Introduction

Wisdom teeth are the last of the adult teeth to come through the gum, usually between the ages of 18-25. Some people never develop any wisdom teeth whilst others develop one wisdom tooth in each of their four dental arches.


The impacted wisdom tooth

Through evolution and dietary changes in humans over thousands of years, the human jaw has gradually become smaller, resulting in insufficient space being available in the jaws for the last tooth to erupt (i.e. the wisdom tooth).

When there is not enough space available in the jaws for the wisdom teeth to erupt in a straight fashion, they become impacted.

Impacted wisdom teeth can cause food and bacteria to stagnate around the gum overlying them (called operculum) and this leads to the gum (operculum) becoming swollen. Pain, gum infection, Bad breath and soreness of the jaw can then begin as the problem worsens.


Types of impacted wisdom tooth:

If you suffer from an impacted wisdom tooth, its likely to be one of the following four types.
  • Mesial impaction - the most common type seen, This type occurs where the wisdom tooth grows at a roughly 45 degrees angle towards the tooth in front.
  • Vertical impaction - This occurs when the wisdom tooth grows straight down but gets stuck against the tooth next to it
  • Horizontal impaction - the wisdom tooth grows at a 180 degrees angle and horizontally pushes against the tooth in front
  • Distal Impaction - the wisdom tooth grows backwards and impacts against the jaw bone behind itself.



When do we extract a wisdom tooth?
  • Repeated episodes of Pericoronitis – This is where there is repeated infection of the gum (operculum) overlying the wisdom tooth caused by plaque and bacteria stagnating between the operculum and the wisdom tooth below it.
  • Cavities - Decay can form on the wisdom tooth itself and also form on the tooth in front due to the patient having difficulty in cleaning their teeth through poor access.
  • Gum disease – Poor cleaning due to difficulties of access can lead to gum inflammation at first which can be followed by gum disease. Gum disease bacteria can spread to the teeth in front and lead to them losing bone and becoming loose.
  • Cysts – The bone tissue surrounding the impacted wisdom tooth can become infected, leading to the formation of a fluid/gas/solid sac also known as a cyst. Cyst formation damages the neighboring bone and if a Large cyst forms, it will need cyst enucleation as well as wisdom tooth removal.


Treatment options for an impacted wisdom tooth:
  • No treatment – for impacted teeth causing no problems this is the best option.
  • Antibiotics – for situations where pus has formed, antibiotics provide temporary relief.
  • The surgical removal or extraction of the impacted wisdom tooth – Where the wisdom tooth has caused infection, cyst formation, tooth decay or gum disease around itself, the extraction of the tooth is the best choice.
  • Cutting back the surrounding gum (operculum) tissue – If pain is caused as a result of the impacted teeth pressing into the overlying gum, an operation to cut back the operculum gum is sufficient. However this gum may re grow and may not be a definitive solution.
  • Coronectomy - This is a technique that involves removing the crown of the wisdom tooth but leaving its roots inside the jaw. This technique is useful when there is a risk of nerve damage if the roots are removed. However this technique can not be used in all cases.


What are the NICE guidelines regarding removal of wisdom tooth?


The National Institute for clinical excellence (NICE) is an organisation consisting of experts that make recommendations to the health professional on best clinical practice. They investigated wisdom tooth management and made recommendations that we at Pearl Dental Clinic follow.



NICE recommendations on wisdom teeth state:
  • Impacted wisdom teeth that are free from disease (healthy) should not be operated on. There are two reasons for this:
    • There is no reliable research to suggest that this practice benefits patients
    • Patients who do have healthy wisdom teeth removed are being exposed to the risks of surgery. These can include, nerve damage, damage to other teeth, infection, bleeding, and, rarely, death. Also, after surgery to remove wisdom teeth, patients may have swelling, pain and be unable to open their mouth fully.
  • Patients who have impacted wisdom teeth that are not causing problems should visit their dentist for their usual check-ups.
  • Only patients who have diseased wisdom teeth, or other problems with their mouth, should have their wisdom teeth removed. Examples include untreatable tooth decay, abscesses, cysts or tumors, disease of the tissues around the tooth or where the tooth is in the way of other surgery.


