Wisdom Teeth: Out or Not?
How to tell when a wisdom tooth needs attention, what having one removed involves, and how to heal well afterwards.
How Do I Know If My Wisdom Teeth Need Removing?
A wisdom tooth needs taking out only when it's causing a problem: repeated gum infections around a half-erupted tooth, decay too far back to repair, harm to the neighbouring molar, gum disease around it, or a cyst picked up on an X-ray. A healthy wisdom tooth that is causing no trouble can usually be left alone. At Peninsula Dentists on Greenwich Peninsula, surgical and wisdom tooth extractions are carried out by oral surgeon Dr Imran Riaz from £295, IV sedation is available for nervous patients, and if a lower tooth lies near the nerve we plan removal from a 3D CT scan taken on site.
Must Every Wisdom Tooth Come Out?
Far from it. Wisdom teeth are the third molars at the very back of the mouth, and they normally appear somewhere between your late teens and mid twenties. Plenty erupt without fuss and do a useful job. Others get only partway through, or never surface at all, because the jaw is too short to fit them. UK clinical guidance says that healthy wisdom teeth causing no problems should be left in place, and that applies to buried ones that are causing no harm too. Lots of people keep all four for life.
What counts is whether it's doing harm now or seems likely to. We review wisdom teeth during your dental examinations, taking an X-ray when it's needed, so a tooth that is decaying or harming its neighbour is spotted early instead of announcing itself as an emergency.
Reasons to Remove One
- Pericoronitis that keeps coming back, meaning infection of the gum flap over a partly erupted tooth, particularly after a second or third bout
- Decay in the wisdom tooth itself that can't be restored, usually because it sits too far back to fill properly
- Decay or damage to the second molar in front, where food gets trapped between the two
- A cyst or other change around the tooth showing on an X-ray
- Gum disease and bone loss around the wisdom tooth that put the neighbouring molar at risk
- An upper wisdom tooth that grazes the cheek or keeps biting the gum overlying a buried lower tooth
Now and then we suggest removing a wisdom tooth because it would get in the way of other planned treatment. Whatever the reason, we'll explain it, along with the option of leaving the tooth and monitoring it. The choice is yours, and the fee is put in writing before we book anything.
Is a Wisdom Tooth Playing Up?
Book an appointment and we'll X-ray it and explain whether it needs to come out.
Why Wisdom Teeth Hurt
By far the most frequent cause is pericoronitis. A partly erupted lower wisdom tooth often has a flap of gum lying over it, and food and bacteria collect underneath, so the gum swells and becomes tender. You might notice an unpleasant taste, trouble opening wide, pain when you swallow and puffiness on that side of your face. Flare-ups are common when you're tired or run down.
A first episode usually calms down with thorough cleaning and warm salt-water rinses, with antibiotics kept for cases where infection is spreading or you're feverish. We can irrigate and clean beneath the flap, and if the upper wisdom tooth is biting into the swollen gum we can adjust it or take it out. When pericoronitis keeps returning, removing the lower tooth is the permanent solution. Should the swelling start to interfere with breathing or swallowing, or creep towards your eye or down your neck, dial 999 or head to A&E.
Planning the Extraction: X-Ray and CT Scan
An ordinary dental X-ray shows how the tooth is angled, what its roots look like and how near it lies to the inferior alveolar nerve, which runs through the lower jaw and gives feeling to the lip and chin. For most wisdom teeth that's all we need. When the roots of a lower tooth come near that nerve, a 3D CT scan, from £120, shows exactly how the roots and the nerve relate to one another. We take it on our own scanner at the practice, so you don't need a referral or a wait.
Why does that matter? The most significant risk of removing a lower wisdom tooth is altered feeling in the lip, chin or tongue afterwards. It is usually temporary and only rarely permanent. Seeing the anatomy in three dimensions lets Dr Riaz plan the safest approach and give you a straight answer about your own level of risk. Our CT scan guide explains what the scan involves.
How a Wisdom Tooth Is Removed
Local anaesthetic numbs the area completely, and nervous patients can also have IV sedation. Expect a sensation of firm pressure, but no pain. A fully erupted wisdom tooth can often be taken out much like any other tooth. A buried or partly erupted one needs a surgical extraction: a small opening in the gum, sometimes removal of a little surrounding bone, and often dividing the tooth into pieces so each can be lifted out gently. Dissolving stitches then hold the gum in place while it heals, and most extractions are finished within an hour.
Surgical extractions here are carried out by Dr Imran Riaz, an oral surgeon with a master's degree in advanced oral surgery from the Eastman Dental Institute and more than ten years' experience. That means even awkward teeth can usually be removed at the practice rather than referred elsewhere. If yours looks unusually complex, he'll tell you at your assessment. Our extractions page has more.
Recovering Well
Most people feel back to normal within three to five days, and the first 48 hours are the most uncomfortable.
- Bite firmly on gauze for 20 minutes to control bleeding, and swap to a new piece should it start up again
- For the first 24 hours, skip hot drinks, alcohol, smoking and energetic rinsing, all of which can dislodge the clot in the socket
- Take your first dose of over-the-counter painkillers, as the packet directs, before the anaesthetic wears off
- Stick to soft, cool food for a day or two and chew on the other side
- From the next day, rinse gently with warm salty water after meals, and keep brushing your other teeth normally
- For several days you can expect some swelling, perhaps a bruise, and a jaw that's slow to open fully; a cold pack against your cheek on day one helps
- Ring us if the pain is getting worse after two or three days instead of easing. That can mean a dry socket, where the clot has been lost, and a soothing dressing placed in the socket brings quick relief
What It Costs
| Treatment | Fee | Plan member |
|---|---|---|
| New patient dental examination, including two X-rays | £30 | Included in your plan |
| Same-day emergency appointment for pain | £70 | Free on your plan |
| CT scan, if needed, per arch, from | £120 | £108 |
| Straightforward extraction, from | £150 | £135 |
| Wisdom tooth or surgical removal with Dr Riaz, X-rays and medication included, from | £295 | £266 |
| IV sedation with Dr Riaz, each session | £500 | £500 |
| IV sedation, every extra 30 minutes | £250 | £250 |
You'll have your fee in a written plan before treatment, and dental plan members pay 10% less for extractions.2 If a wisdom tooth is hurting now, ring 020 8788 6688 before 9.30am, Monday to Saturday, and we'll see you the same day, patient or not. Our fee guide lists everything else.
Having It Done Under Sedation
Of all the treatments we provide, wisdom tooth surgery is the one patients most frequently ask to have with sedation. Dr Riaz gives IV sedation through a small cannula alongside the local anaesthetic, so you're drowsy and calm yet can still follow instructions, and afterwards the appointment tends to be a blur. It costs £500 per session, with £250 for each further 30 minutes. You'll need a responsible adult to collect you and keep you company until bedtime, and driving is off the table for 24 hours. For preparation tips, read our guide to IV sedation.
Questions
This guide explains the options in general terms. Only an examination can tell you which of them suits your own teeth.