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Wisdom Tooth Extraction: Things To Know

Updated: Jan 8

A wisdom tooth extraction is a surgical dental procedure that removes the third molar from the jaw bone in your mouth permanently. It is normal to experience a lot of pressure, pushing, and pulling during this procedure even with anesthesia. The best or worst part of it is that you have four of them in your mouth. One in each corner or quadrant.


Wisdom tooth growing in
Wisdom tooth growing in

Once the procedure is completed, you can let out a sigh of relief but you will still be left with the aftermath to deal with. What that entails is getting the bleeding to stop, managing the pain, and recovering from the surgery.


That is quite a lot to take in because there is a lot of physical and emotional distress that comes with it. This is why it is important for you to be thoroughly prepared prior to getting your wisdom teeth extracted. Luckily for you, we're here to help guide you through it so that you can have the most pleasant experience possible.


Table of contents:


 

When is a wisdom tooth extraction needed?

The wisdom teeth (third molars) are the last teeth in your mouth to erupt through the gums. Since they're the last to come in there is often not enough space in the jaw to accommodate them. This is a hygienic nightmare that can cause a whole host of other problems.


It is not unusual to have them removed since they often cause more harm than good. Then there is also the fact that we don't really chew with them either. In other words, there aren't a lot of reasons to even keep them in your mouth!


Reasons for wisdom tooth removal:

  • Impacted teeth. A lot of times we don't have enough space in our jaw to accommodate them. They often end up impacted in all sorts of directions.

  • Tooth decay. Wisdom teeth aren't immune to cavities because they can get them just like any other teeth in your mouth.

  • Hygienic reasons. They're the last teeth in the mouth which makes flossing and brushing very difficult. In fact, this makes them more prone to cavities than other teeth.

  • Abscess and infection. If they acquire an infection, they'll need to be removed.

  • Fractured tooth. Badly broken wisdom teeth are near impossible to restore due to their location. It is not worth your time nor money to save them with root canals and crowns.

  • Orthodontic reasons. Allegedly, impacted wisdom teeth can push on your teeth and cause crowding. That may cause your straight teeth to shift.

  • Severe gum disease. Since third molars are difficult to keep clean, they're prone to gum disease like gingivitis or periodontitis.

  • Trauma or accidents. Broken jaws can sometimes affect wisdom teeth. You may need them taken out if the fracture line lines up with the tooth.


Types of wisdom teeth impaction

There are 3 types of wisdom teeth impactions.

  • Soft tissue. The tooth is partially covered by the gums and unable to erupt through.

  • Partial bony. Less than 50% of the tooth is still submerged in the jaw bone.

  • Complete bony. More than 50% of the tooth is submerged in the jaw bone.



They can also be categorized based on the direction of impaction:

  • Distally impacted. Tooth is angled towards the back of your jaw.

  • Mesially impacted. Tooth is angled towards the front of your jaw.

  • Vertically impacted. Tooth is upright but unable to erupt.

  • Horizontally impacted. Tooth is sideways, often referred to as laying horizontally.


Who offers the treatment?

If you need a wisdom tooth extracted most dentists and some dental specialists would be able to do it for you. You can often find them at private dental practices, clinics, and hospitals. Although the specialists at taking out wisdom teeth happen to be oral surgeons.

  • General dentists

  • Oral maxillofacial surgeons

  • Periodontists


 

What to expect for the procedure


Preparations prior to beginning treatment

There are a couple of items to go over with your dentist prior to the extraction. Depending on what you decide for these, it may change the course of treatment or require additional preparation.

  • Review medical history. Do you have a blood clotting disorder or are you taking any blood thinners? The former may require the procedure to be done at a hospital. The latter will require you to stop taking the blood thinners before getting the procedure done.

  • Sedation. If you're nervous or anxious, you may want to be sedated in addition to the local anesthesia for numbing.

  • Nitrous oxide. Also known as "laughing gas". You do not need a chaperone.

  • Oral conscious sedation. A prescription medication that you take by mouth an hour prior to the procedure. It is usually one of the anxiolytics: diazepam, midazolam, triazolam, and lorazepam. You'll need a chaperone.

  • Intravenous (IV) sedation. You will be put to sleep via an IV line through the arm. A chaperone is required to take you home afterwards.

