Extracting wisdom teeth: Everything you need to know

What are wisdom teeth?

Wisdom teeth are the rearmost molars (technical term: third molars, Latin: dens serotinus), which only erupt in young adulthood - or not. In medical circles, they are also referred to as "eighth teeth" because the wisdom teeth are the eighth teeth in the row of teeth when counted from the centre. Most people therefore have four wisdom teeth - two in the upper jaw and two in the lower jaw. How many of them actually erupt varies from person to person. In around 80 per cent of young adults, at least one of the wisdom teeth does not erupt. It can also happen that a wisdom tooth only breaks through partially, so that only a crown covered with gum can be seen.

Meaning: Why do wisdom teeth exist?

Wisdom teeth are a remnant from a time long past when people lived as hunter-gatherers. Their diet included raw meat and hard roots. In order to make the food more digestible, a larger chewing surface was needed. The additional teeth therefore had the function of crushing tough food and fitted easily into the mouth. As our eating habits have changed and the size of our teeth has decreased accordingly over the course of evolution, we no longer actually need wisdom teeth today. 

When do wisdom teeth come in?

The eruption of wisdom teeth usually takes place between the ages of 18 and 25. However, this is only an average figure. There have been people who did not get wisdom teeth until they were over 80 or even 90 years old.

There are also people who do not have four wisdom teeth in their jaw: Some people have no wisdom teeth at all, others have three, two or even just one wisdom tooth.

Interesting: While the eruption of the third molars is associated with "wisdom" in German and English-speaking countries, i.e. gained life experience, in Korea it is referred to as "love teeth". The reason for this is that the eruption usually occurs during the period of first falling in love.

What do wisdom teeth look like?

Wisdom teeth can have three to five cusps and up to five roots, which are often fused together or curved. The appearance can therefore vary greatly.

In this article you will find some pictures of wisdom teeth - both x-rays and photos of extracted teeth and graphics - to give you a good idea of what wisdom teeth look like.

Why do wisdom teeth have to be extracted?

Wisdom teeth often do not fit into the dentition because our mouths are too small. If the wisdom teeth try to make their way into the mouth anyway, this can lead to discomfort, which we will discuss in more detail in the next section. Because they were perceived as troublemakers, wisdom teeth were generally extracted for a long time. Nowadays, dentists weigh this decision more carefully against the risks of wisdom tooth surgery. If a wisdom tooth is growing normally and has enough space, it does not need to be extracted.

Symptoms when wisdom teeth erupt

Depending on how your wisdom teeth grow, they can cause different symptoms. We have summarised the most common signs of different types of eruption here.

Pain when wisdom teeth erupt

If your wisdom teeth grow normally and can erupt without any problems, it can still be unpleasant. The eruption of wisdom teeth can cause pain - just like teething when you are a baby. 

The following symptoms can occur during a normal breakthrough:

• Pain
• Redness
• Swelling
• Bleeding gums
• Bad breath
• Unpleasant taste in the mouth
• Swallowing difficulties
• "Lock" (difficulty opening the mouth)

Wisdom teeth often take their time to erupt. It can therefore happen that the pain subsides and then reappears. It is best to make an appointment with a dentist as soon as you notice that your wisdom teeth are erupting. This will allow the dentist to x-ray your jaw to determine whether you have enough space in your mouth or whether the wisdom tooth needs to be extracted before it erupts. To relieve the pain, the dentist may prescribe an ointment or cream or, if the pain is severe, a painkiller. As a rule, a normal eruption only causes slight pain and no inflammation.

Partially retained wisdom teeth

If wisdom teeth try to break through when there is actually no room in the mouth, this can cause severe pain. The wisdom tooth then not only presses against the gum that stretches over it, but also against the neighbouring tooth. It can happen that the neighbouring molar tooth hurts terribly, even though there is no caries or root inflammation. This is referred to as a "partially retained wisdom tooth": The tooth is still partially under the gum and cannot break through. A kind of gum cap often forms over the tooth. This cap can become inflamed very easily because it is difficult to reach with a toothbrush and provides an ideal breeding ground for bacteria.

In the case of partially retained wisdom teeth, the following symptoms may occur in addition to the normal eruption symptoms:

• Severe pain
• Throbbing pain
• Earache, tinnitus
• Headaches, migraines
• Sore throat
• Neck pain
• Fever
• Tooth displacement

If you feel a throbbing pain that radiates into your ear and temples and you also have a fever, you should go to the dentist immediately.

