Wisdom teeth

Also known as third molars

Wisdom teeth are the teeth right at the back of your mouth. They are usually the last teeth to come through. There isn't always enough room in the mouth for them to grow properly, and this can cause can cause dental problems.

Key points

  1. Most people have 4 wisdom teeth, one in each corner of the mouth, although not everyone develops wisdom teeth. 
  2. They usually grow through your gums between the ages of 17 and 25, supposedly a sign of your growing wisdom!
  3. By the time they emerge, the other 28 adult teeth are usually in place, so there isn't always enough space in the mouth for the wisdom teeth to grow properly.
  4. Because of the lack of space, they can come through at an angle or get stuck and only partially emerge. Wisdom teeth that grow through like this are known as impacted.
  5. Your wisdom teeth usually don't need to be removed unless they're impacted and are causing problems.

When should I see a dentist?

undefinedIf you have no pain or any other problems with your wisdom teeth, continue with your usual oral health care and dental visits.

If you have pain or infection, make an appointment to see your dentist as soon as possible. They may take an X-ray of your mouth to give a clearer view of the position of your teeth.

Do I need to get my wisdom teeth removed?

If they are not causing you any problems, there is usually no need to get your wisdom removed. However, you may not notice some problems, such as decay, so it’s important to see your dentist regularly.

If it’s likely that your wisdom teeth will cause problems in the future, your dentist may recommend you have them removed before you experience problems. It is also easier to remove wisdom teeth when you are younger as bone is less flexible and healing is slower in older people. 

If your wisdom teeth are to be left in place, but are at risk, you will need to get your teeth checked regularly.

When should I get my wisdom teeth removed? 

Your wisdom teeth usually don't need to be removed unless they're impacted and causing problems. Some problems associated with wisdom teeth can be managed with antibiotics, antiseptic mouthwash, and by keeping the area very clean. 

Your dentist may recommend having your wisdom teeth removed if you develop:

  • tooth decay
  • abscesses (pus in your wisdom teeth or the surrounding tissue)
  • an infection of your gum caused by an erupting wisdom tooth (pericoronitis)
  • periodontal (gum) disease, such as pericoronitis, or an infection of your connective tissue (cellulitis
  • an infection of your bones (osteomyelitis)
  • cysts or tumours involving the tooth
  • teeth that obstruct other surgery
  • or, if you plan to travel in less-developed countries for an extended period of time. 

What is the procedure for extracting wisdom teeth?

Wisdom tooth removal may be a simple or a complicated procedure, depending on the position of your teeth:

  • Routine, uncomplicated removal of a single wisdom tooth can usually be done in your dentist’s surgery, using a local anaesthetic.
  • Less routine removal may require the use of a sedative combined with a local anaesthetic. Certain dentists are qualified to use sedation in their surgery.
  • Complicated surgery, or the removal of a number of wisdom teeth, may require a general anaesthetic. This must be done in a fully equipped operating theatre, with an appropriately qualified surgeon, anaesthetist and theatre staff.

Usually having anaesthesia is safe and major problems are rare. However, there are some risks associated with having a general anaesthetic for very young children, older adults and people with other health problems. Find out more about anaesthesia.

What should I expect after surgery?

As with any surgical procedure, you are likely to have some swelling, bleeding, bruising and discomfort after having your wisdom tooth extracted. You may also have some temporary numbness of your tongue, lip or chin, which in rare cases can be permanent.

When removing an impacted wisdom tooth, it may be necessary to make a cut in your gum, remove bone and cut the tooth into pieces in order to remove it. You may be left with sutures (stitches) after the extraction (unlike in other dental extractions).

What are the risks of wisdom teeth extraction?

As removal carries some risk of complications, your dentist will weigh up the risks and benefits and advise you of the best course of action.

