A normal adult mouth will contain 32 teeth. Each quarter of a mouth has eight teeth. The molar at the back has become known as the 'wisdom tooth'. Often they need to be removed and because of their position they can present unique problems both before and after surgery.
Wisdom teeth are often short of space and therefore do not fully grow (erupt) into the mouth. They often have a piece of gum over the back part of their biting surface; this makes them vulnerable to infection (pericoronitis). Lower wisdom teeth are very commonly infected. Such infections give symptoms such as swelling over the back part of the jaw, inability to open the mouth (trismus), pain especially to bite on the area, and a bad taste.
Wisdom teeth are also susceptible to dental decay and gum disease (periodontal disease) and their presence may contribute to decay or gum disease in the adjacent molar tooth. There are other more unusual reasons why wisdom teeth are removed in hospitals such as cysts, tumours, and fractures of the jaw in this region.
Although infections are unusual in upper wisdom teeth (unless they are decayed), they often grow in such a way that they rub the cheek. If the lower wisdom teeth are to be removed then most surgeons would consider removing the upper on the same side to prevent it growing too far down (over-erupting) in the future.
There is no doubt that the surgery is easier for the dentist if the area is healthy. If the patient takes steps to keep the tooth as clean as possible with good toothbrushing and rinsing the area with hot salt water mouth rinses or Corsodyl mouth wash, then this will reduce gum swelling (gingivitis) and make it easier for the dentist to operate. Reducing or stopping smoking reduces the chances of problems after the teeth have been taken out.
The dentist may use dissolvable stitches. Some dentists prefer to use non-dissolving stitches and will make an appointment to remove them, usually between 1 and 2 weeks later. If they do need to be removed then this is usually straightforward and painless.
Discomfort is common following any operation on the body. Most patients find that any pain is easily treated by painkillers such as paracetamol or ibuprofen (assuming that there are no reasons why they may not take this medication, eg stomach ulcer). However, if the pain becomes severe then it may be that a dry socket is developing. A return to the dentist will be necessary.
A dry socket is when the clot in the socket gets broken down leaving exposed raw bone. The pain usually comes on seven days after the operation. The pain is deep-seated and described as throbbing. Risk factors include difficult extractions, smokers, poor oral hygiene and ladies on the oral contraceptive pill. It is treated by washing the socket out thoroughly and placing a dressing in the wound. The discomfort typically lasts 7-10 days and may require a further appointment during this time.