Wisdom Teeth: Symptoms, X-rays and When Removal Makes Sense

Wisdom teeth are the third molars, the last teeth to come through, usually in the late teens or early twenties. Some people never develop them; others have all four arrive without any fuss. Problems tend to start when there isn't enough room at the back of the jaw and a tooth only partly breaks through or comes in at an angle. Dentists call this an impacted tooth.

Signs a wisdom tooth may be causing problems

• soreness or swelling of the gum behind your last molar
• a bad taste or smell from the back of the mouth
• pain when biting, or stiffness when opening your jaw
• food repeatedly getting trapped around a partly erupted tooth
• decay in the wisdom tooth or the molar in front of it

Infection of the gum flap over a partly erupted tooth is called pericoronitis. A single mild episode can often be managed with careful cleaning and warm salt-water rinses, but repeated episodes are one of the common reasons removal is advised. If swelling spreads into your cheek or neck, you have a fever, or you find it hard to swallow or open your mouth, seek urgent advice: contact us, call NHS 111, or go to A&E if it is severe.

Why we don't remove them automatically

In the UK, NICE guidance says that impacted wisdom teeth which are free from disease should not be removed routinely. Removal is generally recommended when there is a clear problem, such as repeated infection, decay that can't be repaired, damage to the neighbouring tooth, or a cyst. A wisdom tooth that is sitting quietly is usually monitored at your check-ups rather than taken out.

How the decision is made

A dentist will examine the area and usually take an X-ray to see the position of the roots, the angle of the tooth and how close it sits to the nerve in the lower jaw. For more complex lower wisdom teeth, a 3D CBCT scan can give a clearer picture. At Dental Wellness Mill Hill, wisdom tooth assessments and extractions are carried out by dentists including Dr Nazia Din, a dentist with a special interest in oral surgery, and you will have time to ask questions and weigh up the risks and benefits before deciding.

What recovery usually involves

Most extractions are done under local anaesthetic, so the area is numb during treatment. Afterwards, some swelling, stiffness and soreness for a few days are normal. To help healing:

• avoid rinsing, hot drinks and strenuous exercise for the first 24 hours
• after that, rinse gently with warm salt water after meals
• don't smoke, and don't drink through a straw, as both can disturb the blood clot
• eat soft foods and chew on the other side
• take painkillers as advised by your dentist or pharmacist

Pain that gets worse a few days after the extraction, rather than better, can be a sign of dry socket, where the clot has been lost. Get in touch if that happens, as it can be treated.

Book an assessment

If a wisdom tooth is bothering you, our practice at 46 The Broadway, NW7 3LH is a short walk from Mill Hill Broadway station and easy to reach from Burnt Oak, Colindale and Arkley. Call 020 3930 4900, email smile@dentalwellnessmillhill.co.uk or book online.

You can also read about wisdom tooth removal on our website.