Wisdom tooth removal: everything you need to know

Wisdom tooth removal is a common, usually short procedure, done under local anaesthesia, to take out a third molar that is impacted, infected, decayed or causing pain. Not every wisdom tooth needs to come out. After an examination and an X-ray, your dentist explains whether removal is needed, how it will be done and what recovery to expect.

What are wisdom teeth, and why do they cause trouble?

Wisdom teeth are the third molars, the last teeth at the very back of the mouth. Most people have four, one in each corner, although some people have fewer or none at all. They usually come through in the late teens or early twenties, long after the other adult teeth.

Because they arrive last, there is often not enough room for them. A wisdom tooth that cannot come through fully is called “impacted”. It may stay completely under the gum, remain partly hidden in the bone, or grow at an angle: tilted forward against the neighbouring molar, lying sideways, or leaning backwards.

A tooth that has only partly come through leaves a small flap of gum over it. This flap traps food and bacteria and is very hard to clean, even with careful brushing. That is why most wisdom tooth problems start in this area.

When does a wisdom tooth need to be removed?

A wisdom tooth that has come through straight, is healthy and can be cleaned properly can usually stay. Mainstream guidance, such as the NHS advice on wisdom tooth removal, recommends leaving wisdom teeth that cause no problems and simply checking them at regular dental visits. Removal is usually advised when the tooth causes, or is clearly likely to cause, one of the following:

• Repeated infection of the gum around the tooth (pericoronitis), with pain, swelling, a bad taste and sometimes difficulty opening the mouth.
• Tooth decay (a cavity) in the wisdom tooth or in the molar in front of it, which is often hard to reach and to fill.
• Gum disease or bone loss around the neighbouring molar.
• A cyst (a fluid-filled sac) or other changes in the bone around an impacted tooth.
• A wisdom tooth that is broken or too damaged to be repaired.
• Planned treatment elsewhere in the mouth, when your dentist or another specialist recommends it.

Pain on its own does not always mean the tooth must come out. Sometimes the gum is only inflamed and settles with professional cleaning and good daily hygiene. Your dentist looks at the whole picture, including the X-ray, before recommending an extraction.

How wisdom tooth removal works, step by step

1. Consultation and X-ray

The first visit is about understanding the tooth. The dentist examines your mouth, asks about your general health and any medicines you take, and takes an X-ray, usually a panoramic X-ray that shows all the teeth, the jaw bones and the shape of the roots. In some complex cases, especially when the roots of a lower wisdom tooth lie very close to the nerve, a 3D scan may be advised. You then receive a clear explanation of the plan, the alternatives and what recovery will look like.

2. Local anaesthesia

On the day of treatment, the area is numbed with local anaesthesia, an injection that numbs the tooth, the gum and the surrounding area. You stay awake and can communicate, but you should not feel pain, only pressure and movement.

3. Removing the tooth

How the tooth is removed depends on its position. A wisdom tooth that has fully come through is often removed like any other tooth, by gently loosening it and lifting it out. An impacted tooth usually needs a small surgical procedure: the gum is opened, a little bone may be removed, and the tooth is often divided into smaller pieces so that it can come out with less force. Our guide to the difference between a simple and a surgical extraction explains both approaches in more detail.

4. Stitches and first instructions

The socket, the space left by the tooth, is cleaned and, where needed, closed with a few stitches. Many stitches are dissolvable and disappear on their own within one to two weeks. You then bite on gauze to control the bleeding and receive aftercare instructions before going home.

The procedure itself usually takes from a few minutes to around 40 minutes, depending on how difficult the tooth is, and most people go home the same day. Whether one, two or all wisdom teeth are removed in the same session depends on your situation, your health and your preference.

Does it hurt? Pain and anaesthesia

During the procedure, local anaesthesia means you should feel pressure but not sharp pain. If you feel anything uncomfortable, you can raise your hand and the dentist will pause and add more anaesthetic. Telling us in advance that you are anxious helps us explain each step and go at your pace.

After the numbness wears off, usually within a few hours, it is normal to have some pain, swelling and stiffness of the jaw. These are usually strongest during the first two to three days and then improve steadily. In most cases, common pain relievers such as paracetamol or ibuprofen, taken as advised by your dentist, are enough to keep you comfortable.

