Wisdom Teeth Explained

Do Wisdom Teeth Always Need to Come Out?

No. Wisdom teeth, the third molars, usually appear between the late teens and mid-twenties, and many people have enough room for them to come through and work normally. Others have teeth that stay buried in the jaw and never cause a problem.

UK guidance from NICE is clear that healthy wisdom teeth should not be removed just in case they cause trouble later. Every extraction carries some risk, so the benefit has to outweigh it. Removal is recommended when there is a clear problem. Typical reasons include:

• Repeated or severe infection of the gum over the tooth
• Decay in the wisdom tooth that can't sensibly be repaired
• Decay or damage in the tooth in front caused by the wisdom tooth
• Gum disease around the wisdom tooth or the tooth in front
• A cyst, tumour or other disease around the tooth
• Abscess or infection of the tooth itself

A wisdom tooth may also be removed for another planned treatment, such as jaw surgery. Our extractions and wisdom teeth page summarises the options.

Why Do Wisdom Teeth Cause Problems?

As the last teeth to arrive, wisdom teeth often meet a jaw that has run out of space. A tooth that can't come through fully is called impacted. It may be tilted forwards into the tooth in front, lying on its side, or only partly through the gum.

A partly erupted tooth is the most likely to cause trouble. It leaves a flap of gum over part of the tooth and a pocket that is very hard to clean, sitting right at the back of the mouth where a toothbrush rarely reaches. Food and bacteria collect there, and that's where most wisdom tooth problems start.

A wisdom tooth that is fully buried in bone and covered by healthy gum, by contrast, usually has nothing to trap food against and often causes no problems at all.

Signs of Trouble to Look Out For

Pericoronitis is the most common problem. It's an infection of the gum flap over a partly erupted wisdom tooth. Signs include:

• Pain and swelling at the back of the mouth
• A bad taste or smell
• Difficulty opening your mouth fully
• Pain when you bite, often because the upper tooth bites down on the swollen gum
• In more severe cases, swelling of the face, swollen glands or a temperature

Mild pericoronitis often settles with careful cleaning and warm salt-water rinses. Antibiotics are only needed if infection is spreading. One episode doesn't automatically mean the tooth must come out, but repeated or severe episodes usually do.

Decay can affect the wisdom tooth itself, or, more importantly, the back of the tooth in front. When a wisdom tooth leans into its neighbour, the gap between them traps food, and decay can develop in a spot that's difficult to fill. This damage to the second molar is often painless until it's advanced, which is why we look for it on X-rays.

If you have rapidly increasing facial swelling, difficulty swallowing or trouble breathing, seek urgent medical help straight away. For pain or swelling without those signs, contact us for an emergency appointment.

How Is a Wisdom Tooth Assessed?

The decision starts with an examination and an X-ray. A large X-ray that shows the whole jaw lets us see how the wisdom tooth is angled, how deep it sits, the shape of its roots and its relationship to the tooth in front.

In the lower jaw, the inferior alveolar nerve runs through the bone beneath the teeth. It gives feeling to the lower lip, chin and teeth on that side. Close by is the lingual nerve, which supplies sensation to the tongue. If the X-ray suggests the roots are very close to or crossing the nerve canal, a flat image isn't enough to judge the risk.

That's when a 3D CT scan helps. Our on-site cone beam CT scanner shows exactly where the nerve runs in relation to the roots, from every angle. It lets us plan the safest approach, and sometimes shows that a different technique would be wiser. A CT scan is £160, and we only recommend one when it will change the plan.

What Happens on the Day of Removal?

Most wisdom teeth are removed under local anaesthetic at the practice. You'll be awake but the area will be completely numb, so you should feel pressure but not pain.

Upper wisdom teeth are often straightforward and can come out much like any other tooth. Lower ones, or teeth that are impacted, usually need a surgical extraction:

1. A small flap of gum is lifted to see the tooth.
2. A little bone around the tooth may be removed.
3. The tooth is often divided into sections so it can be taken out with less force and less bone removed.
4. The socket is cleaned and the gum is closed with a few stitches, which may dissolve on their own.

The procedure itself commonly takes between 20 minutes and an hour, depending on the tooth. We'll go through the plan, the risks and your aftercare before we start, and you can ask questions at any point.

When Might Sedation or Another Approach Be Better?

If you're anxious, or the extraction is likely to be long, IV sedation is available at our Comely Bank practice. A sedative given through a fine tube in your arm or hand leaves you deeply relaxed and drowsy, though still able to respond. Many people remember very little afterwards. You'll need someone to take you home and stay with you for the rest of the day. Our sedation page explains how it works.

Coronectomy is an option for some lower wisdom teeth whose roots are intimately wrapped around the nerve. The crown of the tooth is removed and the roots are deliberately left in place, which reduces the risk of nerve injury. It isn't suitable if the roots themselves are infected, and occasionally the roots move later and need removing. We'll discuss whether it applies to you.

Some cases are best treated in hospital, for example when a general anaesthetic is needed or the tooth is especially complex. If so, we'll tell you and arrange a referral.

What Are the Risks?

Most wisdom tooth extractions heal without lasting problems, but you should know the possible complications before agreeing to treatment:

• Pain, swelling and bruising, usually worst over the first two or three days
• Dry socket, when the blood clot is lost from the socket, causing a deep ache a few days after the extraction; it's more common in smokers and is treated with a soothing dressing
• Infection, which is uncommon
• Nerve injury, causing tingling or numbness of the lower lip, chin or tongue on that side. This is usually temporary and recovers over weeks or months; permanent changes are uncommon, and the risk is higher when the roots are close to the nerve
• Damage to the tooth in front or to fillings, which is rare

For upper wisdom teeth, there's a small chance of an opening into the sinus above the roots, which usually heals with simple care. We'll tell you how these risks apply to your tooth, using the X-ray or CT scan to explain.

Recovery: What the First Week Looks Like

The first day: bite on gauze to help a clot form, avoid rinsing, keep to soft cool food and rest. Take painkillers as advised before the numbness wears off.

Days two and three: swelling and stiffness usually peak. Begin gentle warm salt-water rinses after meals, and keep brushing your other teeth carefully.

By the end of the first week: most people feel much better and are back to normal eating, although the socket takes several weeks to fill in completely.

To help healing, avoid smoking or vaping for as long as you can, ideally at least a few days, because it increases the risk of dry socket. Skip alcohol and strenuous exercise for the first day or two. Many people take a day or two off work, more after a difficult extraction or sedation.

Call us if pain is getting worse after day three, swelling is increasing, you have a temperature or bleeding won't stop with firm pressure. Our aftercare page has full instructions.

What Does Wisdom Tooth Removal Cost in Edinburgh?

At Comely Bank Dental, fees for wisdom teeth are:

• Surgical or wisdom tooth extraction: £450
• Routine extraction, for a wisdom tooth that is fully through and straightforward: £170
• 3D CT scan, if needed to assess the nerve: £160

We'll confirm the fee in a written treatment plan after your assessment, so you'll know the cost before treatment starts. Sedation, if you choose it, is quoted separately. Members of our dental plan save 10% on most private treatment.

Questions

This guide is general information, not a diagnosis. A dentist needs to examine you to say what is right for your teeth.