Wisdom Teeth and Impactions

What impaction means

An impacted wisdom tooth is one that cannot fully erupt into a normal, functional position because there is insufficient space at the back of the jaw, or because it is angled against the neighbouring tooth. Impaction can be partial, with part of the tooth visible through the gum, or complete, with the tooth entirely covered by gum and bone.

When removal is indicated

Recurrent pericoronitis, a gum infection over a partly erupted tooth causing pain and swelling, decay in the wisdom tooth or in the molar immediately in front of it, cyst formation around an impacted tooth, persistent pain, or crowding pressure on neighbouring teeth are the usual indications for removal.

An asymptomatic wisdom tooth that is fully erupted, correctly positioned and easy to keep clean may simply be monitored with periodic review rather than removed, since surgery is only recommended where a clear benefit outweighs the procedure itself.

The procedure

A cone-beam CT scan shows the precise relationship of the wisdom tooth roots to the inferior alveolar nerve in the lower jaw or the maxillary sinus in the upper jaw, allowing the surgical approach to be planned with confidence beforehand. Removal is carried out under local anaesthesia, with sedation available for anxious patients or more complex cases.

Most surgical extractions take twenty to forty minutes per tooth. The gum may need a small incision and, occasionally, removal of a small amount of surrounding bone to allow the tooth to be delivered safely, particularly when it is angled or fully buried.

Recovery

Swelling typically peaks around forty-eight hours after surgery and settles gradually over three to five days. Cold compresses applied intermittently on the first day, a soft diet for the first few days, taking prescribed medication as directed, and avoiding smoking or drinking through a straw all help protect the healing blood clot in the socket.

Sutures, where placed, are usually reviewed and removed after about a week if they are not the dissolvable type. Most people return to normal work or study within two to four days, though full soft tissue healing takes several weeks.

Possible complications and how they are minimised

Dry socket, where the healing blood clot is dislodged prematurely, causing delayed and painful healing, is the most common complication and is reduced significantly by following aftercare instructions closely, particularly avoiding suction actions such as smoking or straw use.

Temporary altered sensation of the lip, chin or tongue can occur where the tooth roots lie very close to a nerve, though this is uncommon with careful pre-surgical planning using three-dimensional imaging and usually resolves over weeks to months when it does occur.