So what we can do for you if you need your wisdom tooth removed:


We first do an examination of your wisdom tooth and usually take a panoramic X-ray of the jaws to show the wisdom tooth and its proximity to Inferior Dental (ID) nerve. The ID nerve is the nerve that supplies sensation to the lower lip and chin and can sometimes be very close to the roots of the lower wisdom teeth.
We will then advise you on the type of your wisdom tooth impaction and the procedure for removing it as well as any risks and complications involved.


Wisdom tooth Surgery:

1. We usually do all our wisdom teeth extractions under Local anaesthesia with or without specialist anaesthetist sedation. We do not carry out any extractions under General anaethesia as this type of anaesthetic carries a higher risk of complications.

2. Once the area is very numb, we push the gum back so that we can access the wisdom tooth. If the tooth is easily accessible, then we simply elevate the tooth out.

3. Sometimes, we shave a little bone around the wisdom tooth and split the wisdom tooth into bits in order to remove it.

4. Finally we close the gum back to where it should be with self dissolving sutures. The whole procedure is carried out inside of the mouth so that there are no scars left on the outside skin.


What can be expected after wisdom tooth surgery:

There may well be some pain, swelling, bleeding, soreness of the jaws and muscles of the mouth following wisdom tooth removal.
If necessary, we may prescribe chlorhexidine disinfectant mouthwash and antibiotics and pain killers to combat these problems.



Do's and Dont's after wisdom tooth removal:
  • There may be bleeding from the socket, apply a clean gauze or a clean handkerchief to the top of the extraction site and apply pressure by biting on it. The pressure usually stops the bleeding.
  • If there is profuse bleeding form the socket you will need to come back to see us. Putting an extra pillow underneath your head at night, encourages the blood to go to your lower limbs rather than the extraction site.
  • There can be some pain afterwards from the surgical site. The extent of the pain can depend on the complexity of the surgery and the inflammation that it creates. Make sure you have some Neurofen plus and paracetamol at home (subject to no allergies) to relive the pain that you may have.
  • There may be tingling sensation in the lips and tongue which in most cases eventually disappears. If this sensation persists, please come back to see us.
  • Avoid exercise for a few days and avoid hot drinks for 24 hours. Eat a soft diet for a few days.
  • After 24 hours has passed, gently rinse your mouth with salt water or mouthwash. Avoid rinsing in the first 24 hours as this can break the fragile blood clot and cause further bleeding.
  • Avoid smoking for 1 week post surgery. Smoking after surgery increases the risk of dry socket which can be very painful.
  • If resorbable sutures have been uses, they usually resorb after 2-3 weeks by themselves. Otherwise, you will have to come back to see us for the suture removal.

Risks and Complications of surgery:

1. Common complications of bleeding, infection, allergic reaction to anaesthetic or antibiotics can occur with any oral surgical procedure. We will be able to manage these easily should they arise.

2. Dry socket can occur after any extraction and this is when a blood clot lying inside the socket is lost too early and so the bone underneath is exposed to saliva and air. Dry socket is a very painful occurrence that usually starts around 3 days after extractions and can last for 7 days or so. Dry socket delays healing and makes the healing procedure a more painful affair. Should dry socket arise, we will place a sedative dressing over the socket every day or two until the socket forms its own lining.
Please reduce the risk of dry socket by not smoking for 1 week post extractions.


Complications more specific to wisdom teeth removal:
Temporary or Permanent Paresthesia - The Inferior Dental Nerve and the lingual nerve that lie very close to the lower wisdom tooth roots can be damaged during wisdom tooth extractions.

We will always warn you if the risk of nerve damage is high at your initial consultation visit. Damage to this nerve can result in temporary numbness or “pins and needles” in the tongue, lower lip or lower jaw.

There is also risk of the pins and needles sensation becoming permanent in certain rare cases. Repair surgery can be carried out to repair the nerve damage but the success rate is limited.

Accidental damage to other teeth during the extraction of the wisdom tooth is rare but can occur in some cases.

Our Location

Pearl Dental Clinic is based in Kingston Vale, London SW15 close to the A3. Please Click here to see our location map and find directions to our clinic. There are always lots of free parking spaces available in front of our clinic or in the neighboring Robin Hood Lane. Buses 85 and K3 stop near the practice and come down from Kingston and Putney. The practice is based outside of the London Congestion Charge Zone.


Contact Us

The clinic is open Seven days a week. Weekend and late evening wisdom tooth extraction appointments are available. You can book a wisdom tooth consultation by calling our reception team on 0208 547 9997 or by email.



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