Impacted wisdom teeth

If the wisdom teeth do not grow into the mouth at all, but remain in the jaw, they are referred to as "impacted wisdom teeth". People with impacted wisdom teeth often have no symptoms. However, if the wisdom tooth sits at an angle in the jaw and presses on a neighbouring tooth, it can damage the tooth. This can result in root caries, bone loss in the jaw or the teeth shifting due to the pressure.

Cysts can also form on impacted wisdom teeth, which the dentist can recognise on an X-ray. Cysts are filled with fluid and do not initially cause any pain. However, if they become inflamed, they can cause a feeling of pressure and dull pain.

Have wisdom teeth extracted or keep them?

If you feel that your wisdom teeth are erupting or your dentist recognises during a routine examination that eruption is imminent, the question arises: to extract wisdom teeth or not? 

In the past, the answer was clear: wisdom teeth must be extracted. Today, however, dentists only recommend extracting wisdom teeth if problems already exist or are foreseeable. So far, no health benefits have been found in favour of extracting teeth without symptoms and this procedure is now weighed up against possible complications from surgery. 

If you keep your wisdom teeth in your mouth and do not have them extracted, you have the advantage of being able to use them for a tooth transplant for a damaged or missing tooth instead of having to insert an implant. You and your dentist will decide whether your wisdom teeth should be extracted or not based on the x-rays. 

When do wisdom teeth need to be extracted?

Dentists recommend extracting wisdom teeth if the following complications already exist or are to be expected:

• If a gingival cap over a half-erupted tooth is inflamed
• If the wisdom tooth is affected by caries
• If the root of the wisdom tooth is inflamed and root canal treatment is necessary
• If a cyst has formed near the wisdom tooth
• If the wisdom tooth damages or displaces the neighbouring tooth
• When the wisdom tooth interferes with the bite
• When the wisdom tooth interferes with orthodontic treatment
• When the wisdom tooth interferes with the development of the dentition
• If there is not enough space in the jaw
• When wisdom teeth grow crooked
• If the wisdom tooth would cause crowding, which increases the risk of caries and periodontitis
• If the roots of the wisdom tooth are heavily branched

Side effects and risks of wisdom tooth surgery

If you are thinking about whether or not you should have your wisdom teeth removed, you should also weigh up the risks of wisdom tooth surgery.

The following side effects can occur after wisdom tooth surgery:

• Swelling ("fat cheek")
• Bruises  
• Difficulty opening the mouth (for a few hours or days)
• Pain
• Post-bleeding
• Inflammation of the wound
• Injury to nerves and blood vessels
• Temporary numbness of the tongue and face
• Damage to neighbouring teeth (very rare)
• Permanent sensory disturbances (very rare)

In addition, the risk of a jaw fracture is increased after the removal of wisdom teeth in the lower jaw. As the jawbone is severely weakened by the operation, it can break if hit hard. This is why dentists also recommend being particularly careful when playing sport for three months. You should therefore avoid high-contact sports such as martial arts or ball sports if possible. 

Wisdom tooth surgery: costs, anaesthesia, procedure & co.

For dentists and oral and maxillofacial surgeons, the extraction of wisdom teeth is a routine procedure that is often on the agenda. For patients, however, extracting a tooth or several teeth is anything but commonplace. That's why we've put together the most important information for you here and answered frequently asked questions.

Who removes wisdom teeth?

You can have your wisdom teeth removed by a dentist you trust. However, your dentist also has the option of referring you to an oral surgeon or maxillofacial surgeon if they consider the procedure to be complex. 

Anaesthesia

Thanks to modern technology, the local anaesthetic is sufficient for your dentist to extract your wisdom teeth without causing you any pain. Patients only feel a slight sensation of pressure. The local anaesthetic is injected into the area to be treated. To make the prick of the syringe painless, dentists can apply a surface anaesthetic in the form of a spray or gel beforehand. The tooth is only extracted once the anaesthetic has taken effect and the patient no longer feels any pain. You remain fully conscious during the local anaesthetic.

However, if you suffer from a fear of dental treatment and want to experience as little or nothing of the treatment as possible, you can also use other forms of anaesthesia.

Nitrous oxide and twilight sleep

Nitrous oxide is a gas that you inhale through a nasal mask and has an anxiolytic and euphoric effect. In twilight sedation (also known as sedation or analgosedation), patients are put into a sleep-like, deeply relaxed state using a cocktail of painkillers, sedatives and sleeping pills. A local anaesthetic is also used. With both anaesthesia methods, patients can respond to instructions. When anaesthetised with nitrous oxide, patients have memories of the treatment, but not with twilight sleep.

