Wisdom tooth extraction: when it is needed, what happens and the risks

The Hull leaflet lists the usual reasons: repeated infection of the gum over a wisdom tooth (pericoronitis), decay that cannot be filled, decay or gum disease in the neighbouring tooth, abscess, and cysts around the tooth. Leeds adds severe and repeating pain and says removal is advised where there are signs of disease in line with NICE guidance.

Equally important is when they should not be removed. Leeds says no treatment is needed if wisdom teeth grow normally and cause no problems, and that regular monitoring with X-rays and cleaning advice may be enough. The Hull leaflet frames the decision as a balance: take the tooth out only when the benefits outweigh the risks of leaving it.

In practice this means a tooth that is simply impacted on an X-ray but is not causing symptoms or damage is often watched rather than removed. If you are told to have teeth taken out, ask what problem it is solving.

Leeds mentions monitoring with X-rays and cleaning advice as a legitimate approach where the tooth is not causing disease. Your dentist can show you how to clean around a wisdom tooth that is hard to reach.

These measures do not remove the underlying reason for repeated trouble. The Hull leaflet lists repeated infection of the gum as a reason to remove the tooth, so if infections keep returning, removal becomes more reasonable. Discuss with your dentist how many episodes you have had and what each treatment has achieved.

An X-ray shows the position of the tooth and its roots, including how close the roots are to the nerve in the lower jaw. This helps the surgeon explain the particular risk to you. The Hull leaflet says nerve problems mainly relate to lower wisdom teeth and mentions sinus involvement as a rare issue with upper teeth.

You will be told how to prepare for the anaesthetic. Leeds says treatment may be under local anaesthesia, sedation or general anaesthetic, depending on individual circumstances, and the Hull leaflet suggests general anaesthetic for difficult extractions or anxious patients. If you will have sedation or general anaesthetic, arrange an escort home and time off.

• Ask whether you will be fully awake, sedated or asleep.

• Plan time off, because Leeds says it can take one to two weeks to feel better.

• Avoid scheduling holidays or important events immediately afterwards, as the Hull leaflet advises.

After anaesthetic, the surgeon may need to cut the gum, remove a little bone with a drill, or divide the tooth into smaller pieces so it can be removed more easily, as the Hull leaflet describes. Stitches are usually placed, and the Hull leaflet says they dissolve by themselves in one to two weeks.

The NHS says removal often takes just a few minutes and should not take more than about 40 minutes. You will bite on gauze to control bleeding. The Hull leaflet suggests biting gauze for 20 minutes if bleeding persists.

If more than one tooth is involved, ask whether they will all be done at one visit.

Pain, swelling, bruising and jaw stiffness are expected. Leeds mentions pain lasting two to three days and bruising around the face and neck. The NHS says nerve damage can cause numbness that usually gets better but can last a few weeks or months, and the Hull leaflet gives 2 to 20% as having temporary tingling or numbness and 0.5 to 2% having permanent nerve problems, affecting the lower lip, chin, tongue or taste.

Dry socket, where the clot is lost and pain worsens a few days later, is described by the Hull leaflet as appearing from three to ten days after surgery, and Leeds calls it a common healing problem. Infection can occur and shows as fever, tender glands or jaw swelling, according to the Hull leaflet. Damage to a neighbouring tooth or crown is possible, and with upper teeth the sinus can occasionally be opened.

The NHS says you can usually go back to normal activities the day after, with one to three days off work after a more difficult extraction, and that the jaw may stay sore and stiff for up to two weeks. The Hull leaflet gives 5 to 7 days as the usual recovery with swelling at its worst on days two to three, and Leeds says you may need one to two weeks to feel better.

Practical care: use ibuprofen and paracetamol if suitable, eat soft food at first, and avoid brushing the extraction site early so as not to disturb clots or stitches, as the NHS notes. Leeds advises brushing twice daily, warm salt-water rinses three to four times a day after the first 24 hours, and avoiding smoking for five days and alcohol until healed.

The NHS lists bleeding that does not stop, severe or worsening pain or swelling that painkillers do not control, and pain with a bad taste, a high temperature or feeling unwell as reasons to seek help. Contact the surgery or the helpline on your discharge sheet first, or NHS 111 out of hours.

Go to A&E or call 999 for swelling that spreads to the neck or makes breathing or swallowing difficult, or for heavy bleeding that does not stop with firm pressure on gauze.

• Why does this tooth need to come out rather than be monitored?

• How close are the roots to the nerve, and what does that mean for my risk?

• Which anaesthetic is proposed and why?

• How many teeth, and will they all be done on the same day?

• Who do I call out of hours if bleeding or pain gets worse?

Simple extractions are carried out by NHS and private dentists alike. Surgical removal of impacted teeth is often referred to an oral surgery department, and options for sedation or general anaesthetic differ between settings. If you are paying, ask whether the quote covers sedation, follow-up and treatment of complications such as dry socket.