Impacted wisdom teeth: symptoms, problems and when removal is needed

The NHS says that when wisdom teeth do not have enough space to come through, this can cause pain and swelling, infections in the gums (pericoronitis), food getting stuck, tooth decay, gum disease, a build-up of fluid around the tooth (a cyst) and a dental abscess. Some impacted teeth cause no symptoms at all.

The NHS toothache page says to see a dentist if you have toothache, and to go to A&E if the area around your eye or your neck is swollen, or swelling in your mouth or neck is making it difficult to breathe, swallow or speak. While waiting for a dentist you can take paracetamol or ibuprofen (not aspirin for under-16s), use a pain-relieving gel, rinse with salt water and eat soft foods.

Wisdom teeth develop later than other teeth and usually start coming through into your mouth in your teens or early 20s. The NHS says they might not have enough space to come through into your mouth fully, for example because they are blocked by another tooth (impacted) or partly covered by your gums.

A dentist may take X-rays to check how your wisdom teeth are positioned. If the tooth is not causing problems, it will usually be left where it is and monitored at your routine dental check-ups.

NICE technology appraisal TA1 recommends that prophylactic removal of pathology-free impacted third molars should be discontinued in the NHS, and that surgical removal should be limited to patients with evidence of pathology. It lists unrestorable caries, non-treatable pulp or periapical disease, cellulitis, abscess and osteomyelitis, resorption of the tooth or adjacent teeth, fracture of the tooth, disease of the follicle including cyst or tumour, and teeth impeding surgery or jaw reconstruction.

On pericoronitis, NICE says the evidence suggests a first episode, unless particularly severe, should not be considered an indication for surgery, and that second or subsequent episodes should be considered the appropriate indication. Plaque formation is a risk factor but is not in itself an indication for surgery.

The NHS says a dentist might be able to remove wisdom teeth, or they may refer you to a specialist at a hospital, clinic or another dental surgery. You will usually have a local anaesthetic injection to numb the gum. You may also have sedation, or a general anaesthetic, if the teeth are more difficult to remove or you are anxious.

The dentist or surgeon cuts your gum if it covers the tooth, widens the socket, and removes the tooth in one piece or cuts it into two or three pieces. The gum is stitched if necessary with dissolvable stitches. It often takes just a few minutes and should take no more than 40 minutes, and you usually go home the same day, though after a general anaesthetic you might stay overnight.

If you have the teeth removed by an NHS dentist you will need to pay for a band 2 course of treatment unless you are entitled to free NHS dental treatment.

The NHS says you can usually go back to normal activities the day after, though you might need 1 to 3 days off work if the teeth were difficult to remove or you had a general anaesthetic. For up to 2 weeks you will usually have some pain and swelling, which should start to improve after 1 or 2 days, with possible bruising on the cheek, a sore stiff jaw and discomfort chewing and swallowing.

To help recovery the NHS advises paracetamol or ibuprofen, soft or liquid food until chewing is comfortable, gentle rinsing with mouthwash or warm salt water, careful cleaning of other teeth avoiding the wound, and pressing on any bleeding for at least 10 minutes with a clean cloth. Do not drive for 48 hours after a general anaesthetic or 24 hours after a sedative injection, do not eat hard or crunchy food, do not smoke, and avoid alcohol and very hot drinks.

Complications the NHS lists are dry socket (a painful condition where the blood clot does not form properly or is dislodged before the gum has healed), an infection that may need antibiotics, and nerve damage causing numbness or tingling in the tongue, lips and chin that usually gets better but can last weeks or months.

After removal, the NHS says to ask for an urgent dentist appointment or get help from NHS 111 if you have bleeding that does not stop, pain and swelling that is severe or getting worse and painkillers are not helping, or pain with a bad taste in your mouth, a high temperature or feeling unwell.

If swelling around the eye or neck, or swelling in the mouth or neck is making it hard to breathe, swallow or speak, the NHS says to go to A&E or call 999 and not to drive yourself.

On the NHS a general dentist assesses and removes many wisdom teeth, referring complex ones to a hospital or specialist dental service. NHS dental charges apply, as above, and NICE guidance means that symptom-free impacted teeth are not normally removed on the NHS.

Private dentists and oral surgeons also remove wisdom teeth, with options for sedation. The same clinical thresholds are worth discussing: ask what problem the extraction is meant to solve and what the alternative of monitoring involves.