What are wisdom teeth, and why do they often stay in the jaw?
Wisdom teeth are the third molars right at the back of the mouth and the last teeth to come through. Most people have four, two per jaw. According to Cleveland Clinic, they usually emerge between the ages of 17 and 25; the NHS adds that they can cause problems at any age.
If there is not enough room in the jaw, the tooth stays fully or partly in the bone or under the gum; it is then called impacted. According to InformedHealth.org, the English-language service of the German Institute for Quality and Efficiency in Health Care (IQWiG), up to 80 percent of young adults in Europe have at least one wisdom tooth that has not come through, most often in the lower jaw. Impacted does not automatically mean problematic: according to Cleveland Clinic and InformedHealth.org, some impacted teeth cause no symptoms at all.
Do wisdom teeth have to be removed, or is monitoring enough?
According to InformedHealth.org, there is no scientific proof that removing wisdom teeth that cause no problems has health benefits; removal is usually advised only when problems have occurred or are foreseeable. The British NICE guidance also advises against preventive removal, and the NHS describes that trouble-free wisdom teeth are left in place and monitored.
Reasons for removal, according to NICE and Hull University Teaching Hospitals, are mainly:
- repeated infections of the gum over the tooth (pericoronitis); according to Hull, the most common reason
- decay in the wisdom tooth or the tooth in front that cannot be restored
- an abscess at the root tip or an infection that cannot be treated
- resorption of the neighbouring tooth’s root or gum disease at the neighbouring tooth
- a cyst or another finding around the tooth
- the tooth is in the way of planned jaw surgery
According to NICE, plaque alone is not a reason, and a first, non-severe episode of pericoronitis does not justify removal. Hull stresses that removal should be recommended only when its benefits outweigh the risks of leaving the tooth. The decision is made individually after an examination and X-ray.
How is the removal done?
Removal is usually carried out under local anaesthetic. The steps according to the NHS and Hull:
- If gum covers the tooth, it is opened with a small incision.
- If needed, some bone around the tooth is removed.
- The tooth is taken out whole or, to make it easier, in two or three pieces.
- If needed, the wound is stitched.
According to the NHS, the procedure should take no more than 40 minutes. According to InformedHealth.org, general anaesthesia may be used for more complex procedures. Mention your medicines, allergies and medical conditions beforehand.
Why does proximity to the nerve matter, and when is a CBCT scan taken?
The roots of lower wisdom teeth can lie close to the nerves that supply the lower lip, chin, lower teeth and tongue. According to Hull University Teaching Hospitals, 2 to 20 percent of patients have tingling or numbness that can last several weeks; in 0.5 to 2 percent it is permanent. InformedHealth.org gives permanent problems such as altered sensation or damage to neighbouring teeth in up to 1 in 100 people. Upper wisdom teeth border on the sinus.
To assess these risks, the position of the tooth is X-rayed. A study summary by the British Health Research Authority describes usual practice: first a two-dimensional panoramic X-ray and, if the tooth appears close to the nerve on it, a three-dimensional cone-beam CT (CBCT) scan. CBCT gives more detail but means a higher radiation dose, so it is used only when needed. Hull mentions coronectomy for cases with a high nerve risk, in which only the crown of the tooth is removed; whether it is an option is decided after imaging.
What should you watch in the first 24 hours?
On the first day, the aim is to protect the blood clot in the wound. The recommendations of Royal Cornwall Hospitals, Hull, Cleveland Clinic and InformedHealth.org:
- Bite on the gauze: according to Hull, bleeding usually stops within 30 minutes. If it keeps bleeding, bite firmly on the gauze you were given for 15 to 20 minutes.
- Do not rinse: Royal Cornwall advises no rinsing, hot drinks, alcohol or physical exertion in the first 24 hours. Avoid spitting forcefully too.
- No straws: according to Cleveland Clinic, the suction can dislodge the clot.
- Do not smoke: Royal Cornwall recommends at least 24 hours, ideally as long as possible; InformedHealth.org advises against smoking, hot drinks and fruit juice in the first days and suggests still water or lukewarm chamomile tea.
- Cool the area: according to InformedHealth.org, an ice pack on the cheek in the first days reduces swelling.
- Eat only once the anaesthetic has worn off, so you do not bite your lip or tongue.
- Brush the other teeth: the NHS recommends cleaning the remaining teeth carefully and avoiding the wound.
More in our guide after a tooth extraction.
What happens in the following days?
According to Hull, swelling is worst on days two and three and fades within a week; Royal Cornwall gives up to two weeks until it has fully gone. Limited mouth opening can last a few days.
- Eating: the NHS recommends soft food until chewing is comfortable again; InformedHealth.org names potatoes, fish or pasta.
- Mouth care: Royal Cornwall recommends normal brushing from the second day and gently bathing the socket with warm salt water.
- Sport and sauna: InformedHealth.org advises avoiding both for several days, even if you feel well.
- Stitches: dissolving stitches usually disappear within one to two weeks, according to Hull.
How do you recognise a dry socket?
With a dry socket, the clot is lost early and the bone lies exposed. According to Cleveland Clinic, it affects about 2 to 5 percent of all extractions, more often after wisdom teeth, and smokers are more than three times as likely to develop it. Hull advises getting in touch if pain increases rather than eases 3 to 10 days after removal or a bad taste develops; it is painful but treatable.
When should you get in touch?
Following the advice of Hull University Teaching Hospitals, get in touch if you have:
- bleeding that does not stop despite pressure
- pain, taste or smell that worsens after the third day
- fever, feeling unwell, tender glands under the jaw, or hot, red, hard skin over the jaw
- mouth opening that does not improve over days
- numbness, tingling or pain that does not ease or increases
With difficulty breathing or swallowing, or swelling spreading towards the neck or eye, go to an emergency department straight away; otherwise, outside opening hours, contact your local emergency dental service.
What does this mean for your trip and your flight home?
Do not book your flight home for the day of the procedure. Hull advises against scheduling wisdom tooth removal immediately before travel abroad; for a treatment trip, that means planning the recovery days on site. An article in the British Dental Journal (Felkai and colleagues, 2023) gives 72 hours after a surgical extraction as the minimum before flying, provided there is no pain, swelling or bleeding, and recommends rather a week after most dental procedures. After procedures near the sinus, such as upper wisdom teeth, a longer wait may be advised. Your dentist decides after the procedure; plan at least one buffer day before your flight for a check.
At our clinic in Serdivan, the decision to remove a tooth is made after the examination. A CBCT scanner is available and is used for impacted wisdom teeth close to the nerve or the sinus when needed. The procedure is usually carried out under local anaesthetic; treatment under general anaesthesia is possible if needed. Before treatment starts, you receive a written treatment and cost plan; when you leave, a treatment summary and copies of your X-rays. After your return you can reach us on WhatsApp at +90 532 363 49 54; during opening hours we reply in English and German within 15 minutes. More on our tooth extraction page, on dental treatment in Türkiye and on aftercare and follow-up.