Wisdom Tooth Extraction

Wisdom tooth extraction is a dental procedure that involves the removal of a third molar, commonly known as wisdom teeth, which are the last teeth to develop and emerge in the mouth.

The procedure addresses problems associated with impacted wisdom teeth that cannot properly erupt due to insufficient space in the jaw. By the age of 18, most adults have 32 teeth, but the average mouth is designed to hold only 28 teeth, often leading to complications when wisdom teeth attempt to emerge.

Indications Benefits Techniques Preparation Procedure Recovery Risks FAQ

Indications for Wisdom Tooth Extraction

Wisdom tooth extraction becomes necessary when these third molars cannot properly fit or function within the dental arch for several reasons.

Impacted Wisdom Teeth: Wisdom teeth that cannot fully emerge through the gums due to blockage by other teeth or insufficient space in the jaw. These partially erupted teeth create pockets where bacteria can accumulate.
Misalignment: When wisdom teeth push against adjacent teeth, they can disrupt the natural or orthodontic alignment, potentially affecting previous dental work.
Infection or Periodontal Disease: Partially erupted wisdom teeth allow bacteria to enter around the tooth, causing infection. This can result in pain, swelling, jaw stiffness, and general illness.
Cyst Formation: Impacted wisdom teeth can develop fluid-filled sacs called cysts that can damage the jawbone, teeth, and nerves if left untreated.
Tooth Decay: Due to their position at the back of the mouth, wisdom teeth are difficult to clean properly, making them susceptible to decay. More critically, it may cause decay in the adjacent teeth, which may lead to loss of a functional tooth.

Benefits of Wisdom Tooth Extraction

The removal of problematic wisdom teeth provides multiple advantages for dental health and helps prevent future complications.

Prevention of Crowding

Extraction eliminates the pressure that wisdom teeth exert on adjacent teeth, helping maintain the alignment and spacing of the dental arch.
Reduction of Infection Risk

Removing impacted or partially erupted wisdom teeth eliminates spaces where bacteria can accumulate, lowering the likelihood of infection and gum disease in the back of the mouth.
Pain Management

Extraction addresses the pain and discomfort associated with impacted wisdom teeth, including jaw stiffness and headaches that often occur during eruption attempts.
Prevention of Cyst Development

Timely removal of wisdom teeth helps avoid the formation of cysts or tumours that can damage the jawbone and adjacent healthy teeth.
Protection of Adjacent Teeth

Extraction helps maintain the integrity of neighbouring teeth that might otherwise be affected by pressure or decay spreading from difficult-to-clean wisdom teeth.

Surgical Techniques

Simple Extraction

This technique is used when the wisdom tooth has fully erupted and is visible in the mouth. The dentist loosens the tooth with an instrument called an elevator and then removes it with dental forceps. The procedure is relatively straightforward and is performed under local anaesthesia. No incisions are required, making the recovery process quicker compared to other methods.

Surgical Extraction

When a wisdom tooth is partially erupted or impacted beneath the gum line, a surgical approach is necessary. The surgeon makes an incision in the gum tissue to expose the tooth and bone. Sometimes, bone that blocks access to the tooth root must be removed. The tooth may need to be sectioned (cut into pieces) to facilitate removal through the opening. This technique requires stitches to close the incision and typically involves a longer recovery period.

Partial Odontectomy

When a wisdom tooth’s roots are positioned near sensitive structures such as nerves or sinuses, the surgeon may perform a partial removal. This technique involves removing the crown while leaving the roots in place to reduce the risk of damage to adjacent structures. This approach is less common and is typically reserved for cases where complete extraction would present considerable risk to nearby anatomical structures.

Preparing for the Procedure

Initial Assessment

A dental examination, including X-rays, helps determine the position of wisdom teeth and whether removal is necessary. Anaesthesia options and procedural details will also be discussed.
Medical Review

A complete medical history, including medications, supplements, and allergies, helps identify any conditions that may require special precautions, such as diabetes or high blood pressure.
Medication Adjustments

Some medications, such as blood thinners or aspirin, may need to be paused before surgery to minimise bleeding risks. Medication regimens will be reviewed and adjusted in advance to prevent complications during the procedure.
Pre-Procedure Instructions

Fasting is typically required for at least six hours before surgery if sedation or general anaesthesia is planned. Arrange for transportation home and wear loose, comfortable clothing if IV sedation is involved.

Step-by-Step Procedure

Anaesthesia Administration

The procedure begins with the administration of anaesthesia based on the complexity of the extraction and patient factors. Local anaesthesia numbs the extraction site and surrounding tissues. For more complex cases, sedation or general anaesthesia may be administered.

