There are two approaches to treat impacted wisdom teeth. In the more conservative approach, the teeth are simply monitored unless symptoms develop that begin to cause problems. Many dentists use this conservative approach if x-rays indicate that the wisdom tooth is in a normal position and therefore is less likely to cause any harm to adjacent teeth.

If minor problems occur, they often can be treated with simple techniques, such as using mouthwashes, saltwater rinses and over-the-counter pain relievers. If an infection of a gum flap (pericoronitis) is present, the dentist may remove damaged tissue and pus and give the patient antibiotics designed to kill the infection.

However, a less conservative approach may be necessary if x-rays reveal a wisdom tooth in an abnormal position beneath the gumline (making it more likely to cause problems at some point), or if the tooth is causing symptoms. In such cases, the tooth will likely need to be surgically removed (extracted).

Many dentists believe that impacted wisdom teeth are almost certain to cause problems at some point and recommend surgical extraction in all cases. However, the removal of wisdom teeth that do not seem likely to cause problems remains somewhat controversial. Dentists typically prefer to remove wisdom teeth when the patient is between the ages of 16 and 21. At those ages, the jawbone is less dense, the wisdom tooth’s roots are not as deep and large nerves are less likely to be involved in the root. These factors make extraction less difficult. In addition, younger patients are likely to experience a faster and more complete recovery. Children may have such extraction procedures before undergoing therapy with braces. However, a number of adults have the wisdom teeth removed after age 21. The healing process takes longer as people age because the roots of teeth become embedded in the jawbone in adults.

Older patients may need to have wisdom teeth extracted if they are being fitted for dentures. Wisdom teeth that erupt beneath dentures often cause severe irritation and need to be removed. This changes the shape of the gum, requiring construction of new dentures.

Patients who experience painful or worsening symptoms related to impacted wisdom teeth are very likely to require surgical extraction. If pericoronitis is present, the infection will need to be eradicated before an extraction can take place.

Typically, a patient will be asked not to eat for about six hours prior to an extraction. In addition, patients may be urged to arrange to have someone drive them home following the procedure. Whether a patient is able to drive home depends on the medications used during the extraction and the difficulty of the process. If a patient receives sedatives or general anesthesia then a ride home will be necessary.

Extraction usually takes between five and 30 minutes and usually can be performed by a dentist using local anesthetic. During the procedure, an incision is made in the gum and a forceps is used to remove the whole tooth when possible. If the tooth is fully impacted or if the roots reach deeply into the jawbone, the tooth may have to be broken into pieces and each piece removed.

In cases of more serious impaction, an oral surgeon may have to perform the extraction. This may take place in the surgeon’s office or, in some cases, in a hospital under general anesthesia. If the tooth is particularly embedded, part of the jawbone may also have to be removed.

Stitches may be necessary to close the gap in the gum. In other cases, the socket where the tooth has been removed is packed with gauze to control bleeding for 30 minutes following the procedure. The patient will likely need to rest for the remainder of the day. Smoking is prohibited for the first day following surgery to provide time for a blood clot to form in the socket to aid in healing.

Patients will be restricted to clear liquids and soft foods for the first 12 hours following surgery. Straws should not be used because they can dislodge the clot that is forming. Patients should avoid hard or crunchy foods for two weeks following surgery. They may be asked to chew on only one side of their mouths for a period of time.

Patients are urged to rinse their mouths with warm salt water a half-dozen times after the first day following extraction. The salt water should be made up of a half-teaspoon of table salt and 8 ounces (236 milliliters) of water. Patients can brush their teeth, but they should be careful around the area where the tooth was removed.

Ice packs and over-the-counter pain relievers usually are used to control pain and swelling. In some cases, prescription pain medication may be necessary to control pain. It is normal for bleeding to occur during the first day following extraction. Patients are urged to swallow this blood, so as to avoid dislodging the forming blood clot.

In some cases, complications may develop. They include:

• Dry socket. This is a painful condition that occurs when the socket’s blood clot dislodges and the underlying bone becomes exposed. It can be prevented by closely following post-extraction instructions (e.g., no smoking or alcohol). If dry socket develops a dentist should be consulted immediately for treatment.
  
  
• Infection. This occurs as a result of bacteria or trapped food particles.
  
  
• Sinus problems. These occur when teeth near the sinuses are removed.
  
  
• Temporary numbness of the teeth, gums, tongue and chin.
  
  
• Weakening of the jawbone. This occurs as a result of bone removal or damage.

There is no way to prevent the problems associated with a wisdom tooth. However, careful oral hygiene such as regular brushing and flossing can help reduce the risk of tooth decay, infection or other complications.