Wisdom tooth removal: pain, when it is needed and how recovery goes

As a dentist and founder of Tandarts West in Rotterdam West, I hear the question almost daily whether a wisdom tooth needs to come out. The answer is yes less often than people think. Removing a wisdom tooth is sometimes the best choice, but far from always necessary. In this article I help you weigh it up, and calmly explain what to expect if removal is the best option after all.

Why wisdom teeth cause problems

Wisdom teeth are the last molars at the back of your mouth and usually only come through between the ages of seventeen and twenty-five. In many people, by that time there is simply too little space in the jaw. As a result a wisdom tooth comes through at an angle, stays half under the gum or presses against the neighbouring molar.

That cramped situation causes the familiar complaints. Under a half-erupted wisdom tooth, food debris and bacteria easily collect, which can cause a painful gum infection. Wisdom teeth are also hard to keep clean, so decay and toothache arise more quickly. Sometimes a wisdom tooth feels loose, for example because the surrounding gum is inflamed and swollen.

A wisdom tooth that sits well and causes no complaints does not need to go. We only remove it when there is a good reason.

Does a wisdom tooth always have to come out?

No. Preventively removing all wisdom teeth is no longer the standard. We assess for each situation whether removal is really needed. If your wisdom tooth sits well, comes through fully and you can keep it clean, it can perfectly well stay in place.

We do advise removing a wisdom tooth in the case of:

• recurring gum infections around the tooth;
• decay in the wisdom tooth or in the neighbouring molar that you cannot treat well;
• persistent or recurring pain;
• a wisdom tooth that comes through at an angle or halfway and presses against the neighbouring molar;
• a cyst or other abnormality around the tooth, visible on an X-ray.

At a check-up in Rotterdam West we assess the position of your wisdom teeth, often with a panoramic X-ray. That way we discuss together whether waiting or removal is wiser. Read more about the treatment on our page about wisdom tooth removal.

Wisdom tooth pain: what you can do yourself until the appointment

Are you waiting for an appointment and have pain from a wisdom tooth? With a few simple things you keep it bearable and help avoid worsening an infection.

• Rinse with lukewarm salt water. Half a teaspoon of salt in a glass of lukewarm water, a few times a day, soothes inflamed gum.
• Keep the area clean. Keep brushing gently, including around the wisdom tooth, so no food debris stays behind.
• Take a painkiller. Paracetamol as per the leaflet works well. Do not place a painkiller on the tooth, as that damages the gum.
• Cool from the outside. A cold compress against your cheek reduces swelling and pain.
• Spare the tooth. Chew on the other side as much as possible.

With severe pain, a swollen cheek or fever you do not have to wait. In that case contact Tandarts West Rotterdam or, outside opening hours, the emergency dentist. We prefer to tackle a substantial infection around a wisdom tooth quickly.

How the extraction goes

Much of the tension around removal comes from the unknown. That is why I explain exactly what happens.

Preparation and anaesthesia

First we look at the X-ray to assess the position of the tooth and the roots. Then we numb the area locally. Once the anaesthesia works, you feel no more pain, only pressure and movement.

A simple extraction

If the wisdom tooth is straight and fully erupted, the removal is often quick. With special instruments we carefully loosen the tooth and remove it in one piece. This usually takes only a few minutes.

A surgical removal

If the tooth is half or fully under the gum, a small procedure is needed. We loosen the gum, remove a small piece of bone if necessary and sometimes take the tooth out in parts. After that we suture the gum. This too is done under local anaesthesia and is not painful. For complex wisdom teeth we work together with an oral surgeon.

Recovery step by step

Good recovery begins right after the treatment. These steps help the wound heal quickly and calmly.

1. First hours: bite gently on the gauze until the bleeding stops. Leave the wound alone, do not yet rinse and do not suck on the wound.
2. First day: cool your cheek from the outside, eat soft and lukewarm food and drink no alcohol. Avoid hot drinks.
3. From day two: rinse gently with lukewarm salt water, several times a day, to keep the area clean.
4. Brushing: brush the rest of your teeth normally, but be extra careful around the wound in the first days.
5. Rest: take it easier for the first two to three days. The swelling and tenderness then decrease quickly.

Most people feel largely back to normal after about a week. The gum has healed well after two to three weeks. If you received sutures that do not dissolve on their own, we remove them after about a week.

When to get in touch after the procedure

Some after-pain, a tender jaw and mild swelling belong to a normal recovery. Some signals do not. Contact Tandarts West Rotterdam in the case of:

• Renewed bleeding that does not stop after firmly biting on a piece of gauze.
• Infection: increasing rather than decreasing pain after day three, a swollen cheek, fever or a bad taste.
• Dry socket: severe, radiating pain about three to five days after the extraction, because the blood clot has come loose. This is easy to treat, so feel free to call.
• Persistent numbness of the lip or tongue that remains after the anaesthesia has worn off.

Unsure whether something is normal? Then always call 010 846 6539. Better one phone call too many than too few. We are also easy to reach for patients in Rotterdam West, for example in Delfshaven. At Tandarts West Rotterdam we guide you through the whole journey, from the first assessment to a complete recovery.