Wisdom Tooth Extraction

In this section, we will cover:

Can I have my wisdom teeth removed?
What xrays do I need?
Do I need a 3D CBCT scan?
What are the risks?
Do I need to see a specialist?

This section will focus on the specifics of removing wisdom teeth. For general information about dental extractions, please see here for surgical procedure and here for aftercare advice.

Can I have my wisdom teeth removed?

Many young adults suffer with wisdom tooth pain and want to have them removed to prevent any future problems. As there are risks associated with removing wisdom teeth (which we will come on to later), there are certain guidelines which dentists in the UK follow.

Common reasons for removing wisdom teeth are:

2 or more episodes of pericoronitis, or 1 severe episode
Unrestorable decay or fracture
Wisdom teeth are difficult to restore as there is not enough space at the back of the mouth to fit the instruments needed.
Infected tooth with spreading infection
Untreated decay in a wisdom tooth can cause infection around the root of the tooth. If this infection is left untreated, it can start to spread, causing facial swelling and cellulitis (bacterial infection deep under the skin).

Other, less common, reasons for removing wisdom teeth are:

Disease of the follicle
The follicle is a balloon-like sac surrounding the crown of an unerupted tooth. Examples of diseases of the follicle include cysts and tumours.
If the tooth is impeding jaw surgery or in the field of a tumour resection

The guidelines do not recommend removing a wisdom teeth causing decay in the tooth in front (second permanent molar). However, in my experience, it is not always possible to access and treat the decay in the second molar without removing the wisdom tooth. If this is the case in your mouth, your dentist may offer to remove your wisdom tooth in order to save the tooth in front.

In general, it is accepted that removing wisdom teeth to correct crowding of your lower front teeth is not effective. For specific cases, some orthodontists may request that the wisdom teeth are removed to make space to move the teeth back and correct crowding.

What xrays and scans do I need?

Before any dental extraction, your dentist will want to see what the root of the tooth looks like, whether the tooth is impacted (stuck within the bone or behind another tooth) and where it is in relation to other structures in the mouth, such as the sinus and major nerves.

There are two types of xrays they can take for this:

Periapical xray
This is a type of "intra-oral xray". This means your dentist will need to place a small film, like a rectangle of stiff card, inside your mouth next to the tooth they want to see. Many people struggle to fit this film in their mouth for a wisdom tooth as it is so far towards the back of the mouth.
OPG (orthopantogram)
This is an xray which shows all the teeth, roots and bone. It uses a machine which rotates around your head so you don't have to put anything in your mouth. It is a good option for somebody with a gag reflex or very small mouth. Many dentists prefer to take an OPG when planning to remove wisdom teeth (you can see the wisdom teeth highlighted in red on the OPG below).

One of the most important reasons for having a dental xray before removing a lower wisdom tooth is so your dentist can see where the "inferior dental nerve" is in relation to your tooth. The inferior dental nerve runs along the lower jaw, close to the roots of the wisdom teeth, and supplies the "feeling" sensation to your teeth, gums, lip, chin and tongue on one side of the face.

Do I need a 3D CBCT scan?

If your xray shows the tooth is close to the inferior dental nerve, your dentist may refer you to a specialist who may suggest you have a CBCT.

A CBCT (short for "cone beam computerised tomography") is a 3D scan of the tooth and structures around it. It allows the dentist to see all the structures in 3D to get a true picture of the relation of the tooth to the nerve. It is similar to a medical CT scan but with a significantly lower radiation dose.

Not everybody needs a CBCT. Your dentist will only suggest one if they think it might change the final treatment plan.

If the CBCT shows the nerve is closely linked with the roots of your wisdom tooth, you may be offered a "coronectomy". This is a procedure in which the crown of the tooth is removed and the roots are buried under the gum. It is not routinely offered for decayed or infected teeth as there is a high risk of the roots becoming infected.

What are the risks?

Aside from the generic risks of a dental extraction (see here), there are specific risks of removing wisdom teeth.

For an upper wisdom tooth, the additional risks are:

Oro-antral communication
The roots of the upper wisdom teeth often sit quite close to the sinus. When a wisdom tooth is removed, a small hole can form between the sinus and the mouth. Usually this will heal by stretching the gum over the socket and placing some tight stitches to close the hole. Occasionally the hole will persist and a further procedure is needed to close it using some of the fat from inside the cheek.
Fractured bone
There is a small piece of bone behind the upper wisdom teeth called the "maxillary tuberosity". Due to the force needed to remove a wisdom tooth, this piece of bone can sometimes break when removing the tooth. This will usually also form an oro-antral communication. The main problem if this happens is if you ever lose all your teeth and need to wear a denture to replace them, the denture will not fit as securely.

For a lower wisdom tooth, the additional risks are:

Loss/altered feeling on one side of the mouth
The inferior dental nerve supplies feeling to the teeth, gums, lip, chin and tongue. If it is damaged, you may get temporary or permanent loss/altered sensation to these areas. As a general rule, if the feeling does not return within 12 months, the damage is likely to be permanent.

Although these areas will feel different to you, there will not be any weakness of the muscles. Having said this, you may find it difficult to speak/eat/play a woodwind instrument due to loss of feeling.
Loss of taste
The lingual nerve which runs along the jaw closer to the tongue which allows you to taste food/drink. If this nerve is damaged, it will affect how you are able to taste things. This may be temporary or permanent.

Do I need to see a specialist?

In most cases, if you have a partially erupted wisdom tooth which needs removing, you will be referred to an Oral Surgeon (a specialist in removing teeth amongst other oral surgical procedures).

You may be offered to have the treatment completed under local anaesthetic, sedation or general anaesthetic depending on the complexity of treatment and your level of anxiety.