Wisdom teeth are not teeth that should be extracted instinctively but structures that require scientific and clinical evaluation.
The most appropriate approach is to continue regular dental check-ups from the age of 17-18 and to monitor the condition of these teeth by having a panoramic X-ray taken. Your dentist will assess your specific situation (age, jaw structure, tooth position, oral hygiene, general health) and provide you with a personalized treatment plan. This plan may involve 'extracting them immediately,' 'monitoring them at specific intervals,' or 'leaving them alone.'
Early diagnosis and intervention always result in a simpler, less painful, and lower-risk treatment process.
Situations requiring the extraction of wisdom teeth:
Pericoronitis (Infection of a partially impacted tooth)
When a tooth fails to erupt completely, a pocket called an 'operculum' forms between the gum tissue partially covering it and the tooth surface. Food debris and bacteria accumulate in this pocket, creating an area that is impossible to clean. Once pericoronitis develops, it can be temporarily controlled with antibiotics and mouthwashes, but it often recurs because the underlying anatomical cause (operculum) remains.
Symptoms:
- Severe pain and sensitivity
- Redness, swelling, and bleeding of the gums
- Bad breath (halitosis) and a bad taste in the mouth
- Jaw locking (trismus) and difficulty opening the mouth
- In advanced cases, swelling of the face, enlarged lymph nodes, and fever (signs of systemic infection)
Impacted teeth and complications
The position of impacted teeth is very important. Your dentist will assess this position on an X-ray:
Types of impacted teeth:
Mesioangular impacted:
The tooth is impacted at a 45-degree angle towards the tooth in front of it. This is the most common type.
Distangular impacted:
The tooth is impacted at an angle towards the back. Extraction is more difficult.
Horizontal impacted:
The tooth is completely horizontal and exerts direct pressure on the root of the tooth in front of it. It is one of the most problematic types.
Vertical impacted:
The tooth is vertical but has stopped erupting within the bone or gum tissue.
Secondary problems caused by impacted teeth:
Risk of cysts and tumours:
The tooth sac (follicle) surrounding the impacted tooth may expand and develop into a cyst called a 'dentigerous cyst.' This cyst grows slowly but progressively, causing:
- Resorption of the jawbone and bone weakness (risk of pathological fracture),
- Resorption of the roots of adjacent teeth,
- Pressure on the jaw nerve, causing numbness,
- Very rarely, it can develop into benign or malignant tumors such as ameloblastoma.
Resorption (melting) of the neighboring tooth:
An impacted wisdom tooth can cause resorption (melting) of the root of the healthy second molar in front of it by applying constant pressure. This condition is often noticed late and can lead to the loss of both the wisdom tooth and the valuable second molar.
Caries and periodontal (gum) disease
Difficulty cleaning:
The position of wisdom teeth makes effective cleaning with a toothbrush and dental floss nearly impossible.
Secondary decay:
Not only does the wisdom tooth itself decay, but the decay it causes also initiates decay on the back surface of the second large molar immediately in front of it. This can mean the loss of a much more valuable tooth.
Bone loss:
Gingivitis (gum inflammation) starting in the wisdom tooth area causes the bone surrounding the tooth to deteriorate over time. This bone deterioration can also affect the healthy teeth in front, paving the way for them to become loose and fall out in the long term.
Factors influencing the decision to extract wisdom teeth preventively (prophylactically)
When recommending the extraction of a wisdom tooth that has not yet caused problems, the dentist performs a risk/benefit analysis. Factors influencing this analysis:
Patient age (The most critical factor):
Early 20s:
The tooth roots are 66-75% developed. The bone is more elastic. Recovery after extraction is very rapid. The risk of complications (nerve damage, fractures, etc.) is at its lowest.
30s and older:
The roots are fully developed and curved. Bone density has increased. The healing period is longer. The risk of complications increases significantly. The surgical procedure becomes more complex.
General health status:
Conditions such as diabetes, osteoporosis treatment, and the use of immunosuppressive (immune-suppressing) drugs affect the decision and timing of extraction.
Orthodontic treatment plan:
Orthodontists often request the extraction of wisdom teeth, particularly in patients with narrow jaws, to prevent the realigned teeth from shifting back to their original position following long-term treatment.