Tissue Access

Once the area is numb, the surgeon creates access to the impacted wisdom tooth. For partially or fully impacted teeth, an incision is made in the gum tissue to expose the tooth and surrounding bone. The gum tissue is carefully reflected to provide adequate visibility of the surgical site.

Bone Removal

When the wisdom tooth is covered by bone, the surgeon removes the overlying bone using a drill or osteotome. This step exposes sufficient tooth structure for extraction while preserving adjacent anatomical structures and limiting trauma to surrounding tissues.

Tooth Sectioning

For teeth that are difficult to remove in one piece, the surgeon may divide the tooth into sections. This technique allows for removal of the tooth through a smaller opening and reduces the force needed for extraction, minimising the risk of jaw fracture or damage to surrounding structures.

Tooth Removal

Using specialised instruments, the surgeon carefully loosens and removes the tooth or tooth sections from its socket. Care is taken to ensure complete removal of the tooth while protecting important structures such as nerves, adjacent teeth, and the sinus cavity.

Site Cleaning and Closure

After the tooth is removed, the surgeon cleans the socket to remove any debris or infected tissue. The area is irrigated with sterile saline solution to reduce the risk of infection. The gum tissue is then repositioned, and stitches are placed to promote healing.

Post-Surgical Care and Recovery

Immediate Care	Bite down gently on the gauze for 30–45 minutes to help form a blood clot. Apply ice packs in 20-minute intervals during the first 24 hours to reduce swelling, and take prescribed medications as directed. Avoid rinsing, spitting, or using straws for the first day to prevent dislodging the clot.
Diet and Oral Hygiene	For the first few days, eat soft foods like yoghurt and smoothies, then gradually introduce solids as the healing process continues. Stay hydrated, but avoid hot beverages, alcohol, and carbonated drinks. After 24 hours, rinse gently with warm salt water several times daily, especially after meals, and brush carefully around the surgical sites.
Activity Restrictions	Rest for at least 24–48 hours, keeping your head elevated when lying down. Avoid strenuous activities, heavy lifting, and exercise for 3–5 days. Refrain from smoking for at least 72 hours, as it impairs healing.
Follow-up Care	Attend follow-up appointments to monitor healing and remove any non-dissolving stitches. Contact your surgeon if you experience excessive bleeding, severe pain not controlled by medication, or signs of infection such as fever or pus.

Potential Risks and Complications

While wisdom tooth extraction is generally safe, it carries some risks. Dry socket can occur if the blood clot dislodges, exposing bone and nerves, leading to significant pain. Infection, despite preventive measures, may require additional antibiotics. Other less common complications include damage to nearby teeth, numbness (temporary or permanent), sinus issues for upper teeth, jaw fractures, and prolonged bleeding. Some patients may experience restricted jaw opening (trismus) for several days or weeks. The risk of complications varies based on extraction complexity, individual health, and adherence to post-operative care.

Frequently Asked Questions

How long does the extraction procedure take?

The duration varies depending on the complexity of the case. A single tooth extraction may take 20-30 minutes, while removing all four wisdom teeth typically requires 60-90 minutes. The position of the teeth, degree of impaction, and type of anaesthesia used all influence the total time needed.

When is the best time to remove wisdom teeth?

Most oral surgeons recommend extraction during the late teens to early twenties when the roots are not fully developed, making removal easier and recovery faster. At this stage, the bone is less dense, and the risk of complications is lower than at an older age.

How soon can I return to work or school?

Most patients can return to work or school within 2-3 days after surgery. However, if your job involves physical exertion, you may need additional recovery time. Recovery timeframes vary between individuals based on the complexity of the extraction and individual healing rates.

Complimentary eBook

Patient’s Guide to Wisdom Tooth Surgery

Dr. SL Chan

Singapore Oral Surgeon

BDS | MDS | FRACDS | FAMS |

A Leading Singapore Dental Surgeon specializing in Oral Maxillofacial Surgery, with a special interest in reconstructive & corrective jaw surgery.

Dr Chan has held major leadership position in Singapore Dentistry, including being President of the Association of Oral and Maxillofacial Surgeons (Singapore), Chairman of the Singapore Regional Committee of the Royal Australasian College of Dental Surgeons and President of the College of Dental Surgeons of the Academy of Medicine, Singapore. He has also served in the Singapore Dental Council where he chaired the Credentials Committee and the Aesthetic Facial Procedures Oversight Committee.

Bachelor of Dental Surgery (BDS), National University of Singapore (1989)
Master of Dental Surgery in Oral and Maxillofacial Surgery (Training under Professor H. Tideman), University In Hong Kong
Fellow of the Royal Australasian College of Dental Surgeons
Fellow of the Academy of Medicine, Singapore