Wisdom Teeth: Out or Not?
How we decide whether a wisdom tooth should come out, what's causing the pain if one flares up, what happens on the day, and how to heal well afterwards.
Do My Wisdom Teeth Need to Be Removed, and What Does It Cost in Hamilton?
Only if they're causing trouble or are likely to. Repeated gum infections around a half-erupted tooth, decay that can't be filled, damage to the molar in front, or a cyst on an X-ray are the usual reasons; healthy wisdom teeth, even buried ones, can normally be left alone. At Hamilton Smile Studios a surgical or wisdom tooth extraction is £450, with a 3D CT scan on site where a lower tooth sits near the nerve, and IV sedation if you'd rather not be aware of it.
Leaving Them Is Often Fine
Wisdom teeth are the third molars, the last teeth to arrive, usually somewhere between 17 and 25. In some people they come through straight and work like any other molar. In others there isn't enough space and they stay under the gum or come up at an angle, which dentists call impacted.
Being impacted isn't a reason on its own to remove a tooth. UK guidance is against taking out wisdom teeth that are healthy and causing no problems, buried or not. Plenty of people go through life with impacted wisdom teeth that never cause a day's bother. Any operation has risks, and if the tooth is quiet, those risks aren't worth taking.
What we do instead is keep an eye on them. At your dental examinations we look at how they're sitting and take an X-ray every so often, so that a tooth starting to decay or harm its neighbour is caught before it becomes painful.
Reasons to Take One Out
| Problem | What it means |
|---|---|
| Pericoronitis that keeps coming back | The gum over a half-erupted tooth gets infected again and again. Two or more episodes is a common reason for removal |
| Decay in the wisdom tooth | Right at the back it's often impossible to fill well or keep clean |
| Damage to the second molar | Food gets trapped between the two teeth and decays the back of the molar in front, which is the tooth you really want to keep |
| Gum disease and bone loss | Pockets around the wisdom tooth threaten the support of the tooth in front |
| A cyst or other change on an X-ray | Fluid-filled sacs can form around buried teeth and slowly damage bone |
| Trauma to the cheek or gum | An upper wisdom tooth biting down onto the gum over a lower one, or rubbing the cheek |
We'll explain which of these applies, and the option of leaving the tooth and monitoring it. You decide, and you'll have the fee in writing before anything is booked. 1
Wisdom Tooth Playing Up?
Book an appointment and we'll X-ray it and explain your options.
Why a Wisdom Tooth Hurts
The commonest cause of a painful wisdom tooth is pericoronitis. A flap of gum partly covers the tooth, food and bacteria get trapped underneath, and the gum swells. You may notice a bad taste, pain when you swallow, a stiff jaw that won't open fully, or swelling on that side of your face. It often flares when you're tired or run down, or have a cold.
A first episode usually settles with careful cleaning, including a soft brush right at the back, and warm salt-water rinses several times a day. We can clean under the flap, and if the upper wisdom tooth is biting onto the swollen gum, smoothing or removing that upper tooth often stops it happening again. A prescription is only worthwhile when the infection has started to spread or you have a temperature. If you keep getting it, removing the lower tooth is the lasting fix.
Pain can also come from decay in the wisdom tooth or the one in front, which an X-ray will show. If swelling makes it hard to swallow or breathe, or spreads towards your eye or down your neck, go to A&E.
Scans Before Surgery
Before removing a wisdom tooth we take an X-ray showing the whole tooth, its roots and the bone around it. In the lower jaw, a nerve runs through the bone just beneath the wisdom tooth roots. It gives feeling to your lower lip, chin and, through a nearby branch, part of your tongue. For many teeth, a standard X-ray shows there's a comfortable gap and nothing more is needed.
When the roots look close to that nerve, we take a 3D CT scan, £160, on the scanner at the practice, so you don't need to go elsewhere for it. 1 The scan shows exactly how the roots and nerve lie, which lets us plan the safest way to remove the tooth and give you a realistic idea of your own risk. Occasionally it shows that a different approach, such as removing only the crown of the tooth and leaving the roots, is safer. Our CT scan guide explains the scan itself.
On the Day
The area is numbed thoroughly with local anaesthetic, so you'll feel pushing and pressure but no sharp pain. A wisdom tooth that has fully come through can often be taken out much like any other tooth. One that's buried or half-through needs a surgical extraction: a small flap of gum is lifted, a little bone may be removed from around the tooth, and the tooth is often divided into pieces so each comes out with less force. A few dissolving stitches close the gum. Most removals take between 20 minutes and an hour.
If a tooth looks unusually difficult on the X-ray or scan, we'll say so before booking anything, and if a hospital oral surgery team would be the safer choice, we'll refer you there.
Sedation If You're Anxious
Lots of people would rather not be fully aware while a wisdom tooth comes out, and that's a perfectly reasonable thing to ask for. IV sedation goes in through a fine tube in a vein, on top of the usual numbing. You can still hear us and answer, yet you feel calm and drowsy, and the appointment tends to be a blur afterwards.
It's £500 per session, plus £250 for every extra 30 minutes. 1 A responsible adult has to collect you and keep you company until bedtime, and you can't drive, work machinery or sign anything important for 24 hours. Our IV sedation guide explains how to prepare.
Healing Well Afterwards
Most people feel back to normal within three to five days. The first two days are the sorest, and swelling usually peaks on day two or three.
- Keep the gauze in place with firm biting pressure for 20 minutes. If it oozes again later, use a fresh piece the same way
- Start painkillers before the numbness fades, and take them regularly, as directed on the packet, for the first couple of days
- For 24 hours, avoid hot drinks, alcohol, smoking, vaping, straws and swilling. All of them can dislodge the clot
- Stick to soft, lukewarm food, chewing on the other side
- From the next day, rinse gently with warm salty water after meals, and brush your other teeth as usual
- A cold pack on your cheek in the first 24 hours helps limit swelling
- Skip the gym for a few days, and sleep with your head slightly raised
If the pain gets worse on day three or four instead of better, often with a bad taste, you may have a dry socket, where the clot has been lost. Phone us. A soothing dressing placed in the socket brings quick relief.
What It Costs
| Treatment | Fee |
|---|---|
| New patient examination with X-rays | £70 |
| 3D CT scan, for teeth close to the nerve | £160 |
| Same-day appointment for a painful flare-up | £70 |
| Routine extraction, fully erupted tooth | £125 |
| Surgical or wisdom tooth extraction | £450 |
| IV sedation, per session | £500 |
Your written plan states the fee before any treatment, and members of our dental plans pay 10% less for extractions and scans. 1 If you're in pain now, phone 01698 767220. We keep same-day emergency appointments on weekdays, whether or not you're registered with us. Every fee is on our price list.
Questions
This guide is general information, not a diagnosis. A dentist needs to examine you to say what is right for your teeth.