This turned out to be a very long post, so I have split it into two parts.  You can check out Part 2 here.  

In this month’s blog post, I have something a bit different for you:  I am going to be sharing my wisdom about wisdom teeth!  More specifically, I am going to share with you my recently acquired tips for having a safe and comfortable wisdom tooth extraction.  Never let it be said that I don’t suffer to bring you diverse blog content! 

I’ll being by saying that this is not a general guide about what to expect when having wisdom teeth removed.  There are lots of those on the internet already and if it seems likely that you will be having a tooth extraction anytime soon, I’d recommend that you read some of them before returning to this post.  The purpose of this piece is to share with you some lesser-known information and a few niche tips that you’re unlikely to find elsewhere. 

Before I begin I’ll pop in a modified version of my usual disclaimer.  Please note that I am neither a doctor nor a dentist and nothing in this blog post is intended to constitute medical or dental advice.  Always consult with a qualified healthcare practitioner or dentist before having any oral surgery. 

Now that that’s out of the way, let’s get our teeth into the main post!

Before having a wisdom tooth removed, get an x-ray.

This allows the dentist to see how much of your tooth has erupted, how well aligned it is, and what the roots look like before he begins digging it out! 

If you can possibly afford it, get a CBCT-3D scan.

This is like a three dimensional x-ray.  It uses cone beam computed tomography to generate a detailed 3D image of your teeth, skull, jaws, soft tissue, nerves, sinuses and oral cavity.  It is greatly superior to a bitewing or panoramic OPG x-ray because it allows the dentist to see depth, density and positions of structures in relation to each other.  It enables them to anticipate likely complications or difficulties before they arise, so that the procedure can be planned or adapted accordingly. 

I looked into having my wisdom teeth removed several years ago, because they had erupted very slowly and were partly occluded by my gums.  This meant that I could not properly clean them and as a result they were black and sometimes smelly.  Whenever they grew, I got mild pain in the corners of my mouth and I didn’t think that having black teeth was very healthy.  I asked about having them removed and was sent for an OPG x-ray, which seemed to show that the roots were too close to a nerve to risk removal. 

Last year, I got what I thought was a wisdom tooth growth spurt, but the pain turned from mild to moderate and my face swelled up.  It turned out that I had an infection and my dentist referred me for an extraction.  In light of the x-ray, I was concerned about the proximity of the root to my jaw nerve and decided to get a second opinion before proceeding.  I was also worried about the extraction itself and ideally wanted to have it done under sedation.  I was told that this would not be possible on the NHS – I would have to choose between local anaesthetic at a dental practice or general anaesthetic in hospital.  Neither scenario would involve further consultations or x-rays beforehand. 

It was while researching how to go about getting a second opinion and sedation that I read about CBCT scans.  I decided to get one done before making any further decisions.  To cut a long story short, not many places near me offer CBCT scans, so I ended up travelling to a private dental practice in Kirkby Lonsdale, appropriately called Lonsdale Dental Practice.  Here I had a CBCT scan, followed by a consultation with a lovely dentist who showed me the images and talked me through my options.  The 3D images showed that the roots of my lower wisdom teeth were actually a safe distance from the main jaw nerve – it had only looked otherwise because of distortions in the 2D panoramic x-ray.  Using clear, accurate 3D images, the dentist was able to determine:

• Which wisdom teeth would be best removed and which might be best to stay.  (Lower ones out, as both had been infected by then.  Upper ones to stay in place, because:  they had not caused any issues up until then; they were only half erupted; and they had roots very close to my sinus cavity.  The latter point meant that removal might break the delicate sinus bone.) 
• That the nerve was a safe distance from my lower roots and should not present undue difficulty. 
• What cuts he might need to make in removing the teeth – one had almost triangular roots that should make it slip out easily, whereas the other had trickier roots that would require more digging. 
• Whether I might need stitches. 
• Which tooth to remove first, assuming I chose to have one at a time done. 

Having the CBCT scan gave me enormous peace of mind that removing the lower teeth was the right thing to do.  It also allowed the dentist to put together a proper plan and not end up with any unforeseen complications.  If you can possibly afford to get one done, I highly recommend it! 

If you need to have more than one wisdom tooth removed, do it one tooth at a time!

The extraction and the recovery is not so bad as to deter you from repeating the procedure.  It is bad enough that you definitely wouldn’t want both side of your mouth to be going through it at once.  Having just one tooth (or one side) done means that the whole other side of your mouth can still be used as normal.  You can return to normal foods more quickly; you can sleep on one side of your face normally; you can clean one side of your teeth relatively normally.  More obviously, the pain and jaw stiffness are concentrated on just one side of your face.  All of this makes the days following the procedure easier and more bearable than they would otherwise be. 

Get IV sedation. 