Situations in which wisdom teeth may not be extracted:
For a wisdom tooth to be classified as 'preservable,' the following four conditions must be met simultaneously:
Full function:
The tooth must have a complete and correct occlusal relationship with the opposing tooth and actively participate in the chewing function. If the opposing tooth is extracted, this tooth becomes an 'antagonist-free tooth' and tends to elongate over time, which causes problems.
Accessible hygiene:
Both the buccal surface of the tooth and the surface facing the anterior tooth must be effectively cleanable with a standard toothbrush and dental floss. Your dentist can assess this during an examination.
Asymptomatic:
There should be no pain, discomfort, recurrent gum swelling, or bad breath associated with the presence of the tooth.
Radiographically unproblematic:
On panoramic X-ray,
- There should be no cystic lesion around the tooth,
- It should not exert damaging pressure on the root of the adjacent tooth.
- It should not show abnormal proximity to the jaw nerve.
The process of extracting wisdom teeth and the aftermath
Simple extraction vs. surgical extraction:
A fully erupted wisdom tooth can be extracted with forceps like a normal tooth (simple extraction). However, 'surgical extraction' is required for impacted or partially erupted teeth. In this procedure:
- Local anesthesia is administered (general anesthesia may also be required).
- An incision is made in the gum tissue.
- Access to the underlying bone is gained, and bone removal may be performed if necessary.
- If the tooth cannot be removed intact, it is sectioned (cut into pieces) for extraction.
- The area is cleaned and stitched.
Recovery process:
The first 24-48 hours are when swelling and pain peak. A painful complication called 'dry socket' (alveolitis) may develop. Complete bone and soft tissue healing takes several weeks.
What should you pay attention to after having a wisdom tooth extracted?
The first 24 hours
- During this period, your goal is to stop the bleeding, control the swelling, and prevent a painful complication known as a “dry socket.”
- Keep the gauze pad placed by your dentist in place by biting down firmly and continuously for at least 30-45 minutes.
- If bleeding continues, make a new tampon by rolling a clean gauze pad or cotton wool (by hand), moisten it, and apply pressure to the bleeding area for another 20-30 minutes.
- Do not spit, as constant spitting disrupts the negative pressure in the mouth, dislodging the clot and restarting the bleeding. Swallowing the saliva that fills your mouth is safest.
- To control swelling, apply cold compresses intermittently to the side of the face where the extraction was performed for the first 24 hours. (E.g., apply cold for 20 minutes, then take a 20-minute break). You can use an ice pack or a cold towel for this. Cold constricts the blood vessels, reducing swelling and pain.
- Taking the painkiller prescribed or recommended by your dentist before the pain starts (usually before the anesthetic wears off) is most effective.
- Do not take aspirin. Aspirin can increase bleeding due to its blood-thinning effect.
- Avoid physical activity on the first day. Do not engage in strenuous exercise or lift heavy objects. Sleeping with your head elevated on a high pillow can help reduce swelling.
For the first 3 days
Consume soft and warm foods such as soup, purée, yogurt, banana, pasta, and eggs.
Things to avoid:
- Hot food and drinks (may loosen the clot).
- Hard, difficult-to-chew foods (chips, nuts, toast).
- Spicy and acidic foods.
- Drinking through a straw (creates a vacuum effect in the mouth that dislodges the clot).
First 24 hours: Do not brush your teeth. Do not rinse your mouth. Only after meals, swish lukewarm water around your mouth and slowly spit it into the sink (without smacking your lips).
After 24 hours: you can brush your other teeth with a soft toothbrush, avoiding the extraction site. You can use the mouthwash provided by your dentist or warm salt water (1 teaspoon of salt in 1 glass of water) 2-3 times a day, again gently.
Things to watch out for during the week
- Do not smoke or drink alcohol. Smoking delays healing due to the chemicals it contains and the suction action, and increases the risk of infection. Alcohol can trigger bleeding and interact with medications.
- Do not touch or fiddle with the extraction site with your tongue, finger, or any other object.
- Try to sneeze with your mouth open or soften your cough as much as possible. Sudden changes in pressure can damage the clot.