Wisdom tooth

Wisdom teeth and dental extractions
Commonly the wisdom teeth, in an attempt to erupt, will be prevented in doing so by the teeth in front. As such, the wisdom teeth will remain partially or completely below the line of the gum (also called impaction).
This can lead to an infection around the wisdom tooth or lead problems with adjacent teeth.
We offer wisdom teeth extractions that are carried out by our expert dental surgeons.
We also have a three dimensional ct scanner often found in hopsitals, to reconstruct your jaws in digital three dimension which enables us to carry out comprehensive diagnostics prior to any teeth extractions.
Sedation is offered for teeth extractions if required.
There are specific guidelines for the removal of these impacted wisdom teeth which we will advice you, and we follow guidelines from the National Institute of Clinical Excellence.
The procedure may require the gum around the tooth to be lifted back and the bone around the tooth to be selectively removed to allow the wisdom tooth to be removed. We have specialist technology such as the piezotome to ensure a minimal intervention procedure.
A wisdom tooth, also called third molar is one of the three molars of human dentition. They usually start to come through the back of our gum and at each corner of jaw towards the late teens and early twenties. Adults mostly have 4 wisdom teeth which mean one in each of the four quadrants, however they can have fewer or more. These extra teeth are known as supernumerary teeth. Wisdom teeth is said to affect other teeth when they grow and become impacted. They are usually extracted by wisdom teeth removal procedure when or even before this occur.
Wisdom Tooth Pain and Complications
The lack of room in the human jaw can result in either emergence of these teeth from an angle or below neighbouring teeth; or only partial mergence. In either case, these abnormal emergences are termed “impacted”, and are characterized by wisdom tooth pain, which is the typical pain at the back of our jaws when wisdom teeth come out.
Impacted wisdom teeth can trap food and bacteria, initiating a build-up of plaque, which in return results in further dental complications such as gum disease and tooth decay. However, removal of some impacted wisdom teeth are not advised, as some impacted teeth tend not to cause other dental problems. Nevertheless, some clients tend to go ahead with the procedure of extraction of their impacted wisdom teeth, as in modern days they are not of great benefit, and taking the removal cost to consideration, it is the option many have chosen to protect their smiles.
Wisdom Tooth Extraction
Anesthesia
Before initiating the wisdom tooth extraction, our surgeons prioritize your comfort by administering appropriate anesthesia. Local anesthesia is the most common choice, and it is typically administered as follows:
- Topical Anesthetic Gel: A topical anesthetic gel may be applied to the gum tissue at the extraction site. This gel numbs the surface area, ensuring that you do not feel the initial needle prick.
- Local Anesthetic Injection: Our surgeons will then carefully inject a local anesthetic solution into the gum tissue near the wisdom tooth. This solution contains a numbing agent, typically lidocaine or articaine, which blocks pain signals from the nerve endings in the area. You may feel a slight pinch during the injection, but this discomfort is momentary, and the area quickly becomes numb.
- Monitoring and Adjustments: After administering the local anesthesia, our surgeons will take a few moments to ensure that the entire extraction site is adequately numbed. We may use a dental probe to confirm that you do not feel any pain. If needed, additional anesthetic may be administered to ensure complete numbness.
Step 3.2: Incisions (if necessary)
In some cases, wisdom teeth are partially or fully impacted, meaning they have not fully emerged from the gum tissue or are positioned at an angle that makes extraction challenging. In such situations, our surgeons may need to make small incisions in the gum tissue to access the wisdom tooth. The incisions are strategically placed to provide optimal visibility and access to the tooth’s position.
Tooth Extraction
Tooth Mobility Assessment
Before initiating the extraction process, our experienced surgeons perform a comprehensive assessment of the wisdom tooth’s mobility. This evaluation helps determine the complexity of the extraction. Wisdom teeth can vary in their positioning and attachment to the surrounding bone, which can affect the extraction technique used.
- Tooth Loosening: To begin, our surgeons use dental instruments to assess the mobility of the wisdom tooth. A gentle rocking motion is applied to ascertain the degree of looseness. In some cases, a tooth may already be somewhat mobile due to the natural eruption process or impaction.
- Assessing Bone Attachment: In cases where the tooth is firmly anchored to the surrounding bone, our surgeons carefully evaluate the attachment points. The extent of bone contact and the presence of bony overgrowths or irregularities are taken into account.
Elevator Usage
Once the mobility of the wisdom tooth has been assessed, our surgeons proceed with the extraction process. An elevator, a specialized dental instrument, plays a crucial role in facilitating the extraction. Here’s how it works:
- Placement: The elevator is carefully inserted into the space between the tooth and the surrounding bone. It is positioned in a way that minimizes trauma to the adjacent tissues, such as the gum and the neighbouring teeth.
