Wisdom Teeth Extraction

Wisdom tooth extraction is a surgical procedure to remove one or more wisdom teeth — the four permanent adult teeth located at the back corners of your mouth on the top and bottom.

If a wisdom tooth doesn't have room to grow (impacted wisdom tooth), resulting in pain, infection or other dental problems, you'll likely need to have it pulled. Wisdom tooth extraction may be done by a dentist or an oral surgeon.

To prevent potential future problems, some dentists and oral surgeons recommend wisdom tooth extraction even if impacted teeth aren't currently causing problems.

Why it's done

Wisdom teeth, or third molars, are the last permanent teeth to appear (erupt) in the mouth. These teeth usually appear between the ages of 17 and 25. Some people never develop wisdom teeth. For others, wisdom teeth erupt normally — just as their other molars did — and cause no problems.

Many people develop impacted wisdom teeth — teeth that don't have enough room to erupt into the mouth or develop normally. Impacted wisdom teeth may erupt only partially or not at all.

An impacted wisdom tooth may:

  • Grow at an angle toward the next tooth (second molar)

  • Grow at an angle toward the back of the mouth

  • Grow at a right angle to the other teeth, as if the wisdom tooth is "lying down" within the jawbone

  • Grow straight up or down like other teeth but stay trapped within the jawbone

Problems with impacted wisdom teeth

You'll likely need your impacted wisdom tooth pulled if it results in problems such as:

  • Pain

  • Trapping food and debris behind the wisdom tooth

  • Infection or gum disease (periodontal disease)

  • Tooth decay in a partially erupted wisdom tooth

  • Damage to a nearby tooth or surrounding bone

  • Development of a fluid-filled sac (cyst) around the wisdom tooth

  • Complications with orthodontic treatments to straighten other teeth

Preventing future dental problems

Dental specialists disagree about the value of extracting impacted wisdom teeth that aren't causing problems (asymptomatic).

It's difficult to predict future problems with impacted wisdom teeth. However, here's the rationale for preventive extraction:

  • Symptom-free wisdom teeth could still harbor disease.

  • If there isn't enough space for the tooth to erupt, it's often hard to get to it and clean it properly.

  • Serious complications with wisdom teeth happen less often in younger adults.

  • Older adults may experience difficulty with surgery and complications after surgery.

Preparing for surgery

A wisdom tooth extraction is almost always performed as an outpatient procedure. This means that you go home the same day.

You'll receive instructions from the hospital or dental clinic staff on what to do before the surgery and the day of your scheduled surgery. Ask these questions:

  • Will I need to make arrangements for someone to drive me home after the procedure?

  • When do I need to arrive at the dental clinic or hospital?

  • Do I need to avoid eating food or drinking fluids or both (fast)? If so, when do I begin?

  • Can I take my prescription medications before the surgery? If so, how soon before the surgery can I take a dose?

  • Should I avoid any nonprescription drugs before the surgery?

What you can expect

We may use one of three types of anesthesia, depending on the expected complexity of the wisdom tooth extraction and your comfort level. Options include:

  • Local anesthesia. We administer local anesthesia with one or more injections near the site of each extraction. Before you receive an injection, your dentist or surgeon will likely apply a substance to your gums to numb them. You're awake during the tooth extraction. Although you'll feel some pressure and movement, you shouldn't experience pain.

  • Sedation anesthesia. Your dentist or oral surgeon gives you sedation anesthesia through an intravenous (IV) line in your arm. Sedation anesthesia suppresses your consciousness during the procedure. You don't feel any pain and will have limited memory of the procedure. You'll also receive local anesthesia to numb your gums.

  • General anesthesia. In special situations, you may be offered general anesthesia. You may inhale medication through your nose or have an IV line in your arm, or both. Then you lose consciousness. Your surgical team closely monitors your medication, breathing, temperature, fluids and blood pressure. You'll experience no pain and have no memory of the procedure. Local anesthesia is also given to help with postoperative discomfort.

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