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Treatments and drugs
By Mayo Clinic staffImpacted wisdom teeth don't always need to be surgically removed. You have two main treatment options, depending on the severity of your situation and other factors. They are:
- Conservative treatment
- Surgical extraction
Conservative treatment
If impacted widsom teeth aren't causing problems, you and your dentist may choose to simply monitor them. People who can't have their teeth removed because of certain health problems such as a bleeding disorder also need to choose conservative treatment.
Under guidance from your dentist or oral surgeon, you may be able to care for your impacted wisdom teeth and minor problems using mouthwashes, saltwater rinses and over-the-counter pain relievers. If complications arise or worsen, surgery might become an option.
Surgical extraction
Experts agree that when an impacted wisdom tooth causes complications, it should be extracted to prevent further problems.
Some experts say that impacted wisdom teeth should always be removed, even if they aren't causing problems. The belief is that the impacted tooth will eventually cause problems, and that it's better to remove it when someone is younger and more likely to recover faster from surgery. This is why many teenagers or young adults have their wisdom teeth extracted even before the teeth start causing problems. In addition, if a child might require braces, his or her dentist may recommend extraction of the wisdom teeth first.
There's no scientific evidence to recommend for or against extracting impacted wisdom teeth in adults or adolescents if the teeth aren't causing complications. You and your dentist can evaluate your situation to see which treatment option is best for you or your child.
Extracting an impacted wisdom tooth
Extraction of impacted wisdom teeth often can be done in your dentist's office with local anesthesia. However, if the tooth is deeply impacted or if the extraction may be difficult, your dentist may suggest that you consult with an oral surgeon. Sometimes extractions are done in the hospital. You may need general anesthesia for more complicated extractions.
To reach the impacted tooth, an incision is made in your gum. The incision creates a flap of gum, which can be peeled back to expose the impacted tooth and jawbone.
An impacted wisdom tooth that has partially emerged may be removed with forceps. But if the tooth is fully impacted or if the roots reach deep into the jawbone, the tooth may have to be broken into pieces for removal. In more severe cases, portions of jawbone may be removed.
You may need stitches to close the gap in your gum. The socket where your tooth was located is packed with gauze to control bleeding and to help a clot form, which promotes healing.
Care after surgery
Your dentist or oral surgeon gives you specific instructions about caring for your mouth after extraction of an impacted wisdom tooth. Here are general tips about care after oral surgery:
- Activity. Plan to rest for the remainder of the day after surgery. Limit strenuous physical activities. If you are a smoker, don't smoke for at least the first 24 hours after surgery, as doing this may disrupt the blood clot in the socket.
- Diet. Drink lots of clear liquids and eat only soft foods for the first 12 hours. If you had several teeth removed, stick to a diet of soft foods for the first few days. Don't use straws, as doing so can dislodge the clot that forms in the tooth socket. Avoid hard or crunchy foods, such as popcorn, for two weeks after surgery.
- Pain management. If your pain is severe you may need a prescription pain medication during the first few days after surgery. Or you may find that you can manage your pain with over-the-counter pain relievers. Applying ice packs — a bag of frozen peas or corn works nicely — also may help control pain, as well as swelling.
- Bleeding. Some oozing of blood is normal for the first day after removal of your impacted wisdom tooth. Swallow blood-tinged saliva instead of spitting it out, to avoid dislodging the socket clot. Get instructions from your dentist or surgeon about replacing the gauze packing. Remember that when blood mixes with saliva, the amount of blood loss can look worse than it actually is.
- Swelling and bruising. Swelling of your cheeks and jaw is normal after surgery. You can use ice packs to help control swelling. Swelling normally begins to subside by the third day. Some dentists give an injection of a steroid during the surgery to help minimize swelling. Swelling may make it a bit difficult to open your mouth fully, but this normally improves on its own. You may also have some bruising around your jaw or upper neck.
- Cleaning your mouth. The day after surgery, rinse your mouth gently with warm salt water at least six times a day. Mix 1/2 teaspoon (2.5 milliliters) of table salt in 8 ounces (237 milliliters) of water. Brush your teeth, but be very gentle in the area around your surgery.
Complications of extraction
Recovery after the removal of impacted wisdom teeth is usually quick and without problem. However, complications can arise. Your dentist or surgeon will advise you about signs and symptoms to watch for, such as fever and increasing pain.
Other complications can include:
- Numbness, usually temporary, of your teeth, gums, tongue and chin
- Dry socket when the socket clot dislodges, exposing underlying bone
- Infection from bacteria or trapped food particles
- Sinus problems if teeth near the sinuses were removed
- Weakening of the jawbone from bone removal or damage