Unless you are very confident in your ability to remain still and calm for the entire extraction process, I would not recommend using only local anaesthetic.  While it numbs the pain, it does not block every sensation, so you will feel things happening in your mouth.  You will also see and hear the dentist, so unless you are sure that you can remain relaxed even at moments when you know he is cutting, drilling, or pulling, you should not opt for local anaesthetic alone. 

If you are of a nervous disposition, it might be tempting to jump to the other end of the scale and have a general anaesthetic so that you can be fully oblivious to everything.  I would not recommend this either.  Firstly, it requires you to abstain from eating and drinking.  This is unpleasant even for those in perfect health, but for people with bladder issues, the idea of restricting food and fluid might seem impossible.  Secondly, you are more likely to experience vomiting after general anaesthesia than after sedation.  You will not be able to rinse your mouth or clean your teeth for some time after the extraction, because even supposing you can open your mouth fully, you must not dislodge the blood clot.  If the clot stays in place in the event that you vomit, your choices immediately afterwards will be to dislodge it during the clean up process, or perform a less than thorough clean up.  Both of these sound horrid! 

My dentist explained to me a more serious drawback of having wisdom teeth out under general anaesthetic too.  He said that during extraction under general anaesthetic, the mouth must be held open with retractors, props or gags.  While conscious, a person is able to indicate when the full range of movement has been reached for their mouth.  Under general anaesthetic they are not able to do this, which means that their mouth might be forced to open too widely and be held that way for several minutes.  It is this kind of overextension and strain that leads to many of the horror stories you hear about long or incomplete recoveries from extractions. 

IV sedation represents a kind of middle ground between local anaesthetic and general.  You are awake and fully conscious, but you are extremely relaxed and really don’t care what happens.  Your short term memory is also impaired, which means that even though in real time you know what is happening, you have very little memory of it afterwards.  The major advantage to this is that if you hear or see anything unpleasant during the procedure, you probably won’t remember it, so to all intents and purposes it will be as if it never happened.  And if you do remember, you simply won’t care! 

You don’t need to restrict food and fluid before IV sedation and the recovery time is quicker than general anaesthetic.  You will be back on your feet within minutes and although you might feel very lethargic for the rest of the day, you will be able to eat, drink, get to and from the bathroom and hold conversations.  You will not be able to drive and my dentist required me to have a chaperone to be with me not only for the procedure, but also for the rest of the day thereafter.  I was not allowed to boil the kettle, cook, or go up and downstairs alone, because very occasionally the sedative can get a second wind and make you woozy all over again.  This is rare, but if you do opt for IV sedation, you will need a responsible adult to accompany you to the dental practice and remain with you for 24 hours afterwards. 

IV sedation might not be available at your own dental practice – it is not available at my own local dentist, so I had my extractions carried out at Lonsdale Dental Practice where I had the CBCT scans done.  If for some reason you can’t get or do not want IV sedation then you might also consider oral sedation (some dentists might be able to prescribe benzodiazepines, for example) or inhalation sedation using nitrous oxide (also known as laughing gas).  These are milder than IV sedation, but are good for people who are needle phobic.  Nitrous oxide also has an extremely fast recovery time – so fast, in fact, that you can drive home after the procedure. 

On balance, my dentist and I thought that IV sedation was the best option for me and having used it twice now, I highly recommend it.  You can read more about my experiences with it here. 

Get Plasma Rich Growth Factor (PRGF).

This is your secret weapon against infection and dry socket.  It expedites healing, reduces post-operative discomfort, and eliminates the need for changing gauze at the extraction site.  One of the things I was most concerned about before having my wisdom teeth out was having to bite down on gauze and keep changing it until a blood clot had formed.  The idea of biting down on any kind of material goes through me and I am very squeamish, so I absolutely did not want to look at the extraction site.  I heard about PRGF while searching the internet for ways to get a second opinion about my wisdom teeth.  I was pleased to discover that Lonsdale Dental Practice offers PRGF; this was another major factor in my decision to choose them. 

PRGF entails taking a sample of your own blood immediately prior to a medical or dental procedure and whizzing it about in a centrifuge machine.  This separates the plasma, rich in growth factors which promote cell proliferation and tissue healing, from the rest of the blood.  The plasma is further processed to concentrate the growth factors even more.  PRGF has lots of applications, but in the context of wisdom tooth extractions, it is used to make a clot out of your own blood.  This is then popped into the extraction site, which saves your body the bother of having to make a blood clot from scratch.  Inserting a readymade clot of your own plasma eliminates the need for lots of sitting up, biting on gauze and changing gauze while you wait for a clot to form naturally.  It reduces the likelihood of infection and dry socket, because it provides a cover for the extraction site and accelerates the healing process.  Because the PRGF is made of nothing but your own blood, it carries minimal risk of side effects.  Ordinarily, you might have to sleep sat up for a night or two after a wisdom tooth removal because the site might continue to bleed, but having PRGF means that you should be able to go to bed normally even on the day of the extraction.  Just lie on your good side – your bad side will be a bit tender to take the weight of your head for a day or two! 