General anaesthesia

General anaesthesia switches the patient off completely and should only be used in an emergency - namely for very complex and long operations or in cases of extreme dental anxiety. General anaesthesia places considerable strain on the body. It not only renders the patient completely unconscious, but also switches off vital functions: Patients have to be artificially ventilated, for example. Wisdom teeth should therefore be extracted without a general anaesthetic if possible. 

Important: The extraction of all four wisdom teeth at the same time is a long dental treatment that would actually justify an application to the health insurance company for a general anaesthetic. However, health insurance companies often reject such applications on the grounds that the treatment can be carried out in two sessions under local anaesthetic and a general anaesthetic is not necessary.

What costs will I incur when having my wisdom teeth extracted?

Statutory health insurance providers such as AOK or TK generally cover the costs of wisdom tooth extraction - but only with local anaesthetic. If you would like additional anaesthetic methods such as nitrous oxide, twilight sleep or general anaesthesia so that you feel less of the treatment, you will usually have to pay for these additional services yourself. The costs for this are usually between 100 and 400 euros. However, patients who have a diagnosed phobia of dental treatment can apply to their health insurance provider to have the costs covered. 

Procedure for wisdom tooth surgery

You can have your wisdom teeth extracted in one session or in several sessions. It is usual to schedule two appointments and then remove the wisdom teeth on one side at a time - for example, the two wisdom teeth on the left side of the upper and lower jaw first and the wisdom teeth on the right side in the second appointment. The body can deal with two wounds more quickly than with four. In addition, you always have one half of your mouth with which you can chew. 

This is the actual procedure for wisdom tooth surgery:

1. If you have opted for an additional form of anaesthetic, it will be administered first. Only then will the dentist begin the actual treatment.
2. The dentist will inject the local anaesthetic - he or she may apply a surface anaesthetic beforehand so that you don't feel the injection.
3. As soon as the local anaesthetic takes effect, the dentist extracts the tooth. This depends on whether the wisdom tooth has already erupted or not:
   - Wisdom tooth has already erupted: The dentist pulls the tooth with pliers.
   - Wisdom tooth has not yet erupted: The dentist opens the gum with a scalpel and folds it to the side. Using a surgical bur, he removes the bone until he reaches the wisdom tooth. If possible, he extracts the whole tooth. However, it may also be necessary to split the wisdom tooth and remove the pieces individually.
4. The wound is disinfected and sutured.
5. After about a week, the dentist removes the stitches.

If you are wondering whether the extraction of wisdom teeth is worse on the top or bottom: As a rule, wisdom teeth can be extracted more easily in the upper jaw because the upper jaw bone is softer than the lower jaw bone. When wisdom teeth are extracted in the lower jaw, the force of gravity makes it easier for bacteria to enter the "holes" created by the missing tooth and cause inflammation. Healing complications therefore occur more frequently in the lower jaw.

Duration of wisdom tooth surgery

How long it takes to remove the wisdom teeth depends on how your wisdom teeth have grown so far: If the wisdom tooth has already erupted, it can be removed by an experienced dentist in just a few minutes using pliers. However, if it is still in the jaw and may have twisted or branched roots, it can take up to an hour to extract a wisdom tooth. The duration of the operation also depends on how many teeth are extracted at once.

How long does the healing process take?

The wounds from wisdom tooth surgery usually heal within about a week - the dentist should also issue you with a sick note for this period. How long your mouth is swollen and you feel ill depends largely on whether you follow the dentist's recommendations after the operation. In any case, you should go for a follow-up check after about a week. This is also when the stitches are removed.

What to do in case of pain and post-operative bleeding after wisdom tooth surgery?

As there are relatively large " holes " in your mouth after wisdom tooth surgery, which now have to grow closed, pain and post-operative bleeding can naturally occur. Pain is more likely when extracting wisdom teeth that have not yet erupted because the procedure is more complex and more tissue and bone mass is damaged. 

Pain

To relieve the pain, the dentist will usually prescribe painkillers such as ibuprofen or paracetamol. Studies have shown that a combination of 400 milligrams of ibuprofen and 1000 milligrams of paracetamol relieves pain better than the respective painkillers alone. Adults may only take this combination every eight hours. The maximum daily dose of ibuprofen for adults is 1200 milligrams; for paracetamol it is 4000 milligrams. It is best to discuss the use of painkillers with your dentist. Under no circumstances should you take aspirin for pain, as the active ingredient increases the risk of secondary bleeding. 

