Wisdom Tooth Removal

What the X-ray or scan shows

Before a wisdom tooth extraction, the surgeon looks at three things on the X-ray. The angle: a tooth can be upright, tilted forward into the molar in front, or lying on its side, and the more it leans, the more likely it is that bone has to be removed or the tooth divided. The roots: curved or hooked roots, like those in the scan on this page, make removal harder. And how far it has come through: a partly erupted tooth with a flap of gum over it is approached differently from one still sealed in bone.

For lower wisdom teeth the main question is the nerve. A nerve runs through the lower jaw just below the roots and gives feeling to your lower lip and chin. When a standard X-ray shows the roots overlapping it, a CBCT scan shows how close they really are, and if they are very close the approach is adjusted to lower the risk to the nerve.

Ask to see your own X-ray and have these points explained. It makes the decision easier to follow, and the recovery easier to plan for.

Upper and lower wisdom teeth

Upper wisdom teeth sit in softer bone and often come out more simply. Their roots can lie close to the sinus above them, so after an upper removal you may be asked not to blow your nose hard for some days.

Lower wisdom teeth sit in denser bone, are more often impacted, and are the ones near the nerve. Their removal is usually more involved, and swelling and jaw stiffness tend to last longer afterwards.

Dry socket, and when to call us

Dry socket is the one problem worth knowing by name. After a tooth comes out, a blood clot fills the socket and covers the bone while it heals. If that clot is lost too early, the bone is left exposed. You notice it as a deep, throbbing ache, often spreading towards the ear, that starts a few days after the removal and gets worse instead of better, sometimes with a bad taste. It is more common after lower wisdom teeth and in smokers, and it is treated by cleaning the socket and placing a soothing dressing, so call rather than putting up with it. Not smoking, and not rinsing hard or using a straw for the first day, lowers the chance of it.

Also call the clinic if swelling is still increasing after the third day, if you have a fever, or if your lip, chin or tongue is still numb the next day. If bleeding does not stop with firm pressure on gauze, call the clinic, and if it is closed or the bleeding is heavy, go to a hospital emergency department.

A swelling that spreads towards the eye or into the neck, or makes it hard to swallow, breathe or open your mouth, or comes with a high fever, is an emergency. Go to a hospital emergency department, and call 108 if breathing is difficult. There is more on how to tell when swelling from a tooth infection is urgent, and what to avoid while you wait to be seen.