Wisdom teeth removal

What it is

Wisdom teeth, also called third molars, usually come in between the late teens and mid-20s. A wisdom tooth can be impacted (stuck under the gum or in the bone), come in at an angle, or break through only partway.

Removing one is a kind of tooth extraction. Dr. Minici, a general dentist, removes some wisdom teeth. Teeth that are deeply impacted or close to the nerve in the lower jaw are often referred to an oral surgeon.

Who it helps

Wisdom teeth may need to come out if they cause:

• Pain or swelling at the back of your mouth
• Infection in the gum around a tooth that has partly come in
• Cavities in the wisdom tooth or the molar next to it
• Damage to the tooth in front, or a cyst (a fluid-filled sac) in the jaw

When problems are likely, many dentists suggest removal in the late teens or early 20s. The roots are shorter then, and healing tends to be easier.

What happens

1. Exam and X-rays. An X-ray of your whole jaw shows how each wisdom tooth is growing. If a root sits close to a nerve, a 3D scan may be suggested. You’ll decide together whether to remove the teeth and who will do it.
2. Getting ready. If you’ll have sedation, you’ll get instructions about eating beforehand, and you’ll need someone to drive you home. Plan to rest for a day or two.
3. Numbing. We numb the area, which feels like a pinch and then a spreading numbness in your jaw, lip, and tongue. Some people also have sedation to help them relax.
4. Removing the tooth. If the tooth is under the gum, a small opening is made. Sometimes the tooth is taken out in pieces. Most people feel pressure and pushing, not sharp pain.
5. Closing up. The gum may be closed with stitches, which often dissolve on their own. You’ll bite on gauze to help a blood clot form.

Recovery and aftercare

Most people feel like themselves again within a few days to a week. Swelling and jaw stiffness usually peak on the second or third day. Follow the instructions your dentist gives you.

• Bleeding. Bite on gauze for 30 to 45 minutes. Light oozing for a day is normal.
• Swelling. Ice your cheeks, 20 minutes on and 20 off, during the first day.
• Pain. Take pain relievers as directed.
• Food. Eat soft, cool foods like yogurt, eggs, and mashed potatoes for a few days.
• The clot. For 24 hours, don’t rinse, spit, or use a straw. Don’t smoke or vape for at least a few days.
• Cleaning. After 24 hours, rinse gently with warm salt water after meals.

Call the office if pain gets worse after the third day. Also call about heavy bleeding, a fever, a bad taste or smell, or a lip or tongue that’s still numb the next day. For trouble breathing or swallowing, call 911.

Cost and insurance

The cost depends on how many teeth are removed, how deeply they’re impacted, whether you have sedation, and the X-rays or scans needed. If an oral surgeon removes them, that office bills for its part.

Dental plans often cover part of the cost when removal is needed for your health. Financing can spread the cost; see insurance and financing.

Alternatives

• Watching them. If your wisdom teeth are healthy, your dentist may suggest checking them at regular visits. Problems can still show up later, when removal may be harder.
• Removing only the problem teeth. You don’t always need all four out at once.
• Treating an infection first. A gum infection around a wisdom tooth can sometimes be calmed with cleaning and antibiotics, but it often comes back.
• Leaving the roots. When a root sits very close to a nerve, an oral surgeon may remove only the top of the tooth. The roots stay in place, which protects the nerve.