When Should a Wisdom Tooth Be Removed?
A symptom-free wisdom tooth that harms nothing can be monitored; extraction needs a reason.
Indications for extraction
- Recurrent inflammation around the gum flap
- Causing decay or root resorption in the neighbouring molar
- Decay in the tooth or its surroundings
- A cyst or other pathology around the tooth
- Persistent trauma to the cheek or gum
- As required by an orthodontic plan
Pericoronitis — the usual complaint
A gum flap over a partly erupted tooth cannot be cleaned and shelters bacteria, causing recurrent pain, swelling, difficulty opening the mouth and bad taste. Acute infection is controlled first and extraction planned afterwards.
When monitoring is appropriate
Fully impacted teeth with no contact, pathology or symptoms can be monitored radiographically. However, bone becomes denser with age and healing slower, so delaying an indicated extraction usually makes it harder.
How the Procedure Is Performed
The procedure follows a plan and is completed painlessly under local anaesthesia.
Imaging and planning
A panoramic radiograph shows position, root form and relation to nearby structures. Where the roots appear close to the nerve canal, a CT scan locates it precisely. In the upper jaw the relationship with the sinus is assessed.
Anaesthesia and surgery
Under local anaesthesia the area is fully numb; pressure is felt but not pain. An incision is made, overlying bone removed if needed, and the tooth sometimes sectioned — a technique that spares surrounding bone rather than a sign of difficulty.
Other surgical procedures
Oral surgery also covers surgical extraction of retained roots, exposure of impacted canines for orthodontics, cyst removal, apicectomy, and bone grafting and sinus lift before implants.
Aftercare — The Key to Healing
Healing depends on protecting the blood clot in the socket; the first 24 hours are critical.
The first 24 hours
Bite firmly on the gauze for 30 to 45 minutes; slight oozing on the first day is normal. Do not rinse, spit, use a straw or smoke — all displace the clot.
What is dry socket?
If the clot is lost the underlying bone is exposed, typically causing severe pain radiating to the ear two or three days later that responds poorly to painkillers. Smoking and straws are the main risks; treatment relieves it quickly.
Managing swelling and pain
Swelling peaks on the second or third day. Cold packs help in the first 24 hours and warmth afterwards; sleeping with the head raised also helps.
When to call us
- Bright bleeding that does not stop despite pressure
- Pain increasing or suddenly worsening after the third day
- Swelling that affects swallowing or breathing
- Fever and general malaise
- Persistent numbness of the lip, chin or tongue
- Discharge and a bad taste from the area
Oral Surgery Procedures Beyond Wisdom Teeth
Oral surgery covers a wide field, from exposing impacted teeth to removing jaw cysts and preparing the mouth for prosthetic treatment.
Exposing impacted teeth to support orthodontics
After wisdom teeth, upper canines are the most commonly impacted. Rather than extraction, the tooth is surgically exposed and an orthodontic attachment bonded so it can be guided into the arch — planning is shared between surgeon and orthodontist.
Assessment of jaw cysts and lesions
Cysts within the jaw often remain silent and are found incidentally on radiographs, but they can displace roots and thin the bone. Management depends on type and size, and excised tissue is sent for pathological examination.
Preparatory surgery before dentures and implants
- Smoothing sharp bone ridges left after extractions
- Removing excess soft tissue that prevents denture seating
- Releasing a restrictive lip or tongue frenulum
- Removing retained root fragments
- Procedures that preserve bone volume in the extraction socket
- Imaging bone and nerve position before implant planning
- Adjusting gum level to suit the prosthetic margin
Possible Complications and How They Are Managed
Deviations from expected healing are uncommon, but they are much easier to manage when recognised early.
Dry socket (alveolar osteitis)
Loss of the blood clot exposes bone and causes throbbing pain radiating to the ear a few days after extraction, often with a bad taste. Smoking, rinsing early, straws and suction are common causes; treatment involves gentle irrigation and a medicated dressing.
Bleeding, swelling and limited mouth opening
Slight oozing in the first hours is expected; biting firmly on clean gauze for about half an hour usually stops it. Swelling peaks around the second or third day, and limited mouth opening after impacted tooth surgery normally resolves within days.
Signs that call for prompt assessment
- Bleeding that fills the mouth despite gauze pressure
- Swelling and pain that increase after the third day
- High fever, malaise or chills
- Difficulty swallowing or breathing — go to a hospital emergency department
- Swelling spreading towards the eye or neck
- Numbness of the lip, tongue or chin lasting beyond a week
- Air escaping through the nose or fluid from the extraction site

































































