The wisdom teeth are the third and last molars, usually numbering four, distributed between the maxilla and the mandible (upper and lower jaws). They typically erupt between the ages of 16 and 18, although in some cases, agenesis or failure to erupt may be observed.
Table of Contents
- Why Operate?
- What Should You Know Before the Extraction of Wisdom Teeth?
- The Procedure for the Extraction of Wisdom Teeth
- After the Extraction of Wisdom Teeth
Why Operate?
If a wisdom tooth shows symptoms such as pain, swelling, cheek edema, or trismus (involuntary and persistent contraction of the masticatory muscles that limits mouth opening), it should be evaluated and, if necessary, extracted. Indeed, these signs can precede the onset of cervico-facial cellulitis of dental origin—an infection that spreads to the face and neck. Various stages of life may thus justify the extraction of wisdom teeth.
A) When they are impacted, that is, still within your jawbones, before age 16:
- To facilitate orthodontic treatment by allowing the realignment of teeth and creating additional space,
- As part of an orthodontic-surgical management in preparation for jaw surgery or orthognathic surgery,
- In cases of posterior crowding, meaning there is insufficient space for a harmonious eruption.
B) During their eruption, starting from ages 16–18:
When erupting, often between 16 and 18 years old, the wisdom teeth may emerge partially or become blocked due to a lack of space or dental crowding. This situation can lead to painful episodes caused by recurrent infections (pericoronitis) or promote the development of cavities on the affected tooth or neighboring teeth. In some cases, extraction is necessary to preserve the vitality of the second molar located immediately in front.
C) When the eruption of the wisdom teeth is properly achieved and they are in a satisfactory position on the arch:
Even when they erupt correctly and occupy an ideal position in the dental arch, the wisdom teeth remain vulnerable to cavities, infections, or gingivitis (which can lead to the formation of painful inflammatory pockets), necessitating their extraction.
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What Should You Know Before the Extraction of Wisdom Teeth?
Before the extraction of wisdom teeth, an initial consultation with your dental surgeon is essential and constitutes a mandatory medico-legal step prior to the procedure. This consultation allows for the review of your medical history, allergies, and current treatments. Don't forget to bring your medication prescriptions.
If you have already seen a dental surgeon or orthodontist, be sure to provide the corresponding letter or report.
A clinical examination will assess your wisdom teeth, your ability to open your mouth, and the condition of the adjacent teeth and gums.
A panoramic X-ray, mandatory from a medico-legal standpoint, provides a detailed view of the size and position of your wisdom teeth within your jaws, the length and configuration of their roots, their relationship with adjacent teeth, the inferior alveolar nerve (responsible for sensation in the lower lip and chin), and the maxillary sinuses. Please bring this X-ray to your consultation; if not, we can obtain one at our office in the 17th arrondissement of Paris.
If the roots of your wisdom teeth are in close contact with the inferior alveolar nerve, a mandibular CT scan is imperative preoperatively. It precisely locates the nerve to protect it during surgery. The need for this scan will be determined during your consultation.
The procedure can be performed under local or general anesthesia, with the choice being discussed together. In the case of general anesthesia, a preoperative consultation with the anesthesiologist is required.
During this appointment, specific instructions regarding the management of your personal treatments will be provided, and it is essential that you adhere to them.
The Procedure for the Extraction of Wisdom Teeth
Modalities for Performing Your Surgical Procedure
To extract one or more of your four wisdom teeth, you have two options:
- Local Anesthesia: The procedure is performed in our dedicated operating room, which meets hygiene and safety standards. Please bring your panoramic X-ray and ensure you have eaten beforehand. The management of your personal treatments will have been discussed during the initial consultation. After the procedure, you will receive a prescription for post-operative medications; it is advisable to be accompanied by someone. If extraction of all four teeth is necessary, the procedure may be carried out in two sessions spaced 15 days apart, one side at a time.