  • Number of extractions. How many wisdom teeth are you planning to get taken out? Is it just one or are you doing all four at once? If you're doing all of them it is worthwhile to consider sedation.


What happens during a wisdom tooth extraction

The wisdom tooth removal procedure can be explained in 7 simple steps and it should be painless. Despite your imagination, your dentist putting their knee on your chest for leverage is not a part of the process. If they need to do that then the procedure is not going well.


wisdom tooth extraction socket
Extraction socket

This is the process for removing a fully erupted third molar:

  1. Obtain consent. Read and sign consent forms. This is the time to ask questions.

  2. Administer local anesthesia. Numbing gel applied first followed by the injection.

  3. Release PDL fibers. Cut the periodontal ligament fibers with a periosteal instrument.

  4. Elevate the tooth. Luxate to loosen the tooth with a dental elevator.

  5. Deliver tooth with forceps. Grab the tooth with forceps and remove it from the mouth.

  6. Curette the socket. Clean out the inside of the socket by scraping the walls. This step removes any remaining abscesses and infections.

  7. Irrigate socket. Flush out the extraction hole to remove residual debris.


The steps above describe a routine third molar removal. As you may have noticed, there were no stitches involved in any of the steps because they're not needed.


Surgical extraction

Impacted wisdom teeth will require a surgical extraction. Taking it out surgically involves cutting through the gums, drilling the surrounding bone, and sectioning the tooth into pieces. All of this facilitates the removal of the impacted tooth. Afterwards you will need stitches and be prescribed antibiotics.


Steps for surgically extracting wisdom teeth:

  1. Obtain consent. All procedures require consent!

  2. Administer local anesthesia. Numbing gel applied first followed by the injection.

  3. Lay a flap. With the scalpel, make an incision through the gums to reveal the tooth/bone.

  4. Remove bone. Drill away the bone surrounding the impacted tooth to visualize it.

  5. Section wisdom tooth. It'll be easier to remove the tooth in sections by separating it into pieces. Your dentist will section it by drilling into it.

  6. Elevate each piece. Luxate to loosen each piece of the tooth with an elevator.

  7. Deliver tooth with forceps. Grab the tooth with forceps and remove it from the mouth.

  8. Curette socket. Clean out the inside of the socket by scraping the walls. This step removes any remaining abscesses and infections.

  9. Irrigate socket. Flush out the extraction hole to remove residual debris.


As you may have astutely noticed, no where in any of the steps did it require breaking your jaw. We've been asked a few times about whether or not it was necessary to break the jaw in order to take out those pesky third molars.


What happens after the wisdom tooth is removed

You can't just leave after it gets taken out, there are a few things to do and items to go over prior to you going home.

  • Stitches. Not all wisdom tooth extractions require stitches but the impacted ones do. Some of the stitches dissolve on their own while others will require removal.

  • Stop the bleeding. The most effective way to stop the bleeding from the extraction hole is by biting down on gauze with firm pressure.

  • Post-operative instructions. Your dentist will review with you the dos and don'ts after a tooth extraction. You should receive a written set of instructions as well.

  • Prescriptions. Pain medication is a given but you may or may not need the antibiotics. If it was impacted and required surgical removal, you will need the antibiotics. The routine extractions typically do not require it.


Stitches dyed red in blood
Stitches dyed red in blood

After a couple of days you may begin to notice white stuff in the wisdom tooth socket. That is nothing to be concerned about because it is granulation tissue which is a normal part of the healing process.


 

Risks and Benefits


Advantages for taking it out

  • Instant pain relief. Wisdom teeth can cause spontaneous toothaches. Sometimes they're from cavities and other times because they're inflamed. That can all go away by having them removed.

  • Treats dental abscesses. Taking out the tooth will clear the abscess and infection.

  • Never worry about them again. Once they've been removed, they won't grow back. You never have to worry about them causing you pain again.


Potential complications

The vast majority of treatments are completed and heal without a hitch but sometimes complications do arise. Here is a list of potential ones you may experience:

  • Post-operative infection. The extraction site can get infected during the healing stage.

  • Pop off adjacent crowns. Extracting the wisdom teeth can require a bit of force at times. That means if you have crowns on the teeth next to it, you can risk popping them off or damaging them.

