Impacted Tooth Extraction
The position of a wisdom tooth, your symptoms and the neighbouring tissues are assessed together. Not every impacted tooth needs removing; review and treatment options are discussed at the examination.
What Is an Impacted Tooth?
An impacted tooth is one that has not fully erupted into its expected position. It may be entirely within bone or partly under the gum. It is seen most often with wisdom teeth, though other teeth can be impacted too. The tooth's angle and depth help in planning treatment, but on their own they do not decide whether it should come out.
Does Every Wisdom Tooth Need Removing?
No. Where a tooth causes no symptoms and the examination finds no sign of disease, regular review may be considered. Absence of pain does not on its own mean the tooth is healthy; the neighbouring teeth and surrounding tissues are examined. The interval for review, and for imaging where needed, is set individually.
Recurrent gum infection, decay that cannot be treated, damage to a neighbouring tooth, or a lesion around the tooth may all prompt consideration of extraction. The source of any pain is established first — not every jaw pain comes from a wisdom tooth.
Examination and Imaging
The examination covers mouth opening, the visible part of the tooth, the gum, the neighbouring tooth and any existing radiographs. A panoramic or localised radiograph may be used. Where the roots of a lower wisdom tooth appear close to the nerve canal, and where the extra information would change the treatment decision, a CBCT scan may be requested. A CBCT is not mandatory for every impacted tooth.
Tell us about your medication, your allergies and your general health. Do not stop any medication, including blood thinners, on your own. Bringing previous radiographs helps avoid unnecessary repetition.
Review, Complete Removal and Coronectomy
The benefits and risks of each option, and the possible consequences of delaying treatment, are discussed together. Coronectomy means removing only the crown of certain lower wisdom teeth close to the nerve and leaving the roots in place. It may be considered in order to reduce the risk of nerve injury; it does not remove that risk, and it is not suitable for every tooth.
Roots left in place need follow-up. They can migrate over time, infection can develop, and a further procedure may be needed later. Which option is appropriate is not decided from the angle of the tooth or from a photograph of a radiograph alone.
How the Extraction Is Done
Most procedures can be planned under local anaesthesia. The gum over the tooth may be raised, limited bone may be removed where necessary, and the tooth may be divided into sections to be taken out. Sutures may be needed. How long it takes depends on the position of the tooth and the extent of the surgery.
Susarla and Dodson (2004) timed 250 third molar extractions in 82 patients: the mean operating time was 6.9 minutes with a standard deviation of 7.6 — a spread wider than the average itself, which is the reason a single duration is not quoted to patients. Difficulty was driven mainly by anatomical and operative factors.
If sedation or general anaesthesia is needed, an appropriate facility, an anaesthetic assessment and the preparation involved are planned separately. The method is settled at the examination; the same anaesthetic, or a same-day return to normal life, is not promised for every procedure.
What Are the Risks?
Pain, swelling, temporary limitation of mouth opening and bleeding can occur. Infection, or a painful healing problem where the clot in the socket is not maintained (dry socket), can develop. With lower teeth there is a risk of altered sensation in the lip, chin or tongue, usually temporary but occasionally lasting. With upper back teeth, site-specific risks such as a communication with the sinus are assessed.
Bui and colleagues (2003) reviewed 583 patients and reported an overall complication rate of 4.6%, with increasing age, a positive medical history and the tooth's position relative to the inferior alveolar nerve associated with higher risk. That is a group figure from one cohort; imaging and careful planning do not guarantee that no complication will occur.
Aftercare and Review
Follow the written aftercare and medication instructions you are given. Avoid vigorous rinsing and spitting on the first day, and do not disturb the wound. Until the numbness wears off, take care not to bite your lip or cheek or to burn yourself on hot food. Soft food and gentle cleaning that does not injure the area help healing. Smoking can affect healing adversely.
An antibiotic is not automatically needed after every extraction; that decision follows from the examination. Increasing pain a few days later can be a sign of a problem such as dry socket and needs to be checked. Returning to daily life and healing of the bone are not completed on the same timescale.
Get dental assessment without delay for bleeding that does not stop, steadily increasing pain, fever or worsening swelling. If you have difficulty breathing or swallowing, or rapidly spreading swelling of the face or neck, do not wait for a reply to a message — call the emergency services or go to an emergency department.
Frequently Asked Questions
Does an impacted tooth always have to come out eventually?
No. Some are kept under review indefinitely. What changes the decision is a finding — infection, decay, damage to the neighbouring tooth, or a lesion — rather than the passage of time.
Is the procedure painful?
Pain during the procedure is controlled with anaesthesia. Afterwards there can be pain and swelling; how much depends on the surgery. Pain that increases rather than settles needs to be checked.
Will I be asleep?
Usually not. Most extractions are done under local anaesthesia. Sedation may be planned for anxiety or for multiple teeth in one session, and general anaesthesia is arranged with an appropriate facility when it is needed.
How long will I need off work?
It depends on the extent of the surgery and on your job. This is set individually rather than quoted as a fixed number of days in advance.
How is the fee determined?
By the number of teeth, their position, the imaging needed and the scope of the procedure. Appointments are arranged directly on Uzm. Dt. Aykut Gürel's personal line. International patients are seen at Dentopol Ümraniye on Mondays, Wednesdays and Saturdays, 09:00-18:00 Istanbul time.
Scientific References
- Marciani RD. Third molar removal: an overview of indications, imaging, evaluation, and assessment of risk. *Oral and Maxillofacial Surgery Clinics of North America*. 2007;19(1):1-13. PMID 18088860. DOI
- Bui CH, Seldin EB, Dodson TB. Types, frequencies, and risk factors for complications after third molar extraction. *Journal of Oral and Maxillofacial Surgery*. 2003;61(12):1379-1389. PMID 14663801. DOI
- Susarla SM, Dodson TB. Risk factors for third molar extraction difficulty. *Journal of Oral and Maxillofacial Surgery*. 2004;62(11):1363-1371. PMID 15510357. DOI