When is it a good idea to have your wisdom teeth pulled?

The decision about whether or not to have wisdom teeth pulled will mainly depend on whether they are already causing trouble or whether it is highly likely that they will in the future. It is important to get answers to the following questions before having any wisdom teeth removed:

• Have your wisdom teeth already caused pain or damage to your jaw or nearby teeth, or is there an increased risk of that happening?
• Are the wisdom teeth preventing the other teeth from developing properly?
• Might the wisdom teeth interfere with other dental or jaw-related treatments that are already planned?
• What risks are associated with surgery?
• Could the wisdom teeth "replace" molars (back teeth) that are missing or badly damaged?

People who have crooked incisors (front teeth) or small jawbones sometimes worry that their teeth may be pushed out of place even more if their wisdom teeth grow out of the gum. But that's not necessarily the case. The same is true for those people: Their wisdom teeth can be left in if the dentist doesn't expect them to affect other teeth.

What are the potential side effects of having wisdom teeth removed?

Most people have swelling in their mouth or cheeks after the operation and can't fully open their mouth for a few hours or even a few days. Many have pain right after the procedure, but it doesn't last long.

But if the pain returns after four or five days, gets worse and is accompanied by swelling or bad breath, the wound could be infected. This can happen if the dried blood that closes the wound comes off too soon, leaving the wound unprotected. Antiseptic mouthwashes or gels can help to prevent these kinds of complications. There's usually no need to take antibiotics.

Nerves and blood vessels can be damaged during the procedure. This can cause bleeding and usually temporary numbness in the tongue or face. In very rare cases serious infections may occur. Up to 1 out of 100 people may have permanent problems as a result of the procedure, such as numbness or damage to nearby teeth. The risk of this happening will depend on how extensive the procedure needs to be.

Wisdom teeth are typically removed under local anesthesia. General anesthesia may be used for more complex procedures.

What can you do about pain after the operation?

A lot of people use painkillers after the operation. Sometimes they are already given painkillers beforehand. Both ibuprofen and acetaminophen (paracetamol) can help to relieve pain after the procedure. Acetylsalicylic acid (the drug in medications like “Aspirin”) isn't suitable before or afterwards because it increases the risk of bleeding.

Research shows that a 400 mg dose of ibuprofen relieves pain better than a 1,000 mg dose of acetaminophen does. A combination of 1,000 mg acetaminophen and 400 mg ibuprofen relieves pain better than an equal dose of acetaminophen or ibuprofen on their own, and the effect lasts longer too. Adults should only take this combination every eight hours at the most to avoid going over the maximum dose for both drugs. The maximum dose of ibuprofen in adults is 800 to 1,200 mg in 24 hours. The maximum dose of acetaminophen is 4,000 mg in 24 hours.

Sometimes people are given the enzyme bromelain instead, to reduce the inflammation and pain. But there's a lack of good research on the benefits of this drug.

For a few days after the procedure, holding an ice pack against your cheek can help to reduce swelling. You should avoid smoking cigarettes or drinking fruit juices and hot drinks in the first few days because they can slow down the healing process. Drinks like still water or lukewarm chamomile tea are more suitable. Hard foods also sometimes cause problems. Not-too-hot soups and foods that can be crushed using your tongue are easier to eat, like potatoes, fish or pasta.

It's better to avoid doing strenuous physical activities like sports or going to the sauna in the first few days after having teeth pulled because that could affect the healing process too. This is also true even if you're already feeling better.

Sources

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• IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

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