  • Dry socket. A dry socket is a painful condition where the blood clot does not form. The cause is still not completely understood but smoking does increase the incidence. It seems to be due to a biological mechanism and not a mechanical one.

  • Nerve injury. Impacted lower wisdom teeth are a risk for injury of the lingual nerve.

  • Retained root tip. Curved root tips have a high chance of breaking and getting left behind in the jaw.

  • Maxillary sinus perforation. Not very likely to happen on upper wisdom teeth but it is a possibility. It depends on the shape of your sinus.

  • Delayed healing. Slow healing is most commonly found in those with pre-existing health conditions such as diabetes.

  • Trismus. The amount you can open your mouth may be limited.

  • Reopened hole. The wisdom tooth hole could have closed but then opened back up.

  • Bruising. Excessive bleeding can cause blood to pool and result in a bruise. The highest risk is with the impacted third molars since they're often very surgical in nature.


Expected side effects

  • Bleeding. The procedure separates the tooth from your jaw bone. It would be unusual for you to have no bleeding at all. Imagine if another body part getting removed.

  • Swelling. There should be some swelling with your gums, mouth and even the face. It is due to these reasons that a cold compress or an ice pack comes in handy.

  • Discomfort. We highly recommend taking the pain medication for at least the next 3 days. After that you can take it as needed if you have high pain tolerance.

  • Compromised chewing. You should try to chew more on the opposite side while the side with the extracted tooth is healing. This is to avoid discomfort and also to minimize food getting stuck in the hole.

  • Scar tissue. There may be potential scar tissue formation after the extraction but due to its location, it'll be barely noticeable.


 

Recovery


How long does it take to recover from a wisdom tooth extraction?

The healing time for removing wisdom teeth will depend on a couple of factors. The combination of them will dictate the recovery time.

  • How many you are removing. You will recover faster if you're removing one tooth but if you're taking out all four wisdom teeth at once, it will require more time.

  • How impacted they are. The severity of the impaction will directly influence how quickly you can recover. The non-impacted ones have the shortest healing time while the most impacted will have the longest.


Recovery timeline:

  • First Day. You should spend your time to rest and recover. Please abstain from all activities that are remotely strenuous such as exercise or physical labor.

  • Second Day. Most people can resume daily activities such as going to work. Although if you need an extra day to recover that is okay as well.

  • After a week. The vast majority should be fully functional at this point.

  • After the 3rd or 4th week. This is when the gums heal over and the extraction hole closes. You should've notice the hole getting smaller after each day.

  • After 3 months. Even after the hole closes the bone underneath will require several more weeks before it completely heals. However this second part of bone healing is not something you'd be able to see or even notice.



Note: If you get more than one tooth taken out, the recovery timeline will be impacted. We would add an extra day or two for each of the recovery phases. Nonetheless you should still be very functional by the end of the first week.


When to return to work

You may return to work the next day if your job does not require heavy physical labor such as desk jobs or etc. Just remember to take things slowly and don't push yourself too hard as you're still healing. However if you feel like you need an extra day off then by all means take it since everyone is different.


If your job has a very physical component for it then we would advise you to return to work after two days of rest. Typically if you're in one of the construction sectors where you feel like you're huffing and puffing throughout the day. You should take an extra day of rest!


When can I exercise again?

You should abstain from exercising and working out for two days after having a tooth removed. Here are examples of what we mean:

  • Cardio

  • Heavy weightlifting

  • Strenuous exercises that get your heart rate up


Wisdom tooth extraction aftercare

Follow these best practices for wisdom teeth removal aftercare to maximize your healing and minimize complications.

  • Take prescribed medications. Take the antibiotics and finish the entire course. Also be sure to take your pain medication to minimize the ensuing discomfort.

  • Bite on gauze. You should be biting firmly onto the gauze for at least 3 hours to stop the bleeding. Switch to new gauze every 30 minutes until the bleeding stops.

  • No smoking. Smoking can increase the chances of getting a dry socket. Please abstain for 3-7 days but quitting would be even better for your health.

  • Cold compress. The compression with an ice pack can help reduce the swelling. Alternate with 10-20 minutes on and 10-20 minutes off to prevent frost bite.