Specific risks of having wisdom teeth removed include:

  • Infection of the soft tissue or underlying bone. Signs include a high temperature, yellow or white discharge from the extraction site, and persistent pain and swelling.
  • Haemorrhage (bleeding).
  • Dry socket. This is a painful condition that occurs more often with tooth extractions in the lower jaw and in people who smoke. With dry socket, no blood clot forms (or it is washed away by rinsing too early) and the normal healing process is prevented
  • Trismus (lockjaw). This is a painful condition in which the chewing muscles of your jaw become contracted and sometimes inflamed, preventing your mouth from fully opening.
  • Nerve damage. This can occur in your tongue, lip or chin as tingling or numbness. In rare cases, this can be permanent or long-term. 

See your dentist if you have signs of infection after having your wisdom teeth removed, or if you're bleeding heavily from the extraction site.

What self-care can I do to help recover from wisdom teeth removal?

The risks associated with wisdom teeth extraction are increased through stress, poor oral hygiene and getting an upper respiratory tract infection. You can reduce these risks by taking the following steps:

  • Take time off work or study to recover.
  • Rest for the first 24 hours – overexerting yourself can put pressure on the surgery site and increase pain and bleeding.
  • Keep the area around the extraction clean – follow your dentist’s advice.
  • Avoid chewing on the surgery site for 24 hours try switching to a soft diet for a few days.
  • Avoid smoking, which promotes bleeding and slows healing.
  • Avoid alcohol as this can promote postoperative bleeding.
  • Avoid sucking or spitting as this can promote bleeding and dislodge the blood clot, which may lead to dry socket.
  • Control swelling by using an ice pack.
  • Manage any pain with an anti-inflammatory medication such as ibuprofen (not aspirin, which can increase bleeding).
  • After 24 hours, start regular, gentle rinses of your mouth with a warm saline (salt water) solution, if recommended by your dentist.
  • Contact your doctor or dentist if you develop any unusual bleeding, swelling or pain.

How do I prevent wisdom teeth problems? 

To prevent tooth decay, pain and infection, take extra care of wisdom teeth that have not fully come through.

  • Floss between all your teeth, especially between the wisdom teeth and the teeth in front of them.
  • Ensure that your brush reaches all the way to the back when brushing your teeth.
  • Rinse with a saline solution (salt dissolved in warm water) if you have any early signs of infection, such as redness, heat or tenderness in the area. 

What if I cant afford to have my wisdom teeth extracted?

People on low incomes who have a Community Services Card may be able to get free emergency dental care, such as pain relief or extractions. These services are provided by public hospitals or dentists contracted by your district health board. You can find out who provides this service by phoning 0800 TALK TEETH/0800 825 583.

You may still need to pay some of the treatment cost, and you may only get support for an infection but not for extraction. Find out more at Dental treatment Work and Income, NZ, 2018.

Learn more

The following links provide further information about wisdom teeth. Be aware that websites from other countries may have information that differs from New Zealand recommendations.   

Wisdom tooth extraction Mayo Clinic, US, 2012
Impacted wisdom teeth – do I need them removed? Mayo Clinic, US, 2014
Wisdom teeth Patient Info, UK, 2015
Your oral health – teens Healthy Smiles, NZ

References

  1. Surgical removal versus retention for the management of asymptomatic impacted wisdom teeth. Mettes TDIRKG, Ghaeminia H, Nienhuijs MEL, Perry J, van der Sanden WJM, Plasschaert A. Cochrane Database of Systematic Reviews 2012, 6, Art. No. CD003879.
  2. Wisdom teeth removal NHS, UK, 2015
  3. Publicly funded dental care Ministry of Health, NZ, 2017
  4. Wisdom tooth removal – complications NHS, UK, 2018

Reviewed by

Associate Professor Jonathan Broadbent is an Associate Professor in Dental Public Health, Department of Oral Sciences, University of Otago. He is a dental public health specialist.
Credits: Health Navigator Editorial Team. Reviewed By: Jonathan Broadbent, Associate Professor in Dental Public Health, Department of Oral Sciences, University of Otago