Wisdom teeth removal is an area of dentistry that tends to have a lot of cases at one extreme or another - wisdom teeth removal is frequently either quite easy and straightforward, or else rather difficult, complex and risky.
Every patient of mine panics a little when I tell them that they need a wisdom tooth extraction. But most of the time, there’s no need to panic at all - a lot of the time, wisdom teeth removal can be quite straightforward!!
So what are the things that make wisdom teeth removal either easy or difficult? There are several factors to take into account!
I’ll take these potential problems in order;
1. Upper tooth or lower tooth?
Simply put, upper wisdom teeth are generally MUCH
EASIER to remove than lower wisdom teeth. This is
because of two things;
First, how dense the surrounding bone is.
And Second, what space there is behind the wisdom tooth. The upper wisdom tooth is surrounded by thin egg-shell thin bone. This means that it is not held in place very securely. The bone around it is thin and also NOT DENSE. These two things make the tooth relatively easy to remove. AND - added to that, the upper wisdom tooth does not have any bony structures or obstructions behind it. So there is nothing to prevent the tooth from moving backwards, away from the tooth next to it. Therefore, the upper wisdom tooth is NORMALLY quite easy to remove, by rotating it slowly backwards and downwards out of it’s socket.
2. Is it under the gum? Or has it come through
If the wisdom tooth is completely buried under the gum, then it is a little more challenging to remove. We have to make an incision through the gum, and peel it back so the tooth can be seen.
Usually in this case, the tooth is ALSO surrounded by
bone, and we then have to drill away the caller of bone
around the tooth in order to free it, and allow it to be
- BUT THERE IS A PLUS POINT!
- after the removal of the wisdom tooth, the gum
will go back together with a couple of stitches
(sutures), and heal up real quick!
On the other hand, if the tooth is already through the
gum, then it is easier to see and less likely to have a
lot of bone around the neck of the tooth, holding it in.
So it is not usually as difficult to remove as one that
is under the gum.
3. If the tooth is through the gum, how much is
visible? If it just the tip of a cusp or two, then the
tooth is mostly still under the gum, and not easily
At the other end of the scale, a wisdom tooth may have
grown up through the gum and actually be standing up
above the level of the neighbouring teeth. This means
that there is LESS ROOT still in the jaw bone, so the
tooth is not held in the bone very securely, and
therefore more easily removed.
4. Is the tooth sitting upright like the
neighbouring tooth, or is it angled or tilted?
Obviously, the wisdom tooth will be easier to remove if
it is upright rather than if it is tilted.
5. Is the tooth jammed against the next door
tooth? If it is, then things get difficult.
In the picture here, you can make out the wisdom tooth on the right side, tilted over and jammed up against the next door tooth. And it has caused a cavity in the side of the neighboring tooth. Both teeth will have to be removed.
When a wisdom tooth is jammed against the next one, it
is automatically tilted and also in tight contact with
that next tooth. So there is no room for the tooth to
move. How on earth do we get that tooth out?
Well, there are several tricks of the trade that we can
use! Imagine a tooth that is angled at 45 degrees
against the next tooth. It is held in place by that
tooth next door, and on the other side by a dense bone
collar. So we have to make room for the tooth to move.
Usually, the oral surgeon will first remove the top
one third of the tooth, thereby removing the contact
with the next door tooth. Then he will drill away the
collar of bone around the tooth, particularly from
behind the tooth, to allow the tooth to wiggle and then
move backwards and rotate up and out.
6. Is the tooth near any nerves? This really
only applies in the lower jaw, where a BIG nerve runs
along the middle of the lower jaw bone. It’s usually in
a bony tunnel. But a wisdom tooth can interfere with the
nerve in a couple of ways:
First of all, it can sit just above the nerve channel.
But when the oral surgeon manipulates the tooth, it may
press on the nerve before it comes out, causing nerve
compression. The nerve will usually recover in one to
twenty weeks, but you will have a tingling sensation in
your lower lip and/or tongue on that side of your mouth
during that time.
Secondly, the root of the wisdom tooth may have grown around the nerve channel; This makes it very difficult to remove without affecting the nerve. There is a high risk of (link) nerve damage.
7. Can the dentist or oral surgeon get to the
tooth easily? Is it covered by the patient’s tongue?
Does the cheek tissue fall over the tooth? Does the
patient have a small mouth, or cannot open their mouth
All these things make the job of removing a wisdom
tooth even more difficult, as if it wasn’t difficult
8. Finally, are there any other complicating factors, such as general medical conditions or difficulty with anaesthesia? These problems can include resistance to local aesthetics; especially dense bone; limited blood flow to the jaw bone; excessive bleeding from the operation site; and perhaps previous medical treatment that makes healing difficult, such as radiotherapy to the jaws for cancer, or a history of bisphosphonate treatment for osteoporosis.
So, wisdom teeth removal can be really quick and
easy - if it’s in the upper jaw, grown through the gum
straight, and easy to see for the dentist.
OR it can be complicated and risky if it’s a
lower wisdom tooth that is tilted and jammed against the
next tooth (impacted), and the patient cannot open very
Such a spread of difficulty!
But the more difficult cases are usually treated under
general anaesthetic, so you don’t know what’s going on,
and it’s over when you wake up!
Whatever, don’t believe all your friends and family when they tell you to leave a wisdom tooth alone; it could be VERY easy to pop out!