  • No rinsing, no spitting, no drinking through a straw. All of these activities create a lot of pressure in the mouth which may dislodge the blood clot. These are typically the culprit for persistent bleeding after the extraction.

  • Rinse with salt water. Starting the next day, you should rinse with salt water after every meal. Swish vigorously to prevent food that may be stuck in the wisdom tooth hole.

  • Rest for 24 hours. The rest of the day after the procedure should be reserved for rest.

  • Eat soft foods. It'll be sore and tender to eat right after but it is important to get in nutritious food to assist with the recovery.

  • Avoid strenuous activity for 48 hours. Do not partake in activities which can get your heart pumping because that will induce bleeding.


Nutrition during recovery

Let's be honest, the tooth removal process can be quite traumatic physically and emotionally. You may not be in the mood to eat very much afterwards but nutrition is important for your recovery. We will review the dos and don'ts in regards to your diet after a tooth extraction.


Foods to avoid

  • Require a lot of chewing. This includes baguettes, steak, or anything that is tough to eat.

  • Small particle sized. Seeds, nuts, and granola can get stuck in the wisdom tooth hole.

  • Hard foods. Avoid popcorn, crab legs, and anything hard because they require a lot of chewing force. Your jaw will already be sore and tired from the extraction.


What can I eat?

Choose foods that are softer and easier to eat for the next 2-3 days. You can slowly make your way back to harder foods after that.

  • Yogurt

  • Mashed potatoes

  • Scrambled eggs

  • Avocados

  • Soft pasta

  • Soups

  • Apple sauce


What can I drink?

Please try to drink liquids that are nutritious and avoid the ones that aren't. It is important to stay hydrated with a lot of water.


What you can drink:

  • Water

  • Smoothies

  • Soup


Drinks to avoid:

  • Alcohol

  • Coffee

  • Soda


When can I resume brushing?

You may be excused from brushing your teeth on the night of having your wisdom teeth removed. However you are expected to resume brushing and flossing in the morning after.


It may be a little sore and tender so you should do it gently around the surgical site. Keeping your mouth clean after the procedure is paramount to preventing infections and expediting healing. You do not want to end up with any complications because you did not keep it clean!


 

Cost


Wisdom tooth extraction with insurance

Most dental insurances will cover wisdom teeth extractions at about 80% and that means your copay will be 20% of the cost. However you should be aware that each plan is different so be sure to read the fine print of your contract. We've seen some insurances which cover it at 100% and also some that cover it at 50% or less.


Wisdom tooth extraction without insurance

The average cost of a fully erupted wisdom tooth extraction without insurance is $325.38 and that is according to a national survey by the ADA. It may be higher or lower depending on the cost of living in your area.


However the severity of how impacted they are do affect the cost and here are the averages for each type of impaction:

  • Soft tissue impacted = $369.97

  • Partial bony impacted = $457.52

  • Complete bony impacted = $539.39


Note: You should be aware that these numbers do not make a distinction between general dentists and oral surgeons. If you're seeing the surgeon, you should expect to pay more since they're specialists.


 

When to contact your dentist

Most wisdom tooth extractions should heal without any problems. However there are certain signs which you should look out for that may indicate you've a complication. You should call your dentist if you notice any of these signs.

  • Bleeding is not improving. You want to look for a trend because if it is bleeding less every hour then that is a good sign. If there is no change at all then you've a complication.

  • Worsening pain after 3 days. Pain will peak after 48-72 hours of the procedure. If the pain worsens after that time, you may have a dry socket.

  • Sharp bone sticking out of the gums. If you start feeling something sharp coming out of your gums after 5-7 days, you may have a bony spicule. This will need to be smoothed down by your dentist. Despite what you may think, it is not a leftover piece of your tooth!


Last but not least, most stitches are meant to dissolve. If you had them placed and they feel loose, it is usually okay. They're supposed to loosen up and get absorbed by the body after 10-14 days anyway. The only exception is if you had a bone graft placed. Those stitches are not meant to dissolve.


Aside from those instances above, the healing should go without a hitch. Most of the time, a follow up appointment isn't necessary. Although your dentist may give you one if the treatment was more complicated than usual. Please follow their instructions carefully!



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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!

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