Wisdom Tooth Removal (Extraction): Causes, Treatment and Complication


Wisdom Tooth Removal Overview

Wisdom tooth removal is the procedure of removing Third Molar.

Now, what is “Third Molar”?

Wisdom teeth refer to the third molars in medical terminology. They are the last teeth in the mouth. Wisdom teeth usually erupt between the age of 17-25 years. A wisdom tooth can erupt in the oral cavity fully or partially or it can totally fail to erupt in the oral cavity.

The failure of wisdom teeth to erupt in the mouth is medically termed as Impacted wisdom teeth. Impacted wisdom teeth can be partially impacted or fully impacted.

It is better advised to get your wisdom tooth removal done by Oral and Maxillofacial Surgeons, as they have gained specialization in this.

Wisdom Tooth Removal Causes

  • In the case of recurrent pericoronitis.
  • When continuous wisdom tooth pain and infection is present or deeply decayed wisdom tooth.
  • In the case of deep periodontal pocket, prior to orthodontic treatment (teeth alignment treatment), cysts and tumors present around the wisdom tooth.
  • And last when the wisdom tooth is in the line of fracture.

Know your Impacted Wisdom Tooth

Based on the radiographs, you can check which type of impacted wisdom tooth you are having. Types of Impacted wisdom tooth can be:

  • Mesioangular wisdom tooth impaction
  • Distoangular wisdom tooth impaction
  • Vertical wisdom tooth impaction
  • Horizontal wisdom tooth impaction
  • Inverted wisdom tooth impaction

Mesioangular Tooth Impaction

Mesioangular impaction is term used when your wisdom tooth is in the same position as shown in the picture below:

Wisdom tooth removal - mesioangular impaction

In this type of tooth impaction the tooth is tilted toward the second molar. Mesioangular disimpaction is less difficult among all type of wisodom tooth disimpaction.

Distoangular tooth Impaction

As you can see in the image below, the wisdom tooth is positioned away from the second molar.


Distoangular disimpaction is difficult to remove than Mesioangular disimpaction.

Vertical Tooth Impaction

In vertical tooth impaction, tooth is positioned straight and is below the bone level.


Horizontal Tooth Impaction

In horizontal tooth impaction, the the lies horizontal in the bone as you can see below. This type of impaction is second most difficult to remove.


Inverted tooth Impaction

Here the tooth is totally in the opposite direction, than its natural position. Inverted tooth disimpaction is the most difficult type of wisdom tooth removal procedure and requires a great skills and knowledge.


What your Oral and Maxillofacial Surgeon will do in case of presence of wisdom tooth infection?

Your oral and maxillofacial surgeon will check for wisdom tooth pain as it suggests the presence of infection in it. Most likely, the surgeon will take a radiograph to investigate further. In the case of presence of infection, your surgeon will prescribe you medicines to eliminate the infection. After you complete your medicine course, the oral surgeon will remove the wisdom tooth because in the presence of infection the effects of local anesthesia will be decreased which will lead to pain during the removal of wisdom tooth. So it is better to have your medicine course completed first and then go for wisdom tooth removal.

Wisdom Tooth Removal Treatment (procedure)

Before you go for your wisdom tooth removal, make sure you eat 1-2 hours before your surgery starts. And don’t forget to give the proper medical history like hypertension, diabetes, allergies, blood disorders, etc. before your surgery starts. The surgeon will maintain asepsis before starting the procedure by applying an antiseptic solution like cetrimide + alcohol, cetrimide + povidone + iodine, 5% povidone iodine, chlorhexidine gluconate. Then the surgeon will drape you with sterile drapes. He/she will give local anesthesia to the operating site. In severe cases, like the presence of cysts or tumors around the tooth, the patient is operated under general anesthesia.

After the surgical site is anesthetized, the oral surgeon will place the cut over the gums around the wisdom tooth and reflect the tissues surrounding it. The surgeon will then remove the surrounding bone with micro-motor and remove the wisdom tooth. In certain cases, it may require sectioning the wisdom tooth in segments to remove it easily from the bone. Then he/she will clean the socket with irrigating solution, compress the socket and take sutures (stitches) to make sure better healing will take place. And he/she will place the cotton gauze over the tooth socket for stoppage of bleeding.

Post instructions after Wisdom Tooth Removal

What to Do after wisdom tooth removal (extraction)?

After your wisdom tooth removal, keep the cotton gauze pieces for the next 30-45 min with gentle bite pressure. Take soft cold diet (ice cream) after removal of cotton gauze. After one-day rinse your mouth with salt water and keep the surgical area clean. Take proper medicines prescribed by the surgeon. Take only soft and liquid diet for 2-3 days. Also, apply an ice pack over the surgical site after the surgery is completed. Take medicines on time. If you find allergy immediate stop the medication and contact surgeon.

What not to do after wisdom tooth removal (extraction)?

Don’t eat until the numbness effect of the local anesthesia wears off as to prevent cheek, lip and tongue bite. Do not take hot, spicy and hard food for 2-3 days. Do not rinse the mouth for 24 hours and do not spit. Do not brush for 24 hours at the surgical site. Do not apply hot towel or heat therapy over swelling or extraction site. Don’t do the sucking motion for the next 24 hours like spitting, sucking through a straw, smoking, etc. as this will cause the dislodgement of the blood clot from the socket and may lead to Dry Socket. Do not avoid medication given by surgeon.

Wisdom tooth removal is the routine surgical procedure and more likely to get done easily but it may be associated with certain complication sometimes.

Wisdom Tooth Removal complications

What problems that can occur during the surgery?

During surgery, vessels (buccal or facial) may be cut. During the bone removal, damage to the roots of the adjacent tooth, slippage of the bur into the gums or cheek. Fracture of the jaw in the case of heavy force used during the removal of the tooth. Fracture of the tuberosity. Accidental removal of the adjacent tooth. Slippage of the removed tooth into the mouth which may lead to aspiration of the tooth. Slippage of the tooth into the maxillary sinus. Damage to the underlying nerve, for example, inferior alveolar nerve, mental nerve, lingual nerve. Damage to the nasal wall.

What problems that can occur after the surgery?

Continuous bleeding even after 24 hours of surgery. Pain and swelling at the operating site. Inability to open the mouth completely for few days (trismus). Loss of vitality of the neighboring tooth. Sinus tract formation, oro-antral fistula. Severe pain can occur into the socket due to dislodged blood clot forms the socket, it is referred as a Dry socket.


Wisdom tooth removal procedure can be complicated but doing it with good and skilled oral and maxillofacial surgeon can avoid it mostly.

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