How long the pain lasts also depends on the type of procedure. However, it should subside after a few days. If this is not the case, you should see your dentist and have it checked again. This also applies if the suture has opened. 

Post-bleeding

If you suffer from severe post-operative bleeding, you should go to the dentist - or the dental emergency service - immediately. If the postoperative bleeding is very slight, you can bite on a clean cloth to stop the bleeding by applying pressure. Important: Please do not use a paper towel. This can easily get stuck in the wound. Important: Spit out the blood and do not swallow it to avoid nausea. 

Homeopathic globules for swelling and bruising 

Some patients have had positive experiences with Homeopathy. Arnica globules are said to be able to prevent swelling and bruising. The globules can be taken one day before the operation. Please note, however, that there is as yet no scientific proof of the effectiveness of homeopathy. Positive experiences can often be attributed to the placebo effect.

Tips for the time after wisdom tooth surgery

If you are planning a wisdom tooth operation, you will certainly want to know what to do afterwards. We have summarised all the important tips for the fastest possible wound healing here. 

1. Cool, cool, cool

The best way to prevent the typical thick cheeks after the operation is to keep cooling as soon as the anaesthetic has worn off. It is best to prepare enough cold packs in the freezer or refrigerator before the wisdom tooth operation. If you use cold packs, you should always place a thin cloth between the cold pack and your skin, otherwise the cold will be too aggressive. However, you can also simply use a damp, cool flannel

You should definitely avoid heat in the first few days after the operation and therefore avoid saunas, solariums and sunbathing.

2. Do not eat anything hot or hard

Hot drinks are taboo in the first few days after the operation. You should also avoid coffee completely for at least two days. To help your wounds heal as quickly as possible, you should drink still water or lukewarm tea (e.g. camomile, peppermint or sage tea). 

You should not eat anything while the anaesthetic is still working after wisdom tooth surgery. Afterwards, you can eat soft foods. In general, you should avoid spicy, hard and hot foods because they can interfere with wound healing. Hard food residues - such as crumbs from wholemeal bread or nuts - can get stuck in the wound and cause inflammation. Lactic acid bacteria can also cause inflammation. You should therefore also avoid yoghurt, milk and cheese. The same applies to sugary and acidic foods.    

Here is an overview of foods that are recommended after wisdom tooth surgery:

• Cream soups
• Mashed potatoes (without milk)
• Smoothies (made from low-acid fruit)
• Pancakes
• Applesauce
• Porridge (without milk)
• Pudding (without milk)
• Soft-boiled or pureed vegetables
• Scrambled eggs
• Soft-boiled eggs
• Fish
• Tender meat

3. Allow yourself to rest

Your body now needs as much energy as possible to heal the wound. So plan how you will make time for yourself before you have your wisdom teeth extracted. Of course, the dentist will put you on sick leave and you won't have to go to work, university or school. But also make sure that you have support with other commitments, such as caring for children or relatives in need of care. Talking - just like chewing - promotes blood circulation in the mouth. For this reason, you should speak as little as possible in the first few days after the operation.

Rest as much as possible and take it easy. To prevent post-operative bleeding, experts recommend lying down and sleeping with your upper body elevated - ideally 20 to 30 degrees.

4. Do without sport

After extraction of the wisdom teeth, sport and other physical exertion is taboo for at least a week - this also applies to normal housework such as hoovering. Physical exertion increases blood flow and can therefore cause secondary bleeding. In the worst case scenario, your wound suture will then tear open. You should avoid competitive sport completely for six weeks. You can return to diving after four weeks. If you do any particular sports, it is best to speak to your dentist to find out when you can start playing sports again.

5. Abstain from tobacco and alcohol

Nicotine and alcohol also delay wound healing. You should therefore refrain from smoking and drinking alcohol for at least 24 hours after having your wisdom teeth extracted - ideally, however, until the wounds have healed completely.

6. Do without travelling

As you should rest for a week after wisdom tooth surgery so that your body can put all its energy into healing the wound, you should also avoid travelling during this period. This is the only way you can attend your check-up appointment and be close to the doctor's surgery in the event of any complications. Travelling by plane is particularly unfavourable: The pressure when flying disrupts wound healing.

7. Brush your teeth

You can - and should - brush the remaining teeth normally again around 24 hours after the wisdom teeth have been extracted. The following applies: brush as thoroughly as you can with the pain and possibly limited freedom of movement. You only need to avoid the wound and the immediate surroundings. It is best to discuss with your dentist whether a mouthwash with chlorhexidine (such as the Perio plus range from Curaprox) is advisable.