Extraction Of Wisdom Teeth [3rd Molar] (Patient’s Manual)



Dr.Deb - Founder of DentalOrg.Com
A Happy Dentist, On Line Entrepreneur, Guitarist & Musician, Big Foody & Cinema Lover. He loves to share information that will be of help to students.



Wisdom teeth are your third molars that are way in the back of your mouth. You usually have four wisdom teeth, one in each corner of your mouth – two on top, two on bottom. Wisdom teeth are the last of your teeth to come in, or erupt through the gums. They normally emerge between ages 17 and 25, a time of life that has been called the “Age of Wisdom.


Wisdom teeth do not always cause complications or pain. But because many people have too little space in their jaw, they sometimes grow at an angle, pushing on, or getting stuck against, other teeth. This is known as impacted wisdom teeth, and it affects almost three out of four people in their 20s. A trip to the dentist for an x-ray of your teeth can tell you if your wisdom teeth are impacted.
Symptoms of  Impacted tooth >>>

Wisdom teeth pain, infection, or decay- Why third molars are extracted? from H. Ryan Kazemi, DMD on Vimeo.

Crowding of other teeth.

Tooth decay or gum disease if there’s not enough room to properly care for the wisdom tooth and surrounding teeth.

Pain or jaw stiffness near an impacted tooth. Pain or irritation from a tooth coming in at an awkward angle and rubbing against your cheek, tongue, or top or bottom of the mouth. An infected swelling in the flap of gum tissue that has formed on top of an impacted tooth that has partially broken through the gum.


The pulling out of wisdom teeth has become so rampant. The wisdom teeth can be pulled out when it has failed to emerge fully into its expected position. This problem may occur due to lack of space or room in the persons jaw that can accommodate it, or it may occur when the angulations of the tooth is not proper. When the tooth has been impacted mesially, it can be pulled out. This means its erupting towards the front of the mouth. Wisdom teeth can occur vertically or horizontally.

The procedure for the removal of impacted teeth depends upon the type of impaction.

Before Surgery

Wisdom teeth are molars in the very back of your mouth that come in between the age of 17 and 21. If your dentist determines that your wisdom teeth are impacted–or unable to come in due to their placement or being stuck inside the jaw–the teeth will have to be removed. Another reason for wisdom teeth to be removed is if your mouth is too crowded with other teeth and there is no room for them to come in properly. Your dentist or orthodontist will take X-rays and send them to your oral surgeon. Together, they will make a decision to determine how soon your wisdom teeth need to come out.

A good X Ray photograph and OPG go a long way in diagnosing the case and planning of the extraction procedure.

Before the operation dentist, ask most of the people to stop smoke as smoking increase the threat of wound infection and slow down the rate of recovery. During the time of operation patient is not allowed to take any drink or food. Different dentist use different procedure for removing wisdom teeth.

Surgical Steps

Local Anasthesia

Before extraction of the tooth the dentist will anesthetize (numb) the tooth and the area surrounding it (jaw bone and gums), using an local anesthetic, usually lignocaine with 2% adrenaline. It takes around 5 – 10 minutes for the local anesthesia to act and make the area numb. The numbness may last for 2 – 3 hours.

Some people expect the injection to hurt and whatsoever the dentist says they are not ready to accept nor understand. They don’t give the process a chance, thus making a guaranteed unpleasant experience for both themselves and the dentist. The more cooperative a patient is  when the dentist performs the injection the better it will be for him/her.

The discomfort of the injection is related to the rate at which the anesthetic solution is injected. Slower the rate, lesser the discomfort. If you are being a poor patient the dentist’s natural instinct will be to speed up the injection process and to finish it off quickly.

Additionally, when a dentist performs an injection they must place the anesthetic solution in the proper location. If the dentist is focused more on your behavior, as opposed to only on performing the injection, it will increase the likelihood that the injection will be slightly off target and additional injections will be required to numb the area properly.

During the injection relax completely, do not exert or use force by tightening the muscles of your face, hands and legs. Concentrate on your breathing, and breathe in and out normally.

Remember, the injections are never that painful. Surely you will feel a prick but nothing more. Do not fear the unknown. If you are uncooperative the pain will be 10 times more.

Reflecting the gingival tissue

The dentist checks for the proper numbness around the surrounding tissues. If it is an lower tooth, part of your tongue will also feel numb.

If the tooth is underneath the gums the dentist will first make an incision in the gums and then the gums around the tooth is separated from the tooth with the help of a periosteal elevator.

