Wisdom teeth and difficult extractions

Private wisdom tooth removal and surgical extraction in Leicester, by a Consultant surgeon qualified in both dentistry and medicine.

When wisdom teeth become a problem

Wisdom teeth are the last teeth to come through, usually in the late teens or twenties, and there often isn't room for them. A tooth that comes through at an angle, or only partly, is described as impacted. Impacted wisdom teeth can be entirely harmless, but they can also cause repeated gum infections (pericoronitis), decay in the tooth in front, cyst formation or persistent pain.

Current UK guidance is that wisdom teeth should be removed when they are causing problems or are likely to, rather than simply because they are there. Chris follows that guidance. If a tooth is best left alone, he will say so.

Why see a maxillofacial surgeon rather than a dentist?

Many wisdom teeth can be removed by a general dentist. Your dentist may refer you to a specialist when the tooth is deeply impacted, when the roots lie close to the nerve that supplies feeling to the lip and chin, when previous extractions have been difficult, or when you have a medical condition that makes surgery more complex. Chris's training in both dentistry and medicine is specifically suited to those cases.

Other difficult extractions

The same applies to other teeth: heavily broken‑down teeth, teeth with curved or fused roots, teeth that have failed to erupt, and extractions in patients taking blood thinners or medicines that affect bone healing. Chris also removes teeth ahead of orthodontic treatment when a surgical approach is needed.

What happens

Consultation
Chris examines you, reviews your X‑rays (a panoramic X‑ray or, where the nerve is close, a 3D cone‑beam CT scan) and explains the risks and benefits of removal against leaving the tooth alone.
Choosing anaesthesia
Most wisdom teeth are removed under local anaesthetic, sometimes with intravenous sedation to help you relax. A general anaesthetic is an option for more complex cases or if you prefer to be asleep. Chris will talk through what suits you.
The procedure
Removal usually takes between twenty and forty minutes. A small cut is made in the gum, a little bone may be removed and the tooth is sometimes divided to lift it out in pieces. The gum is closed with dissolving stitches. Day‑case treatment, so you go home the same day.
Recovery
Expect swelling and some discomfort for a few days, usually manageable with ordinary painkillers. Most people are back at work within two to four days. You'll be given written aftercare instructions and a number to call if you're worried.

Risks, explained plainly

Every operation carries some risk and Chris will discuss the specifics with you. For lower wisdom teeth the main ones are pain, swelling and bruising; infection or delayed healing of the socket (dry socket); and, less commonly, altered sensation in the lip, chin or tongue where the tooth lies close to a nerve. This is usually temporary but can occasionally be permanent, and the risk is assessed for your tooth in particular, with a scan where that helps.

Do I definitely need treatment?

Not necessarily. Chris will first establish whether treatment is needed at all and whether there are reasonable alternatives to surgery. He may recommend leaving things alone when:

the tooth has come through fully, is healthy and can be kept clean
it is deeply buried, causing no symptoms and shows no sign of damaging the tooth in front or forming a cyst
it lies so close to the nerve that the risk of removal outweighs the benefit, in which case monitoring or partial removal (coronectomy) may be safer

What does the next week look like?

A typical recovery. Yours will be discussed with you individually before you decide to go ahead.

That evening: Numb for a few hours, then aching. Take the painkillers before the numbness wears off, eat something soft and plan a quiet evening.
Day one: Swelling and a stiff jaw are normal. A little oozing is normal too. Start gentle warm salt‑water rinses after 24 hours.
Days 2 to 3: Swelling usually peaks now and some bruising of the cheek can appear. Stiffness makes opening wide difficult. Keep up the painkillers and rinses.
By one week: Most people are largely comfortable, eating normally and the stitches are dissolving. A lower wisdom tooth socket can take a few weeks to close fully.
Practicalities
Driving: Same day after local anaesthetic once the numbness has gone; not for 24 hours after sedation, 48 after a general anaesthetic.
Work: Usually 2 to 4 days. Longer for physical work or if all four teeth are removed.
Eating: Soft food for 3 to 5 days, normal within a week or two.

Chris's view

"Most wisdom teeth I see have already caused two or three bouts of infection by the time the patient reaches me, so the decision is usually easy. The harder conversation is the tooth that's doing nothing wrong. I don't remove those just because they're there."

Mr Christopher Vinall

When should I get advice?

Arrange an assessment if a wisdom tooth has become infected more than once, if you have persistent pain or swelling at the back of the jaw, if your dentist has seen decay in the tooth in front, or if a tooth has been described as impacted and you want to know whether it needs anything doing.

Arrange a consultation