- Leverage and Lift: Using precise and controlled movements, our surgeons apply gentle pressure with the elevator. This leverage action serves to gradually separate the wisdom tooth from the surrounding tissues and bone. The elevator’s design allows for precise manipulation while minimizing trauma to the neighboring structures.
- Tooth Elevation: As the elevator is maneuvered, it lifts the wisdom tooth within its socket. This elevation process further loosens the tooth, making it easier to extract. The gradual and careful nature of this step helps prevent damage to the surrounding bone and tissues.
Tooth Removal
With the wisdom tooth adequately loosened and elevated, our surgeons proceed to the final stages of extraction:
- Tooth Grasping: Using dental forceps specially designed for tooth extraction, our surgeons securely grasp the wisdom tooth. The forceps provide a controlled grip, allowing for precise manipulation during the removal process.
- Gentle and Gradual Extraction: Our surgeons employ a gentle and gradual extraction technique. The tooth is moved along its natural axis, following the path of least resistance. This minimizes the risk of fracturing the tooth or damaging the surrounding bone.
- Possible Sectioning: In certain cases, such as when a wisdom tooth is deeply impacted or its shape makes removal challenging, our surgeons may opt to section the tooth into smaller pieces for easier extraction. This method minimizes trauma to the surrounding tissues and facilitates the removal of particularly stubborn wisdom teeth.
- Socket Assessment: Once the wisdom tooth has been successfully extracted, our surgeons inspect the socket—the space left in the bone where the tooth once resided. The socket’s cleanliness and integrity are carefully evaluated to ensure optimal healing.
Hemostasis and Closure
After the wisdom tooth has been removed, our surgeons focus on promoting healing and preventing bleeding:
- Hemostasis: Hemostatic agents may be applied to the socket if necessary to promote blood clot formation and control bleeding.
- Socket Inspection: The socket is inspected again to ensure that there are no sharp bony edges or debris that could impede healing.
- Closure (if necessary): If an incision was made to access an impacted wisdom tooth, our surgeons may use dissolvable sutures to close the incision. These sutures are designed to facilitate proper healing and minimize the risk of infection. The use of sutures is determined on a case-by-case basis.
Cleaning and Stitching (if necessary)
After the wisdom tooth is successfully extracted, our surgeons focus on the following steps:
- Cleaning the Extraction Site: The extraction site is meticulously cleaned to remove any remaining debris, fragments, or infection. Thorough cleaning reduces the risk of postoperative complications.
- Socket Examination: Our surgeons inspect the socket (the space in the bone where the tooth was located) to ensure it is free from any sharp bony edges or irregularities.
- Suturing (if necessary): In cases where an incision was made to access an impacted wisdom tooth, our surgeons may use dissolvable sutures to close the incision. These sutures promote proper healing and minimize the risk of infection.
Postoperative Care Instructions
Following the wisdom tooth extraction procedure, our surgeons provide you with detailed postoperative care instructions, which may include:
- Pain Management: Guidance on managing postoperative pain and discomfort, including the use of prescribed pain medications or over-the-counter pain relievers.
- Oral Hygiene: Instructions on how to maintain oral hygiene while avoiding the extraction site during the initial healing period. This often involves gentle rinsing with a saltwater solution and avoiding vigorous brushing or flossing near the extraction site.
- Dietary Recommendations: Dietary guidelines, such as following a soft-food diet for a few days to a week to prevent irritation of the extraction site and promote healing.
- Follow-Up Appointments: Scheduling follow-up appointments to monitor your healing progress, remove sutures if necessary, and address any questions or concerns.
T-he wisdom tooth extraction procedure is a carefully orchestrated process that prioritizes patient comfort through anesthesia, employs precise techniques for tooth extraction, and ensures a clean and well-prepared extraction site. Our surgeons take every precaution to ensure the successful completion of the procedure and set the stage for a smooth and comfortable recovery process.
Signs and symptoms of oral infection caused by a wisdom tooth include:
- Red & itchy gum near the wisdom tooth
- Swelling
- Feeling Pain
- Pus coming from the gum
- Lymph glands under the jaw become swollen and sore
- Feel the difficulties to open the mouth
- Suffering from Fever
Wisdom teeth do not have to be removed in case they are impacted but not creating any problem. This is mainly due to the fact that they carry severe complications.
Sometimes, wisdom teeth which get impacted or have not broken completely may lead to serious oral problems. Both food particles and bacteria may get trapped in your wisdom teeth, causing build-up plaque that can be the reason for:
- Tooth Decay – This mainly occurs when the plaque breaks down on the surface of your tooth. When tooth decay or dental carries becomes advanced, it leaves cavities in the tooth which may affect your surrounding teeth.
