable.
- Bleeding, and infection in a minority of cases.
- For lower teeth, temporary altered sensation in the lip or chin from irritation of the inferior alveolar nerve. Permanent numbness is uncommon but is a real risk and should be discussed before you consent, not afterwards.
- For upper teeth, the maxillary sinus sits close to the roots and can occasionally be involved.
Recovery
Most people are comfortable within three to five days and back to normal within a week to ten days for a surgical extraction. Rest for the first day, keep the head elevated, use cold compresses for the first twenty-four hours, and stick to soft food. Do not rinse vigorously or spit on the first day, because dislodging the clot is what causes a dry socket. Warm salt water rinses start from the following day. Not smoking is the single most useful thing you can do for the healing site.
Common questions
Do wisdom teeth cause crowding of the front teeth?
This is widely believed and not well supported. Late lower incisor crowding happens in people who never had wisdom teeth at all, and removing them prophylactically has not been shown to prevent it. Crowding is generally attributed to normal late growth changes rather than pressure from the third molars.
Does everyone need their wisdom teeth removed?
No. Wisdom teeth that have erupted into a functional position and can be cleaned are kept. Even buried ones that are causing no problem are often best monitored rather than removed, since surgery on a healthy tooth carries risk without a corresponding benefit.
Is upper or lower removal easier?
Uppers are usually more straightforward. The bone is less dense and there is no inferior alveolar nerve to consider, so recovery tends to be quicker and swelling less.
How long does the pain last?
Discomfort typically peaks in the first two to three days and settles over the following week. Pain that worsens after day three, particularly with a bad taste and an empty-looking socket, suggests a dry socket and is worth a call rather than more painkillers.
Can I have them out under sedation?
Yes, sedation is commonly offered for surgical extractions and for anxious patients. It is used alongside local anaesthetic rather than instead of it.
References
This article is general information about dental health and is not a diagnosis or a substitute for an examination. Symptoms that look alike can have very different causes. If something in your own mouth is worrying you, book a visit or call us on +91 95878 15285.
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