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Wisdom teeth often cause no problems. They are described as impacted when there is not enough space for them at the back of the mouth. Impacted wisdom teeth can cause pain, swelling, infection or damage to the teeth next to them. If the gum around the wisdom tooth is swollen the jaw may become stiff and sore. Infection at the back of the mouth can cause bad breath and a bad taste.

The surgical removal (extraction) of one or more wisdom teeth can relieve these problems. However, removing the wisdom teeth does not usually improve crookedness or crowding in other teeth.

People who have problems such as infection, cysts or tumours, tooth decay, or gum disease around a wisdom tooth should think about having it removed.

People who have impacted wisdom teeth that are not causing problems do not need to have them removed.


What are the alternatives?

Having wisdom teeth removed is often the only way to permanently relieve painful symptoms. Although antibiotics can provide temporary relief, the symptoms tend to flare up again in the future.

In some cases, where a wisdom tooth is causing pain because it is pressing into the surrounding gum, removal may not be necessary - an operation to cut back the gum may be all that is needed. However, this alternative is not suitable for everyone.

The operation

Many people have their wisdom teeth removed under local anaesthesia by a general dentist or oral surgeon. This means that they are awake, but the area around the wisdom tooth is completely numb. Sedative drugs can be given with local anaesthesia to help people relax during the procedure.

Some people have their wisdom teeth removed under general anaesthesia. This means that they are asleep throughout the procedure. This has to be done in hospital, but it's almost always carried out as a day case, requiring no overnight stay. Typically, patients are asked not to eat or drink for about six hours before general anaesthesia. However, some anaesthetists allow a few sips of water until two hours beforehand.

The operation will not start until the anaesthetic has taken effect. It is often necessary to make a small cut in the gum over the wisdom tooth, and to remove some bone so that the tooth can be lifted out. Stitches are usually put in to help the gum heal.

What to expect afterwards

It will be necessary to rest for a while after general anaesthesia or sedation. The jaw may feel stiff and sore, but painkillers will help to relieve discomfort.

Most people can go home as soon as they have recovered from the anaesthesia. However, if you have had general anaesthesia or sedation, you will need to arrange for someone to drive you home and stay with you for at least 24 hours.

General anaesthesia can temporarily affect co-ordination and reasoning skills, so you shouldnot drive, drink alcohol, operate machinery or sign legal documents for 48 hours afterwards.

You may be given painkillers, antibiotics and mouthwash solutions to take home. Once home, the painkillers should be taken as advised by the surgeon and nurses. Any pain, swelling or stiffness is usually at its worst two or three days after the operation and then gradually improves.

Do not vigorously rinse your mouth out during the first 24 hours because this disturbs the blood clots that are part of the healing process. After meals, rinse gently with warm salt water (one teaspoon of table salt to a glass).

At first, it may be possible to feel small fragments of bone with your tongue. These are the edges of the tooth socket and will soon disappear as the gum heals.

Depending on the type of stitches used, they may need to be removed (arrangements will be made for this to be done). If dissolvable stitches have been used, they will disappear 7 to 10 days after the operation.

To begin with, you should eat soft foods, gradually returning to a normal diet once any jaw stiffness has settled. Very hot drinks and spicy food can increase pain and bleeding and should be avoided until the gum has healed.

Drinking alcohol and smoking should also be avoided as they can increase bleeding and delay healing.

Anyone who experiences increased bleeding should fold a clean handkerchief or piece of gauze, place it on the bleeding gum and - in a sitting position - bite on it for at least 20 minutes. It is important not to rinse your mouth out or lie down.

Most people experience no problems following an operation to remove wisdom teeth. However, contact your dentist or the hospital immediately if you develop any of the following:

  • bleeding that doesn't stop after applying pressure, or that lasts for more than half an hour
  • difficulty breathing or swallowing
  • a face that continues to swell more than three days after the operation
  • a fever or high temperature
  • severe pain that is not relieved by painkillers
These symptoms may indicate that you have an infection or another problem.

Side-effects and complications

The extraction of wisdom teeth is a commonly performed and generally safe procedure. For most people, the benefits - treatment of pain, decay and infection - are greater than any disadvantages. However, in order to make an informed decision, anyone deciding whether or not to have this procedure needs to be aware of the possible side-effects and the risk of complications.

Side-effects

These are the unwanted but usually mild and temporary effects of a successful procedure. Examples of side-effects include feeling sick as a result of the anaesthetic and occasional bleeding from the gums, which can last 12 hours or more. There may also be some facial swelling, pain and jaw stiffness, which can last for several days.

Complications

Complications are problems that can occur during or after the operation. Most people are not affected. The main possible complications of any surgery include excessive bleeding during or soon after the operation, infection, and an unexpected reaction to the anaesthetic. Complications may require further treatment such as having another operation to stop bleeding, or antibiotics to treat an infection.

Specific complications of having wisdom teeth extracted are uncommon but may include accidental damage to other teeth.

Occasionally nerves in the jaw can be damaged, either by the surgery or by swelling afterwards. This can cause temporary numbness or "pins and needles" in the lower lip or tongue after lower wisdom teeth have been removed. In a small number of cases this altered sensation is permanent.

The risk of complications depends on the exact position of the wisdom teeth, the type of anaesthetic used and other factors such as the person's general health. Your surgeon will be able to explain how these risks apply to you.



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