- Gum Disease (Periodontal disease or gingivitis) – This takes place when plaque releases toxins that cause irritation in the gums causing them to turn red, painful and swollen. Gum disease may even affect surrounding teeth and bone around your wisdom teeth.
- Pericoronitis – When plaque causes infection of the soft tissue that surrounds your tooth.
- Cellulitis – a bacterial infection that occurs in the tongue, cheek or throat.
- Dental Abscess – When pus collects in your surrounding tissue or wisdom teeth due to bacterial infection.
- Cysts and Benign Growths – Wisdom tooth that has not been cut through the gum and develops a cyst or a fluid-filled swelling.
You can treat most of these problems by taking antibiotics and mouthwash. Thus, it is only recommended to remove your wisdom teeth when other treatments do not work out.
Your dental surgeon may remove your wisdom teeth or refer you to a specialist for further treatment.
Before the treatment begins, you will be given local anaesthetic injection to make the area insensitive around the tooth. You might feel some pressure before the tooth is being removed. The oral surgeon has to widen tooth socket by rocking both back and forth.
In certain cases a cut might be required in the gum and your tooth may be cut into small pieces before it gets removed.
The time required to remove the tooth will vary from person to person. Some procedures take only a few minutes, whereas others may require 20 minutes or more.
Local anaesthetic injections are normally given to clients to numb the area, to make the extraction procedure completely painless. The only feeling you will have is the slight pressure upon removal of your tooth. Sometimes your dentist might think it is necessary to cut your gum, and cut your tooth into smaller pieces in ensure that you are not feeling any discomfort throughout the procedure. The procedure is performed by our expert and experienced dentist who reduce the chances of acquiring infections to minimum.
After your wisdom tooth is removed, there might be some complications which include:
- Swelling or inflammation of your cheeks and mouth
- severe bleeding
- dry socket in which blood clot does not form into the tooth socket or if blood clot gets dislodged
- nerve injury that may be the reason for temporary or permanent problems like numbness and pain
- infection which shows signs of white discharge from extraction, high temperature and constant pain and swelling
Generally it’s taken three to four days, although it can be as long as two weeks. The lenth of recovery time for wisdom teeth removal depends a lot on how badly they were impacted and erupting.
- To prevent swelling and skin colour changes use an ice pack
- Exercise your jaw by slowly closing and opening your mouth
- Keep hydrated
- Start brushing your teeth after one day, unless advised otherwise
- Only use the painkillers prescribed/advised by your doctor
- Eating hard or sticky food
- Drinking fizzy drinks as much as possible
- Do not use a straw to drink, as it may loosen your blood clots for the first 48 hours
- Smoking as much as possible
- Vigorous rinsing of your mouth for the first 24 hours
Wisdom tooth extraction cost may vary depending on the extent of the procedure. Generally, a non-surgical removal procedure could cost anywhere from £150 to £350. The mentioned price range only covers the teeth removal procedure and does not include any fees related to X-rays or oral surgeries.
Typically, the cost of extracting a wisdom tooth depends on the following factors:
- The complexity and extent of the extraction procedure (e.g. impacted tooth)
- The type of the procedure (surgical or non-surgical)
The exact wisdom tooth removal cost will be discussed during the consultation session in which the dentist examines the situation and decides which procedure is suitable to conduct the extraction process in the safest possible manner.
Our Wisdom Tooth Surgeon

Dr Javier Perez
Dental Implant and Oral Surgeon
Lic Odont, PG Cert (Implant), MClinDent (Implant), Dip Oral Surg RCS (Eng), PG Cert Cons Sed
GDC No: 225487
Special interest in Oral Surgery & Dental Implants
Dr Javier Perez graduated in dental surgery in 2010.
His clinical practice is focused on dental implants and oral surgery, from simple single tooth replacements to complex reconstructions involving both soft and hard tissues.
Dr Javier has completed a Masters in Implant Dentistry MClinDent (Implant) in London over three years and was awarded a diploma in Oral Surgery from the Royal College of Surgeons of England, one of the most prestigious colleges in UK.
Dr Perez has trained in Oral Surgery at the Maxillofacial Unit in the Queen Victoria Hospital NHS Foundation Trust in South England. He is at the forefront of dental implants and oral surgery regularly attending National and International conferences to develop his skills and learn about the latest trends in Implantology.
At Dulwich Dental our implant team have placed over 5000 implants, often undertaking and being referred cases from other practioners. We also consult and treat cases where you may have been told that you are unsuitable for dental implants. Having assembled one of the countries leading dental implant teams we can treat the most advanced and complex cases here at Dulwich Dental Office.
Outside of work Dr Javier spends the majority of his time with his young family, recently welcoming a new son (October, 2021). He enjoys spending weekends exploring London, especially going to local food markets.
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