Why wisdom teeth cause problems
Human jaws used to be longer and larger, so wisdom teeth had room. Over the course of evolution, jaws became smaller while the number of teeth stayed the same. As wisdom teeth are the last to grow, they often lack space – and the other teeth can shift. Straight teeth are loaded evenly and last the longest.
When should they be removed?
Removal is strongly recommended when:
- the jaw has no room for the wisdom teeth;
- a wisdom tooth only partly erupts and a flap of gum covers it – food gets trapped where you cannot brush, causing a painful infection or decay;
- the lower wisdom teeth push against the back molars, making the lower front teeth shift;
- a wisdom tooth has decay that can spread unnoticed to the healthy neighbouring tooth;
- growth pressure threatens to dissolve the neighbouring tooth;
- the dental follicle that surrounds every tooth before it erupts turns into a cyst in the jaw, which painlessly breaks down bone and endangers neighbouring teeth.
Removal as a precaution
We advise precautionary removal when the opposing tooth is missing – without a counterpart, the tooth loses its function and can develop decay or inflammation. The same applies to wisdom teeth lying in the bone: with age they can come into contact with the mouth, for example through gum pockets on neighbouring teeth, and because they are hard to reach, the risk of severe inflammation is high.
The best time is between the ages of 14 and 20 – not too early and not too late. Before that, wisdom teeth are usually not properly formed. After that, the roots are fully developed, often lie close to the lower jaw nerve and increasingly fuse with the bone. Think of a plant: a small one is far easier to uproot than a tree with strong roots.
Procedure
- Preliminary consultation: we answer your questions and concerns and use X-rays to assess position, root shape and proximity to nerves and the maxillary sinus, with a 3D scan (CBCT) if needed.
- Anaesthesia: usually local; alternatively nitrous oxide or general anaesthesia, especially for anxious patients.
- Exposure: we lift the gum over the tooth and, if the tooth lies in the jaw, gently remove the covering bone with a fine surgical drill.
- Removal: depending on position and shape, the tooth is removed whole or in sections. Erupted wisdom teeth can often be extracted like normal teeth with forceps.
- Closure and check-up: we stitch the wound carefully and monitor healing.
Anaesthesia, duration and stitches
With local anaesthesia, given through a very fine needle, you feel no pain during the procedure – only slight, well-tolerated pressure. For general anaesthesia we have worked for many years with an experienced team of anaesthetists who are present throughout. You must not eat for 6 hours beforehand. All you feel is the small cannula in the crook of your arm; afterwards your lips, tongue and cheek stay slightly numb for a few hours, until the first painkiller you take at home works.
Depending on difficulty, the procedure takes 20–60 minutes. Teeth can be removed individually or one side at a time a few weeks apart – this is easier on you and limits chewing less. We mainly use self-dissolving sutures, so stitches usually do not need removing. As a rule, one check-up within three days is enough, with further visits only if needed.
After the procedure
The wound usually heals within about seven days. We can sign you off work for up to seven days, longer if needed. Have cold packs ready, arrange for someone to accompany you or a taxi, and plan time to recover.
- Cooling: cold packs reduce swelling and pain.
- Exercise: avoid sport and heavy physical work for at least 3–7 days.
- Food: soft food that is easy to chew for the first few days.
- Drinks: no alcohol, no caffeine, nothing hot.
- Oral care: after about 24 hours, brush your other teeth again but leave out the wound. Gently rinsing with cool water or a chlorhexidine solution can help.