Emergency Wisdom Tooth Removal - Can It Be Done?

Updated: 3 days ago

An emergency wisdom tooth removal is required when your wisdom teeth cause you unbearable pain that disrupts the quality of your life. It can be done and must be done but often at inopportune times. Reason is because you have no control over when they decide to hurt you but only know after it happens.


Fortunately your dentist is able to pull a tooth with an active infection, assuming that you're able to get an appointment the same day. If you're unfortunate and not able to get an appointment, you may just have to bear through it until your scheduled appointment time.


This article will explain how to tell if your situation is an emergency. What you should expect during the procedure and if there are any complications. We'll also cover the aftercare as well!



Table of Contents:



Signs of needing an emergency wisdom tooth extraction

It is an emergency if your wisdom tooth causes you extreme or unbearable pain. So much so that you would consider the thought of having them removed from your mouth.


Here are a couple of signs that may indicate an emergency extraction:



Impacted third molar

If the wisdom tooth is not growing out straight such as trying to come in sideways, it can cause a lot of pain. The toothache stems from the tooth pushing into the adjacent teeth, thus causing a lot of pressure in your jaw.


x-ray of impacted lower wisdom teeth
x-ray of impacted lower wisdom teeth

Signs of impacted wisdom teeth:

  • Swollen gums that are painful

  • Tooth pain

  • Sensitivity

  • Shifting of teeth

  • Jaw pain

  • Headaches and possible infection


Cavitation

The tooth could very well have a giant hole in it. If your tooth has a hole and it doesn't hurt, we would be pleasantly surprised. That however is not the norm because it should hurt most of the time. Food will get stuck in the hole and irritate the tooth nerve. It will also be difficult for you to remove the stuck food from the holes as well.


hole on side of wisdom tooth
hole on side of wisdom tooth

Tooth decay

One of the most common causes of tooth pain are your typical cavities. If bacteria have invaded your tooth, they can secrete a lot of acid. That acid will eat through your tooth structure and cause a toothache. Wisdom teeth are not immune to cavities so they can become decayed.


cavity on upper wisdom tooth
cavity on upper wisdom tooth

Infection

Another source of pain that could result in an emergency wisdom tooth extraction would be an infection. The infection could come from a variety of sources such as lodged food, bacteria, or fungi.


Dental abscess

Untreated tooth decay will eventually turn into an abscess. The abscess will progressively worsen and cause your face to swell up. If that happens you'll need more than just an emergency wisdom tooth extraction because you'll also need the abscess to be drained.


facial abscess with a drain
facial abscess with a drain

Gum disease

If you leave gum disease untreated, it can lead to severe gum swelling. The gums can swell up so much that they can almost cover the entire surface of your tooth! This is an emergency and you most likely need the third molar extraction along with possible drainage.


gum swelling
gum swelling

Cysts

Most people are not aware of it but it is possible to develop cysts around your wisdom teeth. This happens most frequently if your molars are impacted. The only way to tell is by taking a panoramic dental x-ray, one which goes around your head. That helps your dentist visualize your entire jaw and everything that is going on. Cysts may require more than just a tooth extraction if it is severe enough.


Periocoronitis

One of the most common reasons for wisdom teeth pain would be pericoronitis, which is essentially gum inflammation around the third molar. The partially impacted teeth are the most prone to this condition because they typically have a flap of gum covering over part of the tooth.


This gum flap is very prone to food and plaque getting caught underneath of it. Due to the location of your wisdom teeth and how far back they are, they are next to impossible to keep clean sometimes. What that means is that it is very likely for them to swell up from time to time until you finally muster up the courage to extract those teeth!


swollen partially impacted wisdom tooth
swollen partially impacted wisdom tooth


The process for an emergency wisdom tooth removal

The procedure for an emergency wisdom tooth removal is actually not any different from a normal third molar extraction. The main difference is that you're most likely in severe pain and that you're willing to have the wisdom tooth taken out. Normally, most people are averse to the procedure!


Aside from that, there is also the chance that you may require a lot more local anesthesia to get numb. Due to the severe inflammation, the anesthetic may have trouble numbing the tooth.


The procedure step by step for fully erupted wisdom teeth:

  1. Administer local anesthetic to numb the whole tooth.

  2. Sever the periodontal ligament with a scalpel.

  3. Elevate and luxate the tooth with an elevator.

  4. Grab the tooth with forceps to deliver it out of the mouth.

  5. Clean out the socket by scraping the walls.

  6. Irrigate out any debris in the socket with water or saline.


The procedure step by step for impacted wisdom teeth:

  1. Administer local anesthesia to the jaw with a numbing shot.

  2. Reflect the gums and lay a flap.

  3. Expose the whole tooth by retracting the gums.

  4. Drill away the bone that is covering the tooth.

  5. Section the tooth into 2-3 pieces using a drill.

  6. Elevate and luxate each individual piece with an elevator.

  7. Grab each piece of tooth with a forcep to remove them.

  8. Curette the socket to remove any infection.

  9. Smooth down any sharp bony spicules with a bone file.

  10. Irrigate with saline to thoroughly flush out the socket.

  11. Place stitches to close up the hole.


Here is a video of what it is like to have an impacted wisdom tooth extracted:




Possible complications

The biggest complication for an emergency wisdom tooth extraction is that you may not be able to get fully numb. If your tooth is severely inflamed and infected, it can be quite difficult for the local anesthetic to reach the tooth and numb it.