The procedure itself won’t hurt.

Not much I can add to that!  Whether you choose local-only anaesthetic, sedation, or general anaesthetic, the actual procedure won’t be painful and nor will the couple of hours afterwards.  If you are afraid of injections but have opted for IV sedation or PRGF, you can buy numbing cream from the chemist (Emla is the leading UK brand) and apply it 30-60 minutes beforehand.  As for oral injections, the dentist can apply ‘magic cream’ (I think they use benzocaine, but whatever it is, it is very fast-acting and good) or some places, including Lonsdale Dental Practice, can administer anaesthetic using a special computerised wand instead of traditional syringes. 

The aftermath will be uncomfortable, but not in the way you imagine.

You probably imagine that in the immediate aftermath of having a wisdom tooth removed, it will feel as if someone has cut your gum and pulled a tooth out.  That is, after all, what happens!  I imagined that the pain would feel like a bad cut in the corner of my mouth, especially as I was warned that I would probably need stitches.  To my surprise, the sensation was nothing like that.  I experienced virtually no pain in the gum itself and was even able to eat some proper food later the same day! 

What you will actually experience is a deep pressure in your jaw that will increase until day 3 when it will reach peak discomfort.  How intense this becomes will depend on factors like how easy your tooth was to extract, how deep its roots were, whether any bone needed to be removed to access the tooth, and how skilled the dentist was.  My dentist was very skilled and managed to extract both lower wisdom teeth without me needing stitches, even though he had told me stitches were likely.  He had warned me that one tooth had nicer roots than the other, so that it would come out more easily.  I had that side removed first and the pressure I felt in my jaw afterwards was not as intense as when I had the second side done a few months later. 

I don’t quite know how to describe the sensation.  It is like a deep gnawing, right inside your jaw.  If anything it is difficult to believe that a tooth has been removed, because it actually feels more like a tooth needs to be removed to relieve the pressure.  You might have a stiff neck from the pulling of the tooth itself and if you don’t then you are almost sure to get one later.  Why?  Because you will really not want any food or liquid to touch the extraction site for a few days, so you will tilt your head when you eat or drink!  You will also instinctively want to guard the affected side of your face, so you might hold your body differently to usual. 

A couple of other unexpected types of discomfort you might notice are sore spots on your head or face and a very sore tongue.  I don’t know why I had sore spots on my head, but I have heard from people who have had molars removed that dentists sometimes apply quite a lot of force to get the teeth out.  Maybe the dentist needed to hold my head tightly as he pulled.  Maybe it was just referred pain from the extraction site itself.  I didn’t realise until I washed my hair a couple of days later, but I definitely had a couple of areas that felt like bruises on my scalp.  You might get a sore tongue at the place where the anaesthetic is administered.  This was actually one of the worst bits for me – the side of my tongue and the fleshy bit under it were very sore for a couple of days. 

Ask in advance what, if any, pain medication you will be prescribed for after the extraction. 

I was surprised to find that I would not be prescribed any!  The dentist asked me what painkillers I normally use and told me to just use those.  (You can’t use aspirin though, as they thin the blood.)  I am fortunate in that I don’t need to use painkillers very often and when I do, paracetamol normally suffice.  I was not altogether convinced that they would be enough for this situation, so I got myself some co-codamol ahead of time.  I’m glad that I did this, because I needed to use them once for each side and would have had a rougher time without them. 

Take your painkillers before the anaesthetic wears off and take them regularly.

My dentist was very clear about this – when I was leaving the practice, he told my mum that I must take my first lot of painkillers as soon as I got home, not wait for the anaesthetic to wear off.  For the first three days, I took paracetamol every four hours, except on the single occasion for each side where I used co-codamol instead. 

For my first tooth extraction, I could probably have managed without pain relief.  It would have been very miserable, but not unthinkable.  The tooth was removed on Monday afternoon and by Thursday I felt fine to leave the house to attend an appointment.  On Friday, I only took painkillers at bedtime so as to get a comfortable night’s rest. 

For my second extraction, the jaw pressure was more intense and I would not have been able to manage without pain medication.  In fact on the worst night, I woke up just 90 minutes after taking co-codamol and then had to wait until 6am to take paracetamol.  The pain was not unbearable, but I felt generally weary and rough, so it seemed like a long wait! 

The articles that tell you the pain will be at its worst on the third day are absolutely correct – it is.  It gets much better very quickly thereafter.  A word of reassurance though:  I am a complete baby about pain and it was never bad enough to make me think that I would be too afraid to get another extraction.  (As a reference point, I have pierced ear lobes.  If they ever healed up, I would not be brave enough to have them pierced again.) 

Okay, that is the end of Part 1.  Join me in the next blog post for Part 2!  

Tiny x

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