- General Anesthesia: Performed in a hospital setting (approximately half a day), following consultation with the anesthesia team and pre-admission. Bring your panoramic X-ray, the mandibular CT scan (if prescribed), and come fasting. It is imperative that you leave accompanied by someone and that you are not alone for 24 hours following the procedure.
Procedure Flow
Regardless of the chosen anesthesia method, any incisions remain hidden inside the mouth, in contact with the areas of the wisdom teeth.
The extraction may involve one to four wisdom teeth.
Absorbable sutures may be used.
An injection of local anesthetic is administered at the end of the procedure to enhance your comfort and reduce pain during the following 24 hours.
Whether following local anesthesia or during your outpatient stay under general anesthesia, you will be able to resume eating and speaking immediately after the procedure.
After the Extraction of Wisdom Teeth
Wisdom Teeth: Post-Operative Course
- It is strictly forbidden to smoke during the month following the procedure, until complete healing is achieved.
- Regularly apply ice packs to the operated areas for several hours a day during the first 2 to 3 days to reduce swelling and improve comfort.
- Avoid excessively hot environments, both day and night.
- Sleep with your head elevated using pillows.
- You may consume food starting on the first post-operative day, provided that it does not require significant chewing effort (soft, pureed, minced, mashed, or liquid foods) during the first 5 days.
- Refrain from consuming hot foods or beverages for 2 days; opt for cold or lukewarm items (for example, ice cream or sorbet) as cold relieves pain while heat may promote bleeding.
- After each meal, thoroughly brush your teeth with a surgical soft-bristled toothbrush (e.g., INAVA 7-8/100), gently cleaning the operated areas. Then rinse thoroughly with cool water and use an antiseptic mouthwash to eliminate any food residue.
- A slight bleeding or a change in the color of your saliva during the first 2 days is completely normal. In such cases, drink a large glass of ice water and suck on some ice cubes.
- Strictly adhere to the prescribed dosage of post-operative medications.
Results of the Extraction
With the post-operative prescription including pain relievers, anti-inflammatories, and, if necessary, antibiotics, pain management and your comfort are ensured.
In general, post-operative swelling or edema disappears within 3 to 5 days, although this may vary.
Complete healing of the gums and the disappearance of scars require approximately 3 weeks.
Possible Complications
As with any surgical procedure, the extraction of wisdom teeth carries some risks, although these are rare. It is essential to have the procedure performed by a specialist with proper training and complete mastery of these techniques.
- Pain at the surgical site, swelling of the cheeks, and difficulty opening the mouth due to muscle spasms may occur. These symptoms are generally alleviated by local anesthetic injections at the end of the procedure, supplemented by pain relievers and anti-inflammatories, which help improve your comfort and reduce pain within the following 24 hours.
- An infection of the surgical site or alveolitis may appear up to 3 weeks after the procedure, often resolved with antibiotic therapy. It is imperative not to smoke during the post-operative period, as this increases the risk of infection.
- Bleeding at the incision sites is common during the first 2 to 3 days but can be minimized by applying ice, consuming cold foods, and sucking on ice cubes.
- A temporary loss of sensation (hypoesthesia or anesthesia) in the lower lip, chin, and tongue may occur. Most patients regain normal sensation within a few days, although for some, recovery may take several weeks or even months, sometimes with residual effects. This complication is related to the proximity of the inferior alveolar nerve (affecting sensation in the lip and chin) and the lingual nerve (involved in tongue sensation and taste) relative to the lower wisdom teeth. However, the mobility of the lip and tongue remains intact, and these changes are generally imperceptible to others.
- For wisdom teeth located in the upper jaw that remain impacted, their proximity to the maxillary sinuses can result in maxillary sinusitis or, in rare cases, an oroantral communication (allowing air and fluid to pass between the mouth and the sinus), as well as rare dislocations into the sinus or pterygopalatine fossa.
- The onset or worsening of preexisting symptoms in the temporomandibular joint (such as pain or joint noises) may also occur, requiring appropriate treatment.
- In exceptional cases, a fracture of the mandible may occur.
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