An analogy would be if you were trying to get onto a crowded train. The novocaine is basically trying to squeeze onto the crowded train and reach the middle of it. That can be quite difficult.


If you happen to be one of the unfortunate ones who do not get numb, you would not be able to have the tooth extracted today. Instead, your dentist may put you on antibiotics for the next two days and then you can come in to try again. Usually the antibiotics will help reduce enough of the infection and swelling so that you can get numb.


Aside from not being able to get numb, here are other potential complications associated with wisdom teeth removal:

  • Broken jaw - if you have osteoporosis, you would be at higher risk.

  • Severe bleeding - bleeding disorders can result in non-stop bleeding.

  • Nerve damage - impacted teeth can be close to the nerve.

  • Dry socket - if the blood clot fails to form, it can result in this painful condition.

  • Infection - an open wound like an extraction socket can get infected.



Emergency wisdom tooth extraction vs regular one

There really isn't much of a difference between an emergency wisdom tooth extraction vs a regular one. Typically, patients who do this as an emergency procedure are in a lot of pain and want the treatment done immediately. On the other hand, patients who are not in pain typically try to postpone having their wisdom teeth taken out for as long as possible.


Basically it all comes down to, do you want to have the wisdom teeth taken out on your schedule or do you want it to dictate to you when they should come out. In our opinion, it is much more pleasant to be ahead of the pain rather than following behind it. That is why you should have them removed before they start causing problems. You'll be a lot less miserable that way.



How long will the recovery be?

Depending on how impacted the teeth are and how many teeth you're removing would determine the recovery time.

  • Fully erupted wisdom tooth. The teeth that have come in fully, you should be fully functional after the first day. Your jaw may be sore for the next few days but it shouldn't stop you from what you need to do after 24 hours.

  • Impacted wisdom tooth. These teeth are much more difficult to remove because you often have to cut through the gums and drill through the bone to get to them. We expect you to rest as much as possible for the first 2-3 days. After that you can slowly ease back into your regular routine.


That is a general guideline for a single tooth but if you need more removed at the same time, expect to add additional time for healing. Also expect more discomfort for the more teeth that needs to be taken out.




Post-operative instructions

The first thing you need to do after having an emergency wisdom tooth removal is to stop the bleeding by biting down onto a 2x2 gauze.

  1. Fold two pieces of gauze in half two times until it forms a square.

  2. Place the gauze over extraction site.

  3. Bite down firmly onto the gauze for 30 minutes.

  4. Repeat steps 1-3 every 30 minutes until it stops bleeding.


In addition to that, there are also three things which you should not do:

  • Spitting. Vigorous spitting creates a lot of suction in the mouth that can dislodge the forming but unstable blood clot. If the blood clot comes out, it will continue to bleed so do not spit whatsoever in the first 24 hours. If you need to get rid of blood, just let it dribble out slowly.

  • Rinsing. Zealous rinsing will also create a lot of pressure in the mouth, which can disturb the blood clot. Please refrain from rinsing within the first 24 hours. However, after 24 hours you should start rinsing with salt water after every meal to prevent food from getting stuck in the wisdom tooth hole.

  • Drinking through a straw. Drinking with a straw also creates a tremendous amount of pressure in your mouth, which can dislodge the blood clot. The consequence of using a straw will cause persistent bleeding but at least it will not cause a dry socket.


Diet wise, we would recommend sticking with soft foods for the first 3 days:

  • Yogurt

  • Bananas

  • Mashed potatoes

  • Soft mac and cheese

  • Smoothies

  • Protein shakes

  • Soup


After that, you can slowly reintroduce harder foods into your diet to see how your body handles it. After about a week you should be functioning at normal capacity.



Takeaway

An emergency wisdom tooth extraction is often done when the patient is feeling immense pain. It often happens at the most inopportune time so they're scrambling to get an appointment as soon as possible. Luckily, there isn't any difference in taking out third molars whether on an emergency basis or a normal one. The procedure is exactly the same.


The only difference is that there is the potential that they may not be numb enough to make it through the procedure. If that is the case, they may need to take antibiotics for a few days to calm down the infection so that they can be properly numb for the treatment.


This is why it is important to go in for your regular dental check ups. If your dentist thinks that they can potentially become an issue later on down the road, you should try to schedule a time to have them removed. That way you do it on your own time and you decide when it happens. If you let it become an emergency then it is no longer in your control and you're forced to do it at that moment.


If you're in need of an emergency wisdom tooth removal in Long Island City, NY our dentists are more than happy to help you out! Otherwise you'd have to get in touch with your own provider.


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About the author: Dr David Chen, DDS

Hello, I'm Dr Chen and I'm an actively practicing dentist in Long Island City, NY. I graduated from Columbia University College of Dental Medicine in 2016 but prior to going to dental school I was already working in the dental field. It's been more than a decade since I first got to know dentistry and let me tell you, time flies by quickly. Since then I've developed a fondness for writing, which is how this all got started!

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Medical Disclaimer:

This blog is purely meant for information purposes and should not be used as medical advice. Each situation in your mouth is unique and complex. It is not possible to give advice nor diagnose any oral conditions based on text nor virtual consultations. The best thing to do is to go in person to see your dentist for an examination and consultation so that you can receive the best care possible.

The purpose of all of this oral health information is to encourage you to see your dentist and to inform you of what you may expect during your visit. Due to the unfortunate nature of dentistry, there isn't really any true home remedies that will get rid of dental problems. Roughly 99.99% of them require in-person intervention by a healthcare professional.

Hint: That is the reason why you can't eliminate seeing dentists in your life!