If you feel any pain during this procedure communicate with your dentist and he may inject more local anesthetic to numb the area further.

Surgical Removal of the Tooth

To remove an impacted tooth the dentist must gain access to it through the bone.

If the tooth is encased in bone then the dentist will remove a portion of the bone which lies over and around the tooth.

Sometimes to minimize the amount of bone to be removed around the impacted tooth the dentist will section the tooth into parts, for easier removal.

When your dentist performs the extraction expect to feel a lot of pressure. You will feel a pressure, but no pain. The reason you feel pressure during the tooth extraction is because our body have different types of nerve fibers, each of which carry different types of sensations. The local anesthetic is very effective at blocking pain transmitting nerve fibers, but the nerve fibers which transmit pressure sensations are not so profoundly affected. Expect to feel a pressure during your tooth extraction but don’t assume this indicates that you will soon be feeling pain, because it doesn’t.

The ‘Wisdom’ Behind Wisdom Teeth Extraction from H. Ryan Kazemi, DMD on Vimeo.

If you do happen to feel pain during the extraction you should let your dentist know so they can numb the area some more. But more anesthetic injections will never decrease the pressure sensation you experience.

Recovery After Wisdom Teeth Are Pulled?

During the first 24 hours

Bleeding may occur for several hours after tooth extraction.

To control it, position a piece of clean moist gauze over the empty tooth socket and bite down firmly. Apply constant pressure for about 45 minutes.

A moistened tea bag is an effective alternative. The tannic acid in tea helps healing blood clots to form (blood clots function similarly to scab over an open wound). Repeat this process if a small degree of bleeding continues; if heavy bleeding continues to occur, contact your dentist or oral surgeon.

Avoid rinsing or spitting for 24 hours after tooth extraction, avoid “sucking” actions (for example, don’t drink beverages through straws or smoke) and avoid hot liquids (such as coffee or soup). These activities can dislodge the clot, causing a dry socket (see below) to develop.

Facial swelling in the area where the tooth was extracted typically occurs. To minimize swelling, place a piece of ice, wrapped in a cloth, on that area of your face on a schedule of 10-minutes on, followed by 20-minutes off. Repeat as necessary during this first 24-hour period.

Pain medications, such as acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) can be taken for minor pain. Your dentist or oral surgeon may prescribe more potent pain relievers, such as narcotics, if necessary.

Antibiotics that may have been prescribed prior to tooth extraction (to treat any active infection around the wisdom tooth to be extracted) should continue to be taken until the full prescription is gone.

Foods should be restricted to a liquid diet until all the numbness from anesthesia has worn off. Eat soft foods for a few days. Also avoid alcohol if you’re also taking narcotic pain medication.

Continue to brush your teeth, but avoid the teeth directly neighboring the extracted tooth during the first 24 hours. On day two, resume the gentle brushing of your teeth. Do not use commercial mouth rinses — these can irritate the extraction site.

After 24 hours

Rinse your mouth with warm salt water

Facial swelling in the area of the tooth extraction should be treated with heat after the first 24 hours of ice. Apply a moist warm towel to the area on a 20-minute on, 20-minute off schedule. Repeat as necessary.

Stitches, if used and if not of the self-dissolving type, need to be removed by your oral health care provider in about 1 week. If you do require stitches, ask what type you have been given.

Watch for signs of dry socket (described below). This condition requires treatment by your oral health care provider.

Complete healing doesn’t occur for a few weeks to a few months following the extraction. However, usually within the first week or two, enough healing has taken place for use of your mouth to be reasonably comfortable in the area of the extraction. Your dentist will explain what to expect in your specific case.

Post surgical complications

2 post surgical complications are most common :

Dry socket. Dry socket is a common complication that occurs when either a blood clot has failed to form in the extracted tooth socket or else the blood clot that did form has been dislodged. Without clot formation, healing will be delayed. When it happens, dry socket typically occurs 3 or 4 days following the extraction and is accompanied by pain (ranging from “dull” to moderate to severe) and a foul mouth odor. Your dentist or oral surgeon will treat the dry socket by placing medication in the socket.

Paresthesia. Paresthesia is a less frequently occurring complication. Wisdom teeth entrapped in the jawbone are often close to nerves. Sometimes these nerves can be bruised or damaged during the tooth removal process. The result is a numbness (called a paresthesia) of the tongue, lip, or chin that can last a few days, weeks, months, or may even be permanent.

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