Management

If the impacted tooth is completely embedded in the jaw bone, or if the partially erupted wisdom tooth has no discomfort and doesn’t cause any problem to adjacent tissues, it may not be necessary to remove it. However, one must keep good oral hygiene to prevent any problem. On the other hand, if the impacted wisdom tooth causes frequent discomfort or causes severe problems, it may have to be extracted.

Photograph of a totally impacted wisdom tooth inside the jaw bone.

Consider removal of impacted wisdom tooth

  • Severe problems associated with wisdom tooth
    • Frequent inflammation of gingivae covering the wisdom tooth causing recurrent Pericoronitis
    • Suffered from severe Pericoronitis
    • Severe decay, gum disease, pulpitis or periapical infections of wisdom tooth
    • Impacted wisdom tooth causing root resorption of adjacent teeth
    • Cyst around the wisdom tooth can damage the structure of jawbone.
      (If there is a cyst formation, the cyst together with the impacted wisdom tooth must be extracted.)
  • Prior to the following treatments
    • Extraction of mal-positioned wisdom tooth prior to orthodontic treatment
    • Radiotherapy
    • Jawbone reconstruction surgery

Procedures on surgical extraction of impacted wisdom tooth :

It has to take balance between the risks and benefits of the surgical extraction of tooth. In some cases, the impacted wisdom tooth is deeply embedded in the jaw bone and its roots are close to main nerve, surgical extraction may impose risk of damaging the nerve, leading to numbness of the mouth. Therefore, the decision on removal or not or when to remove the wisdom tooth is dependent on clinical situation.

The dentist will take radiographs to confirm the position and shape of the wisdom tooth, and explain to the patient on the situation, procedures and any risks. Usually, the procedures will be done under local anaesthesia (numbness of mouth only), but in some cases, it may be done under general anaesthesia or under sedation. The procedures should be painless.

There are five main steps:

  1. Raise the gum flap
  2. Remove the covering bone
  3. If needed, cut the tooth into few parts
  4. Rinse and clean the wound
  5. Close the wound with sutures, and stop the bleeding

One week after extraction, remove the sutures by the dentist who will check the healing of the wound. If the suture is of self dissolve type, then it is not necessary to remove the sutures by the dentist. However, it is still necessary to let the dentist to check the healing of the wound. In general, the wound will heal within 2 weeks.

To avoid bleeding from the wound after the surgical extraction of the wisdom tooth, you should pay attention to the followings :


  • On the same day after surgery
    • Do not disturb the wound, rinse the mouth or brush the teeth
    • Take soft diet for a few days and use the teeth of the opposite side of the jaw for chewing
    • Do not perform heavy work or strenuous exercise
    • Do not smoke or drink alcoholic beverages
  • On the following day after surgery
    • Resume gentle toothbrushing and chew normally

Reduce discomfort after surgical extraction of wisdom tooth

Wound pain, facial swelling and difficulty on mouth opening are common after surgery
  • On the day of surgery, apply ice pack to minimize facial swelling to the affected side of your face
  • On the second day, apply a warm towel to the swollen area to reduce discomfort
  • Maintain good oral hygiene to prevent wound infection
  • On day 3 or 4, continue to take soft diet. If there is pain from these wound ,take painkiller as prescribed by the dentist

Normally, any discomfort will slowly subside in a week after surgery. Meanwhile, consult your dentist if you have any queries.