The wisdom tooth (or third molar) removal is one of the common oral surgical procedure. It is usually the last tooth to erupt in the mouth anytime after 16 years of age. Frequently there is not enough room to accommodate wisdom teeth and as such they do not come into the mouth normally. When this happens, the wisdom teeth are said to be “impacted”. Wisdom teeth are usually either impacted forwards into the tooth in front or backwards into the jaw bone.

An impacted wisdom tooth is usually removed if they cause problems. This commonly includes:

• Repeated attacks of  infection in the gum surrounding the tooth  leading to pain and swelling
• Food packing between the partially erupted wisdom tooth and the tooth in front.
• Caries of wisdom tooth or causing caries of the tooth in front
• Cysts can form around the wisdom tooth.
• Other pathology like cyst formation etc

Since the wisdom tooth has not fully erupted into the mouth it is often necessary to make a cut in the gum over the tooth. Sometimes it may be necessary to remove some bone surrounding the crown of the wisdom tooth. Rarely the tooth needs to be cut into pieces to remove it. Once the wisdom tooth has been removed the gum is put back into place with stitches. These stitches usually dissolve in around two weeks.

It depends on difficulty and patients choice.

• ⦁ Local anaesthetic – this is an injection in the mouth, similar to that you may have had at your dentist for a filling. The injection takes a couple of minutes to numb the area and means that you will feel no pain while the wisdom tooth is removed. This is the best option for wisdom teeth that are simple to remove.
• ⦁ Local anaesthetic and intravenous sedation – in addition to a local anaesthetic injection you can be given an injection into your arm. This makes you feel relaxed and less aware of the procedure.
• This means you are put to sleep during the procedure. It is usually possible to be done as a “day case” procedure, ie you will be able to go home on the same day as surgery.

This is a variable, depending on the difficulty and number. Some wisdom tooth may take only a few minutes to remove. More difficult ones that need to be cut into pieces can take around 20 -40 minutes to remove.

• Bleeding: Usually rare. However blood tinged saliva may cause concern to some patients. If it does bleed when you get home, you can usually stop it by applying pressure over the area for 10 to 20 minutes with a rolled up handkerchief or swab given by the hospital. If the bleeding does not stop, please contact the department
• Infection:  is uncommon particularly if antibiotics are used. Delayed healing is common especially if you smoke.
• Nerve damage: There are two nerves that lie very close to the lower wisdom teeth. One  supplies feeling to your lower lip, chin and lower teeth. The other supplies feeling to the tongue and helps with taste. Sometimes these nerves may be bruised (10%) causing tingling or numbness in your lip, chin or tongue, and more rarely altered taste. This usually recovers completely. Less than 1% will have permanent problems. These risks may be higher if the wisdom tooth is in a difficult position and the roots are close to the nerve. This will be discussed during the initial consultation
• Stiffness of mouth opening: last for few days. Painkillers and anti-inflammatory will be helpful.

It is likely that there will be some discomfort and swelling both on the inside and outside of your mouth. There may be some bruising of the skin of your face.This is usually worse for the first couple of days, but it may take up to two weeks for complete recovery. You may also find that your jaw is stiff and you may need to eat a soft diet for a week or so. Regular pain killers and anti-inflammatory will be helpful for the first few days. It may also be necessary to have a course of antibiotics after the extraction.

It is important to keep the extraction sites as clean as possible during the healing period. It may be difficult to brush your teeth around the sites of the extraction as it may be sore. It may therefore be useful to gently rinse with a mouthwash or warm salt water (dissolve a flat teaspoon of kitchen salt in a cup of warm water). This should be commenced after 24 hrs.

It may vary from few days to a week depending on how you recover and also the type of anaesthetic used. You should also avoid strenuous exercise during this time. Depending on the type of anaesthetic used you will not be able to drive (24 hours after intravenous sedation and for 48 hours after a general anaesthetic)