For very anxious patients or particularly difficult teeth, sedation (medicine that helps you relax) or general anaesthesia are sometimes used. These are usually arranged in a hospital or another specialised setting, and your dentist can discuss whether they are appropriate in your case.

Recovery and aftercare

Most people feel well enough to return to normal daily activities within a day or two, although a difficult removal may need a few more days of rest. Some swelling, bruising on the cheek and difficulty opening the mouth wide can last up to one or two weeks before they settle completely.

The first 24 hours matter most for good healing:

• Keep biting firmly on the gauze for about 30 to 45 minutes, and repeat with clean gauze if there is still some oozing.
• Do not rinse, spit forcefully or drink through a straw on the first day, so the blood clot can stay in place.
• Hold a cold pack wrapped in a cloth against the cheek for short periods to limit swelling.
• Eat soft, lukewarm food, and avoid hot drinks while your mouth is still numb.
• Avoid smoking and alcohol, which slow healing.
• From the next day, rinse gently with warm salt water after meals and keep brushing your other teeth carefully.

For a detailed timeline, read our hour-by-hour instructions after a tooth extraction.

One complication worth knowing about is dry socket: the blood clot is lost or does not form properly, leaving the bone exposed. It usually appears two to four days after the extraction as a pain that gets worse instead of better, often throbbing and sometimes with a bad taste. It is not dangerous, but it is painful and should be treated by your dentist. Learn more about dry socket symptoms, treatment and prevention.

Contact your dentist promptly if bleeding does not stop with pressure, if pain or swelling keeps increasing after the third day, or if you develop a fever. Swelling that spreads towards the neck, or difficulty swallowing or breathing, needs emergency care straight away.

Risks, precautions and alternatives

Wisdom tooth removal is a routine procedure and serious complications are uncommon. As with any surgery, there are some risks that your dentist will explain beforehand:

• Infection of the socket, which may need antibiotics.
• Dry socket, described above.
• Numbness or tingling of the lower lip, chin or tongue if a nerve close to a lower wisdom tooth is irritated. This is usually temporary but can, rarely, last longer.
• For upper wisdom teeth, a small opening into the sinus (the air space above the upper back teeth), which usually heals by itself or with a simple repair.
• Prolonged bleeding, mainly in people who take blood-thinning medicines or have a bleeding disorder.

Tell your dentist about all your medicines and health conditions. Blood thinners, certain medicines for osteoporosis or cancer (such as bisphosphonates), uncontrolled diabetes, some heart conditions and pregnancy can all change how and when an extraction is planned. Never stop a prescribed medicine without first speaking to the doctor who prescribed it.

There are also alternatives to consider. A healthy wisdom tooth can simply be monitored. A mild gum infection may settle with cleaning and good hygiene. When the roots of a lower wisdom tooth lie very close to the nerve, a coronectomy, which removes only the crown of the tooth and leaves the roots in place, is sometimes considered to reduce the risk to the nerve.

What determines the cost of wisdom tooth removal in Tripoli?

There is no single price for wisdom tooth removal, because every tooth is different. The cost mainly depends on:

• whether the tooth has fully come through or is impacted under the gum or in the bone;
• whether a simple or a surgical extraction is needed;
• how many wisdom teeth are removed, and whether this is done in one or several sessions;
• the X-rays or scans needed to plan the treatment safely;
• any medication and follow-up visits.

The clearest way to know what your treatment involves is a consultation, during which the dentist examines the tooth and explains the plan and its cost before anything is done.

Wisdom tooth removal at Ajam Dental Clinic in Tripoli

Ajam Dental Clinic offers oral surgery and extractions, including the removal of wisdom teeth, alongside preventive care, prosthodontics and other treatments. You can read more about our oral surgery and extraction treatments. We take the time to explain your X-ray, answer your questions and plan the treatment with you, so that you know what to expect at each step.

Patients come to our clinic on Fouad Chehab Boulevard (Al-Makateb Building, 1st floor) from across Tripoli, including Zahriyeh, Al-Tall, Dam wa Farez, Azmi Street, Bahsas and Beddawi, as well as from the rest of North Lebanon.

If a wisdom tooth is bothering you, or a dentist has suggested removing it and you would like a clear explanation of your options, contact us by WhatsApp or phone to book a consultation.

This article provides general information for patients. It does not replace an examination by a dentist, who can advise you on your own situation.