Wisdom tooth extractions / Impacted wisdom teeth.

This page provides information about the process that's used when a wisdom tooth, either erupted or impacted, is removed.

A) Factors that can influence how difficult a wisdom tooth's extraction will be.

1) Tooth position.

A great deal of the difficulty associated removing a wisdom tooth will have to do with the way it's positioned in the jawbone.

In general, the more normal the alignment of the tooth, and the further through the gums it has been able to erupt, the less involved its extraction and subsequent healing process will be.

Dentists typically use a panoramic x-ray to evaluate the shape and positioning of a patient's wisdom teeth (like the one shown to the right).

Rules of thumb.

• You can expect that erupted wisdom teeth will be easier to extract than impacted ones.
• Soft-tissue impactions are typically less involved than bony ones.
• Vertical and mesial impactions are usually easier to remove than distal and horizontal ones.

(For diagrams illustrating these various alignments, see our types of impactions page).

2) Tooth shape.

Wisdom teeth have multiple roots. (Lower wisdom teeth typically have two roots whereas upper wisdom teeth usually have three.) And there can be quite a bit of variation in the way these roots are shaped.

In some cases, each root will be separate and distinct. In others, they may be fused together (fully or partially) or have an irregular shape or curvature. These anatomical variations will affect the relative ease with which the tooth can be removed.

Rules of thumb.

If the "average" wisdom tooth extraction is one where the tooth's roots are relatively straight, distinct and separate. In comparison:

• Teeth with fused roots (partial or fully) are often easier to extract (this is especially true for upper third molars).
• As you might expect, teeth that have roots that have an irregular shape or curvature can be more difficult to remove.
• Teeth with fully formed roots are typically more difficult to remove than those with partially developed ones. (The ideal age for wisdom tooth extraction is partially based on this factor.)

B) The extraction process.

1) Wisdom tooth extractions can be comparatively simple.

You don't have to expect the worst. Some wisdom teeth are no more difficult to remove than any other tooth. And in some cases (such as with a fully erupted upper third molar having fused roots) easier.

As part of your pre-extraction examination, your dentist should be able to give you an idea of what to expect.

(This page outlines the steps that take place during the typical extraction procedure.)

2) Some wisdom teeth will need to be removed "surgically."

A dentist will, of course, need to have access to the tooth they're extracting.

If it lies impacted within the jawbone, or is even just covered (fully or partially) by gum tissue, the dentist will need to perform what's termed a surgical extraction (the process used to reflect back and/or remove these obscuring tissues).

3) Sectioning wisdom teeth.

A dentist can minimize the amount of bone that must be removed to get a tooth out by cutting it into pieces.

Since each individual part is smaller than the tooth as a whole, they can be removed through a smaller access opening. This procedure is termed "sectioning" a tooth.

C) Anesthetic - Numbing up the tooth.

Before a wisdom tooth is extracted, the tooth and its surrounding tissues must be numbed so the patient won't feel any pain. Dentists numb teeth using "local" anesthetic. It's administered by way of giving an injection (a "shot").

Numbing up a wisdom tooth for extraction really isn't all that much different, or worse, than having one numbed before a filling is placed. Although, to adequately anesthetize both the tooth and its surrounding gum tissue, more than one injection will probably be given.

(Related content: Will my dental injection hurt?)

D) Conscious Sedation - Placing the patient at ease.

Some people may have apprehensions about their upcoming wisdom tooth extractions. And in these cases, the dentist and patient may decide that the use of sedation technique is needed to control their anxiety.

Conscious sedation refers to the use of medication that causes the patient to become very relaxed or drowsy. The patient is still awake, in the sense that they are responsive to stimuli (therefore the use of a local anesthetic is still required), and all of their protective reflexes are functional.

The benefit of this technique is that it makes the surgical procedure more pleasant/tolerable for the patient.

Choose sedation for the right reasons.

• Conscious sedation is used to control anxiety, not pain. Beyond just administering the sedative, your dentist will still need to numb up your tooth using a local anesthetic (see above) so you won't feel pain during your procedure.
• The use of any medication involves risk. And for that reason, when one is administered it should be for good reason. If you're not convinced you need a sedative, ask your dentist why they think you do. The patient cooperation that a sedative can provide can make an extraction go easier and more quickly. But in some cases it may be utilized simply as a convenience or additional billable service for the dentist.

Listed below are some of the ways dental sedatives are administered.

1) Nitrous oxide / Laughing gas.

Nitrous oxide is often referred to as "laughing gas." It produces its calming effect as a patient breathes it. The gas's effects appear quickly and, once the patient stops breathing the gas, they disappear fairly rapidly also.

Precautions.

Your dentist will need to give you specific instructions, but in most cases a patient will be capable of driving home after having nitrous oxide sedation.

2) Oral Sedatives.

"Oral" sedatives are medications that are taken by-mouth (you swallow a liquid or pill). One common dental oral sedative is Valium.

Precautions.

Your dentist will provide you with the instructions that you need, and you must follow them. In most cases, a patient is instructed to take their oral sedative about one hour before their dental appointment.

Because this type of medication can make you drowsy and also affect your behavior and ability to function, when it's taken you must have someone who can monitor you and drive and escort you to and from your dentist's office.

3) Intravenous sedatives.

Intravenous sedatives are administered by way of injecting them into one of your veins ("I.V."). In general, a deeper and more controlled level of sedation can be achieved when using intravenous sedatives as opposed to nitrous oxide or oral sedatives.

Intravenous sedatives are more likely to be administered by an oral surgeon, as opposed to a general dentist, because they have the specialized training and monitoring equipment that's need when these types of medications are used. Some intravenous sedatives produce an "amnesic effect," meaning that the patient has little or no memory of the dental procedure that has taken place.

Precautions.

Your dentist will need to provide you with instructions and it's very important that you follow them. They usually include rules about not eating or drinking for some hours prior to the administration of the sedative. When this type of sedation is used, you will need to make arrangements for someone to monitor, drive and escort you home after your dental appointment.

E) Aftercare / Post-extraction healing.

In general, the easier it has been for a dentist to access and remove a wisdom tooth, the less involved the patient's healing process will be.

For example, the postoperative inconvenience and aftercare associated with the routine extraction of an easily accessed, fully erupted third molar may be surprisingly minimal, almost non-existent. At the other extreme, the pain and swelling resulting from the removal of a difficult impaction may require several days of recuperation.

Aftercare guidelines and instructions.

For the most part, post-extraction aftercare is broken into two general time frames: 1) The first 24 hours after your surgery and 2) The time period after 24 hours and beyond. Use these links for more information.