Wisdom Teeth Extractions: Risks and Complications

Wisdom teeth are the last molars in, and the back of the mouth is a crowded place for them to arrive. Some people never develop a full set. Others have four that settle in quietly and never cause trouble. When they do cause trouble, the fix is well understood, and the outcome has a lot to do with the week after the surgery rather than the surgery itself.

If you have been told yours need to come out, the useful thing to know is what the surgery involves, what can go wrong, and which of those problems you can influence. That is the whole of this piece.

When a wisdom tooth has to come out

The trigger is usually one of a few things: a tooth coming through sideways or at an angle, pressure on the teeth in front of it, decay or gum infection in a spot that is hard to keep clean at the very back of the mouth. A dentist confirms the picture with an x-ray, including how close the roots sit to the nerves in the lower jaw. Not every wisdom tooth needs removing. One that is healthy, fully through and reachable with a toothbrush can stay under review.

The risks, stated plainly

Every operation has a list, and this one is short and well known to the people who do it. None of these is common, and the standard precautions exist for a reason.

• Infection at the site. Swelling, increasing pain and a fever in the days after surgery can point to an infection that needs treating rather than waiting out.
• Dry socket. The clot that protects the socket comes loose, and a dull, deep ache sets in a few days later. It is painful and it is easy for a dentist to treat once you describe it.
• Bleeding that keeps oozing. Some spotting is normal. Steady bleeding that does not settle with pressure is not, and it is worth a call the same day.
• Nerve injury. For lower wisdom teeth, the roots can sit near a nerve that supplies sensation to the lip and chin. The x-ray is taken to measure that risk, and the numbness it causes is usually temporary, though it can last.
• Damage to the neighbouring tooth. A tooth crowded against its neighbour can be bumped on the way out, which is one more reason removal is planned from a scan rather than improvised.
• Stiffness, trismus and bruising. Unpleasant, temporary, and mostly a matter of following the aftercare rather than doing anything clever.

The first week, realistically

Swelling usually peaks in the first two days and then settles. Soft food, cold packs in short bursts, and resting the jaw all help. Smoking and straws undo good healing by disturbing the clot, which is why every clinic bans both for a period after surgery. Pain that is easing day by day is the normal path. Pain that gets worse after day three or four deserves a phone call.

What you can influence

Most of the risk list responds to things decided before and after the appointment. Tell the dentist about every medication you take, particularly anything that thins the blood, along with any health conditions that affect healing. Follow the aftercare instructions even when you feel fine, because the instructions exist for the days you feel worst. Ask, before the day, what the plan is if the tooth turns out to be more complicated than the x-ray suggested.

What happens to the gap afterwards is a separate question from the surgery. Not every removed tooth needs replacing, and when one does, what a replacement involves and what changes the price is worth understanding before you are sitting in a chair being quoted.

When to call the clinic

Call the same day for bleeding that will not settle, swelling that spreads down the neck or under the jaw, a fever, or pain that is getting worse after the first few days rather than better. Call also if numbness in the lip or chin has not faded when the rest of the swelling has. None of these means the surgery failed. They mean something needs looking at sooner rather than later.

The aftercare is the treatment

The removal itself takes an afternoon. The week that follows decides how the whole episode is remembered. Follow the dull instructions: rest when it says rest, skip the straws, keep the site clean, take the medication as directed, and ring the clinic the moment something on the watch list appears. Healing likes boring behaviour, and this is one week where boring pays well.

Sources: healthdirect (healthdirect.gov.au) publishes consumer guidance on wisdom teeth and their removal; the Australian Dental Association provides patient information on dental procedures; your own dentist’s aftercare instructions take precedence over any general advice, including this article.